Recently, I was asked by the Oregon Health Forum to be on a panel of local “experts” to discuss the future of addictions treatment in Oregon. As CODA’s executive director, you can imagine I have a lot to say on the manner. As I was preparing for this engagement, I continued to drift back to a frequently quoted indicator: Oregon has some of the highest rates of addiction in the country, yet it ranks at the bottom when it comes to treatment availability.

We hear this a lot. And we are right to be disappointed and outraged. But each time this is raised, I can’t help but wonder what it really means. Is it as simple as needing to provide more treatment? Maybe, but that seems too simple. Is it because there aren’t enough residential beds in the state? While that’s true, residential treatment isn’t right or necessary for everyone. It is because we have too narrowly defined what “treatment” is and what it looks like to “be in treatment”? Now I think we’re on to something.

This article that IRETA published last year is exactly what was turning around in my mind as I was preparing to speak at last month’s forum.

The difference between “needing” treatment and “receiving” treatment is entirely defined by those of us who are trained to diagnose and treat substance use disorders. But it completely ignores the wants and preferences of the people experiencing that so-called need. Dig a little deeper, and it’s clear that “needing treatment” is riddled with assumptions: that one is ready to acknowledge their use is out of control, that one can accept that abstinence is a desired goal, that one can readily add recurring visits to a provider’s office (or residential facility) to their list of obligations.

Don’t get me wrong. The work of CODA, and similar organizations, is essential to the recovery of many individuals and families. The challenge, however, is getting our partners in healthcare and community service to take every opportunity to ask about the impacts of substances on people’s lives. Just ask. If an individual says “no” to an offer of help, be willing to ask again later. And more essentially, ask in a way that isn’t threatening, judgmental or withholding, or that assumes interest in change. Treatment becomes as available as water when we are able to speak of risky behaviors in ways that engage, support, and encourage those who may be in need. It requires we don’t impose our assumptions about what type of change is realistic or welcome. Without a wide open door, some may never know it’s there to pass through.

Alison Noice,
Executive Director, CODA