Table of Contents: Biases and Misconceptions
Introduction and Fundamental Premises
The fundamental biases and their correlated misconceptions
I. Substance users are not like me.
II. Drug use always means addiction.
III. Heavy drinking always means addiction.
IV. All their problems are caused by their substance use.
V. Treatment doesn’t work.
VI. Drug users and heavy drinkers always need detox or intensive care.
VII. Twelve-step programs are the way to go.
VIII. Any mental health professional should be able to treat such symptoms
Introduction and Fundamental Premises
I received a request to address staff at an HMO about substance abuse. I was given this question: “What information about substance use and abuse will be most useful for nurse case managers?”
Thinking about that question, I knew the answer lay in one attitude that had troubled me more than any other. Namely, too many colleagues in the mental health field believed that knowledge of substance use disorders (SUD) was outside their competence and, what’s more, they did not want to become knowledgeable about SUDs and their treatment.
Rather than learn the basics about treating substance use disorders – treatment which does work and which has applicability well beyond the treatment of SUDs — I heard many mental health professionals avoid knowledge of addictions and refer even mild cases to substance abuse professionals. So the answer to the question “What information will be most useful?” is simply, “Before you can help change patients with substance use disorders, you first change yourself, your own attitudes, biases, and misunderstandings about substance use disorders.”
Over several weeks, I developed lists of such biases. I also polled some of my colleagues who work in our Dual Disorders Department. The result is a fairly comprehensive list of biases and misconceptions, each of which is juxtaposed with corrected information.
While I was organizing these biases by category, the list factored into what turned out to be eight domains. A few crucial premises emerged from these ideas. These premises summarize the main purpose and point of this presentation.
A. The persistence of biases and misconceptions often leads to inappropriate, out-dated treatment recommendations and other potentially incorrect clinical decisions. Accurate information AND attitudes lead to higher quality recommendations, treatments, and clinical decisions.
B. Resolving our biases, we can connect with the substance using patient rather than distance from the patient or judge that person. We can believe in and express hope – the foundation of motivation to change – rather than convey disapproval, judgment, or pessimism related to the patient’s lifestyle and distress. Many of our biases derive from cultural beliefs and attitudes; therapists quite successfully overcome cultural beliefs about mental disorders, so they should easily overcome biases and misconceptions about SUDs and persons with addictions.
C. If we judge addicts as weak and hopeless, will we do our best to help? If we see them as people with strengths and abilities as well as with problems, we are more likely to see the best in them and do our best to help.
D. Furthermore, a common fallacy is that we can cajole, guilt, criticize, admonish, confront, punish, or push a substance abuse patient into changing his or her outlook, attitudes, needs, burdens, pains, or behavior. What we truly can change is our own outlook and attitudes. Rightly aligning ourselves, we can then better express empathy and help the other to see a hopeful vision of the changes he or she may be able to make.
Shorehaven Behavioral Health, Inc 