It’s complicated!

What is an addiction? When is someone an ‘addict’? Is it true that ‘once an alcoholic, always an alcoholic’?

My answer to all the above – “It’s complicated!”

Roughly half of ACT clients have a history of significant substance use problems. So called “quadrant IV” clients – those with high mental health needs and severe substance use issues – struggled seemingly forever with so many problems.

“For decades many addicts have been subjected to treatment interventions that had almost no likelihood of success. And when that success had indeed failed to materialize, the source of that failure has been attributed, not to the intervention, but to the addicts’ recalcitrance and lack of motivation”

Slaying the Dragon SS

William White’s book Slaying the Dragon; The History of Addiction Treatment in America is interesting but it was the last chapter that really grabbed me. In it White articulates what he’s learned from a lifetime of work in addiction treatment. I found his words so thought provoking I put – with his permission – excerpts into a Prezi presentation (like PowerPoint on steroids).

These excerpts are meant to challenge. Clinicians need to examine preconceptions as the daily face questions such as why Joe continued to drink, why Susan was still shoplifting, why Brent would risk his life using cocaine as he did.

Have a click through and let me know what you think.

Shalom Coodin



  1. Apartmtent senario is a typical one for ACT. Generally if the team obtained the apartment for the client. There is a clear understanding the person is receiving assistance from a team who can and intevene on their behalf. However, if the client obtained the apartment on their own, confidentiality rules apply. Further, as a team member I can not reasonable assure a landlord the individual will or wont do anything even if the client gives me permission to speak to the land lord. All I can do is make more frequent interventions, counsel the client, work on social skills and track if they are becoming more symtomatic and make approipriate interventions. I can urge the person to speak to the owner and rehearse the talk. I can contact family if I have permission and ask them to assist. I can offer to go with them. But ultimately its about the client’s choice. If there is an eviction proceding I can assist the and advocate for the client if they wish for me to do so.
    Thomas Patitucci, LCSW former VP of the ACTA Association and ACT Consultant

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