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Millennia mark milestones and momentous events (remember the Y2K scare of 2000). Decades remind us of new breakthroughs and trends, as in technology, medicine and machinery, but we so often fail to see the stranger that just walked in our door who will rearrange all of the house’s furniture without our even noticing.
As we turn another decade with this issue, perhaps we might reflect on trends that have been underway, that came in our side door, unseen or unnoticed at the time, but will change what we do from 2010 to 2020 in addiction counseling.
Megatrends 2000
It seemed more popular in the 1990s for megatrend books to predict the new millennium, such as Naisbith’s 1990s book Megatrends 2000: Ten New directions for the 1990s. Looking back, Naisbith wasn’t too far off when he predicted the 1990s would be marked by the rise of the Pacific rim, the age of biology, religious revivalism in the form of fundamentalism, the great economic boom of the 1990s, the decade of women’s rise in business and globalization. Future Shock by Alvin Toffler (1990) and Barry Minkin’s Future in Sight (1995) foresaw the dominance of the super-power economies, amazing technological breakthroughs, shifting population demographics, wealth accumulation by the filthy rich, materism-ismo, the real estate and cyber booms, subversive cable-ization of the media and political power shifts.
Then came 2000
Who could have predicted the dramatic and cataclysmic changes that occurred early in the 21st century and dominated this decade? Thomas Friedman tells us both the World is Flat, and we now face a future that will be Hot, Flat and Crowded. Although many current tends existed before in the 1990s, such as health care system reform, the downsizing of addiction and mental health services due to shrinking census and mergers and acquisitions, nothing in our past seems to have prepared us for the world we now face, especially in the behavioral health care field.
So, as we cast our eyes into this next decade of Counselor Magazine, what might be clues as to what’s ahead? Rather than seek out another Naisbith, Toffler or Minkin, perhaps the future is right before us as we seek who’s snuck in our back door.
• In the past decade, much of our research has given us a greater understanding of the neuroscience of addiction and psychotherapy. The National Institute on Drug Addiction (NIDA) has lead the way in this search. Surely, this pattern will continue. So, counselors, get to know your neuroscientist better.
• Neuroscience and contemplative sciences have met and kissed each other. As we continue to learn more about consciousness, our focus will continue to expand into the use of attention, presence and relationship in the change process. Contemplative science will allow for a deeper knowledge of mental phenomena, including a wider range of stages of consciousness and an emphasis on strict mental disciplines, combined with our sacred cows of cognitive behavioral therapy (B. Alan Wallace, Contemplative Science, 2007).
• As we learn more about the biology of belief, we will find new ways of unleashing the power of matter. Genes and DNA do not control our destiny, but instead, our behavior, thoughts and actions are influenced by signals from outside the cell, including the energizing messages emanating from beyond us (Bruce Lipton, The Biology of Belief, 2005). We will see the healing effect of placebo when combined with compassionate care (W. Grant Thompson, The Placebo Effect and Health, 2005). Science will better understand the neuro-plasticity of the brain to heal itself, from stroke, brain and tissue damage, and even addictions.
• Jay Katz, in The Silent World of Doctor and Patient (2002), reminds us of the time-honored belief in the virtue of silent care and the essence of the doctor-patient relationship. He holds out hope that, in the next decade, practitioners will relearn the age-old wisdom of “bedside manner” based on a new, informed dialogue representing the skills of the doctor and the rights and needs of the patient.
• Perhaps we will learn the wisdom of Jeffrey Wilson in Irrational Medicine (2004), who writes of America’s over-reliance (even among addiction specialists) on antidepressants and the over-diagnosing of dual-diagnosis. It has taken us 20 to 30 years for the addiction community to see that alcoholics can also be depressive. Now, perhaps we will see that some patients recover concurrently from their addiction and dual diagnoses. Perhaps we will see that addiction specialists are contributing to unnecessary behavioral drug use and abuse.
• Jerome Groopman from Harvard Medicine School taught us that doctors think, sometimes. In his 2007 book, How Doctors Think, Groopman gives us a rational tour of the doctor’s/healer’s thought processes, or lack thereof, and encourages us to have a sense of enlightened cynicism by lifting the veil of the pervasive nature of misdiagnosis. Along those same lines, the reader is referred to What Therapists Don’t Talk about and Why
by Pope, and Bad Therapy by Jeffrey Kottler. Perhaps, if addiction counselors were better able to say “I don’t know, what do you think,” or “I could be wrong,” we might be better able to empower the body to better use its innate healing capacity.
• CEO of the University of Maryland Medical Center, Stephen Schimpf, MD, writes in The Future of Medicine: Megatrends in Health Care (2007) how genomics, stem cell and regenerative medicine, vaccines, imaging, digitized records, complementary /integrative medicine and prevention will change everything we do in health care from 2010-2020. As Larry Dossey reminds us, we have now entered the third era of medicine, non-local medicine, where the body will learn to heal itself. Our role as caregivers is to enable the innate healing forces within a person to emerge. This changes everything in how we look at helping the addicted and those in pain.
• Clinical supervision must become an essential part of all we do in the addiction field, according to CSAT Treatment Improvement Protocol #52 on supervision.
• Finally, the struggle for better care is universal and summarized by our emphasis on evidence-basedpractices. Atul Gawande in Better (2007), reminds us that to be better healers we need more resources, face our fatigue, hopelessness and imperfect abilities, and practice the proven principles that work: diligence, doing what’s right and what works, and relying on our innate ingenuity (not science alone). The art of healing is found in the skills and sensitivity of the healer herself, and the patient’s desire and abilities to be well.
On the other hand, forget megatrends 2010. Perhaps we know what lies ahead. Perhaps, hopefully, we have learned from the lessons of the 1990s and first decade of the 21st century.
PS: And as always, my New Year’s resolution for 2010 is: May the addiction field finally unite and maximize its potential as a single force for patient advocacy.
This article is published in Counselor, The Magazine for Addiction Professionals, February 2010, v.11, n.1, pp.14-15.
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