If you have an alcohol or drug problem, you probably think that the next step is “rehab”. This typically means going away for a month to a residential facility. This seems to be the accepted practice. It’s a knee jerk response to a complicated, multi-factorial problem. Have an addiction? Go to rehab. Remove yourself from the real world and immerse yourself in yourself where you become the center of attention. Then after 28 days or when the insurance/money runs out, return to the real world where you go from 24/7 supervision and support, to much less structure and guidance, no longer the center of the universe and having to face the same challenges that you left behind. Ironically, this is when the “real” work begins in learning how to live with the chronic condition of addiction, and yet, access to support and services is limited. It is interesting that one goes from inpatient rehab to “aftercare” as if all the care you needed was during the inpatient residential stay and now, you are cured. Herein lies the disconnect in addiction treatment as we know it today. Addiction is a chronic condition much like Type 1 Diabetes or Hypertension. Someone with Type 1 Diabetes may require hospitalization for acute episodes of hyperglycemia, but once the blood sugars are brought under control, it is not as if that person is cured and does not require ongoing physician care and medical monitoring. And no one would dream of discharging that patient to the care of another person with Type 1 Diabetes. Sound ludicrous? Most definitely. But we do just that with people who have an addiction problem. We treat them acutely for excessive use or withdrawal and then discharge them to home with recommendations to attend community meetings and find a “sober coach” or sponsor, usually someone whose sole credential as an “expert” is that this person likewise has an addiction problem. The disconnect in addiction treatment is that the medical system treats this condition like an acute illness and not the chronic condition it is. This sort of approach is doomed to fail. Am I saying anything new? Well, no, not really. So, why, then, does this continue to be the standard of care?