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Tuesday, January 21, 2020  

Treating addiction may be moving in new direction at Kaiser PermanentePublished 4/30/2003

by Mike Lee

Quitting a habit or addiction cold turkey may be for the birds, according to Kaiser Permanente of Colorado’s medical director of chemical dependency treatment.

Kaiser Permanente Dr. Allan Graham said health providers are beginning to understand that kicking a person’s addiction really depends on that person’s state of mind.

"We’re tailoring treatment to where people’s readiness to make change is," Dr. Graham said.

Researchers understand that a person’s success rate in kicking a habit such as alcohol or drug addiction has more to do with their view on the subject than once thought.

Dr. Graham said people with addiction, or anyone wanting to change a habit for that matter, are either in one of two states. The first state is a pre-contemplative state, where someone doesn’t believe they have a problem. The contemplative state is where someone is beginning to understand that they have a problem and may be considering action.

Out of 100 people, Dr. Graham said approximately 40 percent don’t think they have a problem, another 40 percent are ambivalent and may be contemplating whether they have a problem while 10 percent are getting close to taking action on their problem. The remaining 10 percent is actually in that action stage of fixing the problem, Dr. Graham says.

Dr. Graham said normally it will take an individual two years to contemplate and decide they have a problem. It takes another two years to decide to act.

Dr. Graham said Kaiser Permanente officials realize that statistically eight percent of its members likely have an alcohol addiction. But among that group 80 percent don’t believe they have a problem.

Therein lies the problem. How do you treat a problem with 100 percent effectiveness if 80 percent of the group is unwilling to change.

"How can we work more effectively with these people and help move them on to an active stage?" Dr. Graham said. "Doctors tell people what they ought to do and the majority of the time the patient won’t do it."

Dr. Graham points to a statistic that asserts only 50 percent of doctors’ prescriptions are ever filled.

The answer, Dr. Graham said, is to move people in the right direction, to get them thinking about change. If they’re not ready, help them see their problem. Once they’re agreed there is a problem, get a commitment to move toward fixing the problem.

Dr. Graham said the approach will likely become commonplace in physician’s offices as doctor’s understand they can’t alienate their patients and still expect them to be healthy.

"I think this applies to all kinds of healthcare," Dr. Graham said, noting the implications for weight loss and other areas. "It makes my job much easier. I’m not trying to fight someone and convince them."

Dr. Graham said some type of measuring tool must first be created to assess a person’s willingness to change. Much like taking a patient’s history, Dr. Graham said nurses and doctors may one day do a willingness-to-change assessment.

"Once a physician begins to recognize this it makes more sense," Dr. Graham said. "They recognize their role may be different. We want to keep a good relationship between the patient and the provider."

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