THE MOST IMPORTANT PART OF ADDICTION TREATMENT ISN’T THE TREATMENT!!

Imagine two people entering the same rehabilitation centre

Same programme. Same therapists. Same groups. Same interventions

One feels understood, begins to open up and experiences something meaningful

The other feels judged, misunderstood and increasingly withdrawn

We might explain the difference through motivation, readiness, resistance, personality or the severity of their addiction

But what if we’re overlooking something?

The relationship each person has with their own experience, and the relationship they experience with the people trying to help them

We can deliver an evidence-based intervention while someone feels fundamentally unseen

We can teach emotional regulation while the person feels unsafe in the room

We can encourage honesty while unknowingly communicating that certain answers are more acceptable than others

And we can genuinely care about someone while remaining unaware of the beliefs we’re bringing into the relationship

I wonder how much of what we call treatment resistance is sometimes a perfectly understandable response to the treatment environment itself

If two people receive exactly the same treatment but experience it completely differently, what are we actually measuring when we say the treatment works?