As I write this, something called attention deficit/hyperactivity disorder (ADHD) is all the rage as a handy explanation of human problems. Thirty years ago, if you experienced mental or emotional problems, you might have been called a schizophrenic. Before that, people with problems were simply called neurotics. Depression of various degrees and types is also currently fashionable, possibly because certain drugs become popular from time to time. And whatever happened to the popular existential neurosis diagnosis? O.K., you’ve never heard of that, but it occupied the attention of the mental health field not too many years ago, and now it’s a bit out of fashion.

In addition to fashionable diagnoses, different types of therapy also come and go leaving little impact. It seems like only yesterday that something called EST groups were meeting all over the country and making money for their operators. Do you remember Transactional Analysis, or electroshock treatments?

Human problems are pretty much the same year after year, but the labels and the professional smoke and mirrors change often and rather irrationally. As I write this, in the early years of the Twenty-first Century, something called Harm Reduction is making the rounds of therapy shops. This is not so much a new discovery as a new way of looking at the therapist’s task. If abstinence is too much to ask or expect, perhaps we can reduce the damage done by addiction and by relapse if we are tolerant of the client’s desire to go on using. Applied to the skateboard, we would say that if you insist on using a skateboard, then wear your helmet, elbow pads and kneepads. If a child often gets hurt using a skateboard, riding that board is just a bad idea. If you’ve been badly hurt by addiction, more use is just a bad idea no matter how passionately you want to get back in and win that lost battle.

Some therapists will insist that you not use your favorite addictive while in treatment, others won’t even ask. Intense addictive activity is mind altering; psychotherapy is also supposed to change how you think. Can both of these go on at the same time? I think not. Let us never forget that any addiction can be hazardous to your physical, mental, financial and spiritual health. Addiction is really just a dumb idea no matter how compelling and attractive is seems to you just now, but you probably know that. In any case, as you well know if you are a heavy user, addiction is not about money. Maybe therapy could help you figure out what it’s really about.

Research has recently discovered something called natural recovery. What this refers to is something that should have been obvious to all of us for years: many, many people get into trouble with alcohol, gambling or other addictions only to come to their senses and either stop altogether or moderate their use. We know little about such folk other than that they do exist in significant number. They would have to be called problem gamblers or problem drinkers since, in our ignorance, we cannot diagnose them as pathological or compulsive users. We just haven’t had a chance to get to know very many of these critters, but they are out there.

This natural recovery, free of any professional mental health intervention, would be the ideal treatment: low cost, self-initiated, responsible, and often effective. Thousands upon thousands of people get over-involved in gambling, drug abuse, alcohol, and other addictive behaviors, and when the pain starts to build up, they simply decide to quit. Sadly, many thousands more cannot quit without some kind of help. By the time gamblers reach Gamblers Anonymous or professional treatment, they have sworn off gambling many times; natural recovery has not worked for them, as it will not work for many addicts.

When eventually you get to reading something like this document, you have probably tried to slow down or stop the addiction on your own and failed. But, if you have just decided to stop, why not try it? Just stop and don’t go back. Find better, more constructive things to do, or spend the time with family. But, if you’ve been down that road and stumbled, read on and try something new.

If you choose the right help for an addiction problem, will you be analyzed objectively for your personal strengths and weakness by a practitioner broadly trained in all aspects of mental and physical health, or will you be caste into the mold of whatever biases and prejudices are currently rumbling around in your clinician’s head? Will you be fitted into the most appropriate type and level of care, a type of therapy chosen from a broad array of possibilities, or will the clinician stamp you into a mold and expect you to fit his or her diagnosis and specialty? Will you ever, should such a referral seem most appropriate, be referred to a Twelve Step group or to some other inexpensive self-help group, or even be told that you do not need treatment? I wouldn’t bet on any of it, not as long as your money or insurance hold out. Once you’ve passed through the therapist’s door, the chances of getting an official diagnosis rise almost to a certainty.

Simple naïveté. If you should happen to go to a clinician whose reaction to your problem is, “Oh, what an interesting problem. I’ve heard that some people can be addicted to X,” my suggestion would be to leave at once. Find someone who works with X, it’s becoming a real specialty these days. There is no substitute for experience. Seeing one addict a month doesn’t get a therapist very far in terms of experience. You need someone who has been immersed and who has survived the onslaughts of daily contact with problem users. During the years of my own work with gamblers and other addicts, my best referrals came from self-help groups. If your therapist has never heard of The Twelve Steps, or is dimly aware that something called Alcoholics Anonymous is somewhere out there, look for a specialist if you are looking for help with an addiction problem. The ideal would be someone who was broadly trained in psychiatry, psychology, or social work before specializing in addictions.

If, on the other hand, you have achieved a significant time of abstinence from your addiction, and if you are still bothered by other disabling symptoms, you may wish to seek professional help for those problems rather than for addiction itself. If you had problems such as anxiety, depression or mood swings before you ever started using, they are likely to re-surface during abstinence, and they will make relapse more likely.

Therapists should be chosen with a specific problem and goal in mind and it is extremely important that the potential client be precise about what he or she hopes to gain in therapy. Just trying to get a spouse to stop nagging you is not a good therapy goal.

If you are using an addictive now, and if it is a major life problem, you should first spend some time going to a Twelve Step group. People there are more likely to know of clinicians who specialize in addiction problems and they can tell you their experiences. If, on the other hand, you are abstaining completely and are still having personality and emotional problems, a self-help group along with a more general and less specialized approach may be helpful, although it is best if your therapist remember that addiction has been a problem for you.

Finances. Mental health clinicians work for money, just like the rest of the world. They will often do some pro bono or charitable treatment, but for an addict who may have squandered thousands of dollars in the past, giving free treatment just doesn’t seem like the right thing to do. In the United States, some health insurance programs pay for limited amounts of psychotherapy, and some will even pay for gambling, alcohol and drug treatment programs. Many therapists, however, are not above diagnosing you with something the insurance company will pay for while treating you for an addiction. Money is a powerful lever, as you certainly know.

However, alcoholics with great insurance programs have been known to enter alcoholism treatment time after time just to get healthy again and prepare for the next bender. That kind of program helps no one, of course. Most problem gamblers in a free enterprise economy will be asked to pay out-of-pocket for services when they are provided. And it’s not cheap. In the United States today there is no general feeling that the addicted person is entitled to a free program of rehabilitation. Our prisons are packed with addicts of one kind or another; that’s our version of free treatment. Other countries, with socialized medical systems, do offer immediately available programs that are either free or low cost. The citizens of those countries, of course, pay in terms of much higher tax rates to cover social programs like these. They may also give up the right to choose their therapist and their treatment style, and that responsibility to choose makes a document like this all the more important.

The One-Size-Fits-All approach to psychotherapy. Unless you are referred for a very specific problem, beware of therapists who operate with one basic methodology. We have a hypnotherapist in town that does only hypnotherapy, and he makes claims for its effectiveness that are simply incorrect and are not based on research. Hypnosis is not very effective for addictions such food, smoking, gambling or alcoholism. In the hands of a general and well-experienced practitioner, someone who knows and uses many different techniques, it has occasional uses.

Some therapists offer other single method cures such as meditation, biofeedback, mega-vitamin therapy, massage, relaxation training, deep bowel cleansing, acupuncture, hypnosis and whatever else is making the rounds on talk shows. Sadly, there are no magic cures, there are no easy answers, but there are better science-based solutions than the gimmicks I’ve mentioned. A person who does only one trick, acupuncture, for example, should only be seen if one is referred by a more general and well trained professional. Always ask to see the research that substantiates wild claims, and remember that opinions and testimonials are not research. Some of my past clients were used car salesmen and, wow, did they have strong opinions about what car a customer should buy. It was usually the one with the highest mark-up or biggest commission.

Unfortunately, I have to include some evangelical preachers in with the One-Size-Fits-All group. Be particularly careful about religion-based treatment. There are many fine pastoral counselors working out of or with a church or temple. They are broadly trained and usually have at least a Masters degree, but in working with clients they make sure that their work fits whatever guidelines church dogma sets. For example, some pastoral counselors will not refer a client for abortion or encourage anyone to get an abortion. Some will reject any possibility of divorce even when one partner seeks it. People of faith will, of course, not want to violate their principles, but they can and do work with secular (non-pastoral) mental health clinicians; when they do, they should inform their therapists of their convictions. Any ethical clinician will respect those beliefs and work within any restrictions they impose.