Addiction Treatment Review

recovery managementA periodic addiction treatment review is helpful, I believe, because many people reaching this blog don’t know much about addiction treatment. There’s a lot of bad information floating around. Because  addiction is difficult to treat, the perception among many is that treatment doesn’t work. So, a lot of people reaching out for help for themselves or a loved one are skeptical. Treatment can and does work. This doesn’t mean a person goes into a treatment facility, completes treatment and never has any more problems with drugs. That does happen, but other times a process starts that can eventually lead to recovery from addiction. 

Recovery from addiction depends on a number of factors — motivation, family support, follow-up with a continuing care plan, attendance at a local support group, environmental factors (Does the person live in an area of high drug use? Does the person have a job that entails a lot of socializing and drinking functions? Are family members using drugs?) A person can recover from addiction under any circumstances if they follow a comprehensive plan and have a strong desire to recover, but it’s harder to recover if conditions are conducive to drug use. As always, when I write “drug use” I’m referring to alcohol as well, if that’s the person’s drug of choice, or if alcohol is the drug that someone uses and then returns to their drug of choice.

Many people believe that if, say, cocaine, is the drug with which they have a problem, then that’s the only drug they need to avoid. The recovering cocaine addict will then substitute alcohol and either develop a problem with alcohol or, more often, while drinking with alcohol impaired judgement, begin craving cocaine and return to the drug of choice. The same goes for a recovering alcoholic who insists that pot is no problem, then while impaired smoking pot makes a bad decision to drink alcohol. Recovery requires clear, sober judgement.

Just like going on a diet, a person can play all sorts of games and rationalize shortcuts and substitutions, but when the half-measures don’t work it’s another lesson. Treatment works, but it’s not a magic cure-all. Basically treatment teaches a person what they have to do after treatment in order to have the best chance at long-term recovery. If a person follows the recovery management plan, they can recover and live a drug-free life. 

Addiction Treatment: Lapse and Re-Lapse

Lapse and relapseIn addiction treatment and recovery, we talk about lapse and relapse. Lapse is when someone is just beginning addiction treatment and starts using again shortly after. Lapsing is common. Think about dieting and how easy it is in the beginning to eat a candy bar when the urge gets strong. The alcoholic or other-drug addict, cocaine addict, opiate addict, etc, in early recovery hasn’t learned how to control the compulsion to drink/use, so, unless they’re following all directions in recovery, they’ll likely give in to the compulsion. It will seem to the person as if they have no control whatsoever over the compulsion that drives them to drink/use. I’ve heard it described by alcoholics as if they went on autopilot, and zombie-like walked into the liquor store, bought the bottle, and before they knew they were drinking. 

If the person returns quickly to recovery to start again and learn why they drank alcohol or used some other drug, then it can be a learning experience. There was a lapse in recovery, the person started back in recovery and went forward. No one has to have a lapse, but it happens. The person will usually feel guilty and beat themselves up, but this shouldn’t last long — the person has to get over it, talk with someone who understands and start again. Addiction recovery is tough in the beginning– lapses happen. I don’t want to make light of a lapse. Some people drink/use again and bad things happen, like a DUI, a fight where someone is seriously injured, the final straw for a spouse who leaves — then the person loses hope and the return to drinking/using turns into the continuance of addiction and down-hill slide. There are much easier ways to learn how to stay sober than going back to alcohol, cocaine, opiates, and suffering consequences. There’s an old saying in recovery communities – it’s easier to stay in recovery than to leave and come back.

A re-lapse is when someone has recovered, then gets away from the things that got the person straight and sober to start with, and they return to active addiction. This can happen after a year in abstinence, 10 years of abstinence or 40 years of abstinence. Re-lapse is usually more severe, because the person becomes more confused, guilt-ridden, filled with shame and anger at themselves. It takes quite a lot for someone who relapses after years of recovery to come back into recovery. Many people don’t make it back. The worse thing the person can do is give in to the shame and guilt and wallow in it.

Just remember, if you’re in recovery, it’s much easier to stay in recovery and continue to maintain recovery – however, if you lapse in early treatment or relapse after years of abstinence, quickly get back and learn from the experience. Remember that’s it’s a disease and you’re human – humans don’t always do what’s best for them. We can start feeling healthy and start believing we never really had a real problem after all, then start drinking or using again only to find that we again lose control. Learn about addiction, and once you know the truth believe that the truth doesn’t change, no matter how long you’ve been abstinent or how healthy and powerful you feel.

 

Benzodiazepines And Opioids Are A Dangerous Combination

Benzos and opiatesBenzodiazepines and opioids are a dangerous combination. Used together the combined sedative effect can lead to overdose and death. A large portion of people who overdose  from opioids are also using benzodiazepines, like Xanax or Klonipin. Below is an excerpt from the National Institute on Drug Abuse:

Revised September 2017

More than 30 percent of overdoses involving opioids also involve benzodiazepines, a type of prescription sedative commonly prescribed for anxiety or to help with insomnia. Benzodiazepines (sometimes called “benzos”) work to calm or sedate a person, by raising the level of the inhibitory neurotransmitter GABA in the brain. Common benzodiazepines include diazepam (Valium), alprazolam (Xanax), and clonazepam (Klonopin), among others.

Combining opioids and benzodiazepines can be unsafe because both types of drug sedate users and suppress breathing—the cause of overdose fatality—in addition to impairing cognitive functions. In 2015, 23 percent of people who died of an opioid overdose also tested positive for benzodiazepines (see graph).1 Unfortunately, many people are prescribed both drugs simultaneously. In a study of over 300,000 continuously insured patients receiving opioid prescriptions between 2001 and 2013, the percentage of persons also prescribed benzodiazepines rose to 17 percent in 2013 from nine percent in 2001.2 The study showed that people concurrently using both drugs are at higher risk of visiting the emergency department or being admitted to a hospital for a drug-related emergency.

It’s amazing that doctors still prescribe these drugs in combination. To be sure, many patients probably get one prescription from one doctor and the other prescription from another doctor, but if a patient is using opioids long term, the prescribing physician should perform a drug screen periodically to make sure the patient is not using a dangerous combination of drugs. Most people don’t know that benzodiazepines and opioids are a dangerous combination. We need more drug use education, and physicians need more training in medical school. It’s a problem that’s getting worse.

Happy Sober Holidays

 

 

 

 

 

 

 

I wish everyone a happy holiday season. Just because I work in the field of addiction treatment doesn’t mean I’m a prude about drinking. For all who enjoy their drink and don’t have a problem — Cheers! For all who seek happy sober holidays, may you experience the best this time of year has to offer.

Motivation and Recovery From Addiction

When considering motivation and recovery from addiction, there are basically three types of motivation: submission to external pressure, calculation, and commitment. A person can recovery through any of these motivations, but they’re not all equally effective.

The first is when someone comes to treatment because a judge orders it, an attorney recommends it because he wants it to look good in court, a spouse threatens to leave if the person doesn’t get treatment, an employer gives an ultimatum of get addiction treatment or get fired, etc. Succumbing to external pressure is the weakest form of motivation. Leverage such as this is a powerful motivator to get someone in treatment, but getting in treatment and getting into recovery aren’t the same. If a person who’s forced into treatment doesn’t realize the severity of the problem and doesn’t get involved in their treatment, then they’re just killing time to meet the requirements of those who forced them into treatment. They aren’t really forced, because they have the freedom to refuse and face the consequences, but many find the consequences too dire, so they agree to go to treatment. Most people forced into treatment don’t do well, but for some it’s a wake up call. When we consider statistics related to treatment success, these clients bring the success rate down because they never intended to recover from addiction to begin with, just satisfy a judge, spouse or employer. Although the motivation to keep a spouse, stay out of jail, or keep a job is strong, once a little time goes by and everyone is off the person’s back, they usually return to the their drug use (remember, alcohol is a drug).

The second form when considering motivation and recovery from addiction is calculation. This is when a person looks at what drugs have done to them and makes a rational calculation that it’s costing too much money, they’re taking to many risks legally and healthwise, they’re spending too much time away from family, so on and so forth. This motivation is stronger because at least the person’s considering recovery and has given addiction recovery some thought. Most people who talk with someone who’s calculated the risks and decides to give recovery a try think this person is doing great and is ready to change for good. Calculation is stronger than submission to pressure, but it’s still not enough for most addicts who’ve been using for a long time. What happens is that as long as the calculation proves to be a wise move, then all is well, but once there are bumps in the road, and there will be bumps, the person re-calculates and might say something like “things are worse in recovery” – they might start thinking about using/drinking again. Just because someone stops drinking alcohol or using some other drug doesn’t mean every thing will progressively get better with no problems. Life’s full of problems whether someone’s an addict or not. A person can get into treatment and everything can be fine, but then a spouse can tell the person they want a divorce. The person in early recovery can get fired. Something the person did before might catch up with them and they get into legal trouble. If a person gets sober and straight because they calculate everything will always be good and positive, then they’re setting themselves up for disappointment and likely a relapse.

The third form when considering motivation and recovery from addiction is commitment. This is when a person accepts they suffer from a chronic brain disease and commit to recovery no matter what happens. This person usually knows that it will be hard but they commit to follow directions and do all the things necessary to recover and deal with life as it is, not how they imagine it should be or pretend it is. This person knows no matter how bad things get, drinking or using only makes it worse. The person who commits to recovery from addiction accepts help and realizes he/she can’t do it alone. The person who commits follows through and decides to stay sober and straight one day at time, knowing they might still crave the drug, but choosing to use all the recovery tools to not take the first drink or first hit, or first snort, or first pill, whatever drug changes their perception of reality.

As I wrote above, a person can recover from any form of motivation, but it usually has to progress to commitment for the recovery to be strong and lasting.

Atheists & Agnostics in Alcoholics Anonymous

Atheists & agnostics in Alcoholics Anonymous (AA) is a controversial subject among some in AA. The concept of a Higher Power is alien to an atheist and often not viable for the agnostic. Depending on where a recovering alcoholic first tries AA, the subject of “God” might be too much for someone who doesn’t accept God as real. AA literature is loaded with references to God, yet AA states that a belief in God is not necessary to join AA. Many AA members who are Christians don’t understand how someone who doesn’t believe in God can stay sober.

Can an alcoholic who is an atheist or agnostic stay sober? This is how some have solved the problem – this an except from AA Agnostica:

AA Agnostica is meant to be a helping hand for the alcoholic who reaches out to Alcoholics Anonymous for help and finds that she or he is disturbed by the religious content of many AA meetings.

AA Agnostica is not affiliated with any group in AA or any other organization.

Contributors to the AA Agnostica website are all members of Alcoholics Anonymous, unless otherwise indicated. The views they express are neither their groups’ nor those of AA, but solely their own.

There is an increasing number of groups within AA that are not religious in their thinking or practice. These groups don’t recite prayers at the beginning or end of their meetings, nor do they suggest that a belief in God is required to get sober or to maintain sobriety. If the readings at their meetings include AA’s suggested program of recovery, then a secular version of the 12 Steps will often be shared.

If you asked members of AA who belong to these non-religious groups about their vision of the fellowship, they would probably describe it this way:

ALCOHOLICS ANONYMOUS is a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others recover from alcoholism. The only requirement for AA membership is a desire to stop drinking. There are no dues or fees for membership: we are self-supporting through our own contributions. AA is not allied with any sect, denomination, politics, organization or institution: neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

AA Agnostica does not endorse or oppose any form of religion or atheism. Our only wish is to ensure suffering alcoholics that they can find sobriety in AA without having to accept anyone else’s beliefs or having to deny their own.

For those who think this is against the true purpose of AA, this a quote from Bill W., an AA co-founder:

 

 

Alcoholism and Holidays

Alcoholism and holidaysI could have titled this recovery and holidays rather that alcoholism and holidays, but I believe we all need to come to terms with the word “alcoholism”and “alcoholic”. Alcoholism is perceived as a harsh word that some prefer to soften with terms like Alcohol Use Disorder (AUD). Regardless what we call it, the reality’s the same. I’m okay really with using a different term as long as it doesn’t change the way people perceive the seriousness of the disease. Yes, alcoholism, or AUD, is a serious, debilitating. progressive and deadly brain disease. Recovering alcoholics have to make adjustments, and one adjustment in early recovery is how to deal with holidays and all the attendant festivities.

It seems like a downer when a newly recovering alcoholic comes up on a holiday like Christmas and invitations to parties arrive. What to do? Go and drink a soda that looks like a mixed drink? Tell the host that you aren’t drinking? Don’t go? Make a pledge to yourself or your spouse, partner or friend who might be going with you to leave if you get uncomfortable? Each individual has to make their own choices, of course, but it’s much better to get advice from someone in long term recovery who’s dealt with alcoholism and holidays a few times, or many times.

If the recovering alcoholic is going to AA, they suggest that newcomers get a sponsor, someone who’s been in recovery for awhile and knows the pitfalls. No one has to recover alone. There are many people who can and will support you in recovery — the recovering alcoholic has to seek them out and ask for advice and support. It’s difficult for most people to admit they have such a serious problem they have to ask for help, but there’s no shame in asking for help. If you don’t know anything about real estate, you find someone who does. If you want to learn a new language, you seek out people and methods to teach that language.

Alcoholism and holidays are tricky. There’s unnecessary stress during the holiday season — it doesn’t have to be that way. If a person in early recovery chooses to avoid parties with heavy drinking, then that’s probably a good choice. There will be other holidays, and when that person is strong in recovery and the desire to drink has gone away, a recovered alcoholic can do anything others can do, except drink alcohol without consequences.

Gratitude in Addiction Recovery

An Gratitude of AttitudeIn the recovery communities you’ll hear a term — an attitude of gratitude. Gratitude in addiction recovery is significant because it helps rewire the brain. The reason it’s an attitude of gratitude is because constancy is necessary to change years of negative thinking caused by addiction. I used to be a skeptic. I didn’t believe in the power of positive thinking, and I still don’t believe in the gimmicky “positive thinking” that changes a person in a short period just from reading a book or going to a seminar.

But positive thinking as a constant attitude toward life makes powerful and lasting changes. Below is an excerpt from Psychology Today:

 

If you want to be happy the rest of your life, make sure you keep your brain happy. Why? Because being happy matters more to your brain than you might think. In fact, feeling pleasure can be so stimulating for your brain that it is primed to respond to pleasure in a way that reinforces pleasure. Your brain offers rewards to steer you on a pathway to happiness, and you can offer your brain rewards that will encourage it to become even more finely tuned-and to grow well into your old age. Other reasons to want a happy brain: Negative mood variance disturbs your interaction with your environment, affecting your ability to perceive, remember, and reinforce existing or create new neural connections, while being happy improves your ability to be more cognitively alert and productive. Other than being much more fun to be around, being happy:

  • stimulates the growth of nerve connections.
  • improves cognition by increasing mental productivity.
  • improves your ability to analyze and think.
  • affects your view of surroundings
  • increases attentiveness.
  • leads to more happy thoughts.

Happy people are more creative, solve problems faster, and tend to be more mentally alert.

Thanksgiving is coming up and it’s a prime example of recognizing the power of gratitude. The only problem with Thanksgiving is that many people quickly go back to their negative thinking after the day is gone, the games are over, the turkey is cold and family has left. Positive thinking, like gratitude in addiction recovery, is a practice, an orientation toward positive, happy living. Although positive thinking is not magic and doesn’t automatically change a painful reality, it empowers the brain to find solutions and healing — it can generate inner strength and courage to endure hard times.

Treating Opiate Addiction

opiate addiction treatmentTreating opiate addiction is difficult. Detox alone is insufficient for most opiate addicts. After getting opiates out of the body, you’re left with the 90% of the problem. After detox, there’s what’s called Post-Acute Withdrawals. This is an excerpt from Addictions and Recovery.org:

There are two stages of withdrawal. The first stage is the acute stage, which usually lasts at most a few weeks. During this stage, you may experience physical withdrawal symptoms. But every drug is different, and every person is different.

The second stage of withdrawal is called the Post Acute Withdrawal Syndrome (PAWS). During this stage you’ll have fewer physical symptoms, but more emotional and psychological withdrawal symptoms.

Post-acute withdrawal occurs because your brain chemistry is gradually returning to normal. As your brain improves the levels of your brain chemicals fluctuate as they approach the new equilibrium causing post-acute withdrawal symptoms.

Most people experience some post-acute withdrawal symptoms. Whereas in the acute stage of withdrawal every person is different, in post-acute withdrawal most people have the same symptoms.

The Symptoms of Post-Acute Withdrawal

The most common post-acute withdrawal symptoms are:

  • Mood swings
  • Anxiety
  • Irritability
  • Tiredness
  • Variable energy
  • Low enthusiasm
  • Variable concentration
  • Disturbed sleep

Post-acute withdrawal feels like a rollercoaster of symptoms. In the beginning, your symptoms will change minute to minute and hour to hour. Later as you recover further they will disappear for a few weeks or months only to return again. As you continue to recover the good stretches will get longer and longer. But the bad periods of post-acute withdrawal can be just as intense and last just as long.

Each post-acute withdrawal episode usually last for a few days. Once you’ve been in recovery for a while, you will find that each post-acute withdrawal episode usually lasts for a few days. There is no obvious trigger for most episodes. You will wake up one day feeling irritable and have low energy. If you hang on for just a few days, it will lift just as quickly as it started. After a while you’ll develop confidence that you can get through post-acute withdrawal, because you’ll know that each episode is time limited.

Post-acute withdrawal usually lasts for 2 years. This is one of the most important things you need to remember. If you’re up for the challenge you can get though this. But if you think that post-acute withdrawal will only last for a few months, then you’ll get caught off guard, and when you’re disappointed you’re more likely to relapse. (Reference: www.AddictionsAndRecovery.org)

The reason most people think treatment doesn’t work is because they consider detox and short-term counseling to be treating opiate addiction — it’s not. For treatment to work it should be comprehensive and long term. In reality, a recovering addict is always “treating” the condition, because a recovering addict can go back to the drug at any time after any length of time. Just like the diabetic never becomes un-diabetic, the recovering addict never becomes un-addict.

Addiction Prevention

Addiction preventionDo addiction prevention programs work? They do if they’re comprehensive. Comprehensive means consistent, repetitive, thorough, pertinent, etc. Below are 16 Prevention Principles from the National Institute on Drug Abuse

 

 

 

 

 

Prevention Principles

These principles are intended to help parents, educators, and community leaders think about, plan for, and deliver research-based drug abuse prevention programs at the community level. The references following each principle are representative of current research.

Risk Factors and Protective Factors

PRINCIPLE 1 – Prevention programs should enhance protective factors and reverse or reduce risk factors.14

  • The risk of becoming a drug abuser involves the relationship among the number and type of risk factors (e.g., deviant attitudes and behaviors) and protective factors (e.g., parental support).32
  • The potential impact of specific risk and protective factors changes with age. For example, risk factors within the family have greater impact on a younger child, while association with drug-abusing peers may be a more significant risk factor for an adolescent.11, 9
  • Early intervention with risk factors (e.g., aggressive behavior and poor self-control) often has a greater impact than later intervention by changing a child’s life path (trajectory) away from problems and toward positive behaviors.15
  • While risk and protective factors can affect people of all groups, these factors can have a different effect depending on a person’s age, gender, ethnicity, culture, and environment.5, 20

PRINCIPLE 2 – Prevention programs should address all forms of drug abuse, alone or in combination, including the underage use of legal drugs (e.g., tobacco or alcohol); the use of illegal drugs (e.g., marijuana or heroin); and the inappropriate use of legally obtained substances (e.g., inhalants), prescription medications, or over-the-counter drugs.16

PRINCIPLE 3 – Prevention programs should address the type of drug abuse problem in the local community, target modifiable risk factors, and strengthen identified protective factors.14

PRINCIPLE 4 – Prevention programs should be tailored to address risks specific to population or audience characteristics, such as age, gender, and ethnicity, to improve program effectiveness.21

Prevention Planning

Family Programs

PRINCIPLE 5 – Family-based prevention programs should enhance family bonding and relationships and include parenting skills; practice in developing, discussing, and enforcing family policies on substance abuse; and training in drug education and information.2

Family bonding is the bedrock of the relationship between parents and children. Bonding can be strengthened through skills training on parent supportiveness of children, parent-child communication, and parental involvement.17

 

  • Parental monitoring and supervision are critical for drug abuse prevention. These skills can be enhanced with training on rule-setting; techniques for monitoring activities; praise for appropriate behavior; and moderate, consistent discipline that enforces defined family rules.18
  • Drug education and information for parents or caregivers reinforces what children are learning about the harmful effects of drugs and opens opportunities for family discussions about the abuse of legal and illegal substances.4
  • Brief, family-focused interventions for the general population can positively change specific parenting behavior that can reduce later risks of drug abuse.27

 

School Programs

PRINCIPLE 6 – Prevention programs can be designed to intervene as early as preschool to address risk factors for drug abuse, such as aggressive behavior, poor social skills, and academic difficulties.30, 31

PRINCIPLE 7 – Prevention programs for elementary school children should target improving academic and social-emotional learning to address risk factors for drug abuse, such as early aggression, academic failure, and school dropout. Education should focus on the following skills:8, 15

  • self-control;
  • emotional awareness;
  • communication;
  • social problem-solving; and
  • academic support, especially in reading.;

PRINCIPLE 8 – Prevention programs for middle or junior high and high school students should increase academic and social competence with the following skills:6, 25

  • study habits and academic support;
  • communication;
  • peer relationships;
  • self-efficacy and assertiveness;
  • drug resistance skills;
  • reinforcement of anti-drug attitudes; and
  • strengthening of personal commitments against drug abuse.

Community Programs

PRINCIPLE 9 – Prevention programs aimed at general populations at key transition points, such as the transition to middle school, can produce beneficial effects even among high-risk families and children. Such interventions do not single out risk populations and, therefore, reduce labeling and promote bonding to school and community.6, 10

PRINCIPLE 10 – Community prevention programs that combine two or more effective programs, such as family-based and school-based programs, can be more effective than a single program alone.3

PRINCIPLE 11 – Community prevention programs reaching populations in multiple settings—for example, schools, clubs, faith-based organizations, and the media—are most effective when they present consistent, community-wide messages in each setting.7

Prevention Program Delivery

PRINCIPLE 12 – When communities adapt programs to match their needs, community norms, or differing cultural requirements, they should retain core elements of the original research-based intervention27 which include:

  • Structure (how the program is organized and constructed);
  • Content (the information, skills, and strategies of the program); and
  • Delivery (how the program is adapted, implemented, and evaluated).

PRINCIPLE 13 – Prevention programs should be long-term with repeated interventions (i.e., booster programs) to reinforce the original prevention goals. Research shows that the benefits from middle school prevention programs diminish without follow-up programs in high school.25

PRINCIPLE 14 – Prevention programs should include teacher training on good classroom management practices, such as rewarding appropriate student behavior. Such techniques help to foster students’ positive behavior, achievement, academic motivation, and school bonding.15

PRINCIPLE 15 – Prevention programs are most effective when they employ interactive techniques, such as peer discussion groups and parent role-playing, that allow for active involvement in learning about drug abuse and reinforcing skills.6

PRINCIPLE 16 – Research-based prevention programs can be cost-effective. Similar to earlier research, recent research shows that for each dollar invested in prevention, a savings of up to $10 in treatment for alcohol or other substance abuse can be seen.

Addiction and drug abuse are major problems, so, addiction prevention efforts have to be major.

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