Alcoholics Anonymous Is Not Addiction Treatment

Alcoholics Anonymous is not addiction treatmentThere’s a tendency for some people to confuse AA with addiction treatment. Often we’ll ask someone if they’ve had addiction treatment before and the person will say they attended a few “classes”. When we ask what type of classes, they describe AA meetings. Nowadays, judges will often mandate that DUI violators attend AA, so it gets mixed up in the attendee’s head what is AA, what is connected with the court and what is addiction treatment. Alcoholics Anonymous is not addiction treatment, and AA is not affiliated with the courts.

AA is a support group and their only requirement for membership is a desire to stop drinking. Anyone, though, can attend AA, because no one will be asked at the door if they have a desire to stop drinking. It’s really left up to the individual when and if they attend. The person attending AA can say something in a meeting or not. No one has to give anyone any information in a AA meeting. I suggest googling AA to get a better understanding. Below is AA’s Preamble:

 

A.A. PREAMBLE©

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 to recover from alcoholism.

The only requirement for membership is a desire to stop drinking. There are no dues or fees for A.A. membership; we are selfsupporting through our own contributions. A.A. is not allied with any sect, denomination, politics, organization or institution; does not wish to engage in any controversy, neither endorses nor opposes any causes. Our primary purpose is to stay sober and help other alcoholics to achieve sobriety.

Copyright © The AA Grapevine, Inc. Reprinted with permission

Addiction treatment is something else entirely. Treatment facilities are licensed by the state and under state and federal regulations. Addiction treatment covers a wide array of issues and doesn’t necessarily adhere to AA except in broad recovery principles. In treatment, physicians are involved and medical issues are considered. There are assessments and formal treatment plans developed in addiction treatment, and there’s a cost to treatment, although some facilities are state funded and the cost is not covered by the individual in treatment. In AA, the people in the meetings are in recovery themselves — in addiction treatment there are paid licensed professionals who work with the clients.

This is not to say that everyone with an addiction problem must go through treatment and receive professional assistance. Many alcoholics go straight into AA and stay sober long term. It’s just that they’re two separate things that shouldn’t be confused with one another. When clients come to treatment, the treatment facility will often recommend AA for long term support. So, even though Alcoholics Anonymous is not addiction treatment, we all work together when possible to help those in need reaching out for help.

 

The Latest News on Suboxone

The latest news on SuboxoneSuboxone has become standard use in Medication Assisted Treatment (MAT) for opioid addiction. In the latest news on Suboxone, Congress has formed committees to create national standards for opioid addiction and MAT is seen as a vital part of any treatment plan. Because the withdrawal from opioids is so painful, most opioid addicts won’t even attempt to enter outpatient treatment, and inpatient treatment is usually unaffordable or considered inappropriate level of care by insurance providers. This is from Drugs.com:

MONDAY, June 19, 2017 – The rate of opioid addiction among Americans age 25 and under rose nearly sixfold from 2001 to 2014. But few young addicts get medical treatment that might prevent overdose or relapse, a new study finds. Only about 27 percent of youths treated for addiction to prescription painkillers or heroin receive either buprenorphine or naltrexone, two recommended anti-addiction medications, researchers reported. “These medications are considered the evidence-based standard of care for opioid addiction by the American Academy of Pediatrics,” said lead researcher Dr. Scott Hadland. He’s an assistant professor of pediatrics at Boston University School of Medicine. Buprenorphine (Buprenex, Suboxone) has been shown to reduce cravings, while naltrexone (Revia, Vivitrol) blocks the high from opioids, he said.

The problem is access and the availability of quality treatment programs. Other studies show that opioid addicts who enter medical care that’s not an addiction specialty treatment facility are far more likely to die from opioid addiction. There’s still a lack of knowledge and understanding of the latest treatment methods related to dealing with opioid addiction, especially when it comes to Suboxone.

The good news is that opioid addiction can be treated and people do recover. Long term treatment is better than short term. It’s not that we don’t know what to do to deal with the epidemic — it’s access and availability to treatment facilities that provide evidence-based, quality care. The next time you hear someone say that opioid addiction is a serious and vexing problem, remind them that there are solutions. We just have to develop innovative ways to fund and get opioid addicts into treatment.

Good News For Alcoholics

Good news for alcoholicsThanks to scientific research and the modern capabilities of medicine, there’s good news for alcoholics in early recovery. First of all, research has shown that a certain receptor, mGluR5 , in the brain related to craving alcohol actually reduces in number after a heavy drinking bout — researchers believe the brain is trying to adapt to the damage caused by the receptor which is creating the craving for alcohol.

Research shows that this receptor in some alcoholics returns significantly after detox from alcohol, and this is what’s causing the intense craving and relapse for these alcoholics. Below is an excerpt:

Alcohol abuse disorder is a devastating and complicated disease affecting millions of people worldwide. A study presented at the 2017 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI) reveals how brain receptors involved in the compulsion to drink, adapt to alcohol-dependency by reducing their bioavailability, but return to their normal availability after a modest period of detoxification. Receptor availability at the outset of sobriety could also serve as a predictor of long-term success.

If they can devise a medicine that reduces the brain receptor, this is indeed good news for alcoholics. This will significantly reduce the compulsion to drink after a short period of sobriety. Science gets closer and closer to discovering what creates the insane craving for alcohol that has confounded so many doctors, family members, friends and the alcoholic who continues to drink in spite of negative consequences. Another excerpt:

These results could be used to further investigate mGluR5 downregulation and other biomarkers for molecular imaging and the evaluation of novel therapies that could increase an alcoholic’s ability to achieve long-term sobriety.

Yes, the language is difficult to understand for a lay person, but if you read the article, you’ll understand that this is definitely good news for alcoholics. The problem with treatment often is that when the person is out of treatment, the alcoholic brain often still craves alcohol, and, if the receptors causing the craving return to full force, it makes it difficult for some alcoholics to stay sober — the craving and triggers just wear the person down mentally and emotionally. It takes a long time for the brain to rewire itself and recover. If medicines are discovered which can reduce the craving long-term, then the person has a better chance of staying in a support group, working on a recovery management plan and achieving long-term sobriety.

Here is the article:

Society of Nuclear Medicine. “Neuro-receptor PET could provide an early warning for alcoholic relapse.” ScienceDaily. ScienceDaily, 12 June 2017. .
Society of Nuclear Medicine. (2017, June 12). Neuro-receptor PET could provide an early warning for alcoholic relapse. ScienceDaily. Retrieved June 13, 2017 from www.sciencedaily.com/releases/2017/06/170612094112.htm
Society of Nuclear Medicine. “Neuro-receptor PET could provide an early warning for alcoholic relapse.” ScienceDaily. www.sciencedaily.com/releases/2017/06/170612094112.htm (accessed June 13, 2017).
 

 

More on Relapse Prevention

More on relapse preventionThis is a follow-up from the previous post, more on relapse prevention. For those who’ve never been addicted to a drug and don’t understand how someone can go back to a drug that is obviously killing them, think about something in your life to which you can relate it, like dieting. Who has said they’re going on a diet only to find themselves stuffing chocolate in their mouth one week later? With drugs, though, the compulsion to use is much greater in early recovery. Lots of people have made resolutions that they can’t maintain. It takes discipline and support to make big changes, and when someone has had their brains rewired by drugs for years, the recovery is slow and arduous. In addiction recover, relapse happens, but it doesn’t have to kill recovery — a person can try again and again.

The good news is people can go on diets and lose weight, they can quit smoking, stop gambling, quit cheating in relationships and stay free from drugs. The mind can be rewired – we can change at any age. Science has discovered that our brain is plastic, it can change, and we can grow new cells. The old idea that we’re set in our ways or stuck with our upbringing is not true. If you think of the mind as a computer program that’s programed to believe a certain drug is holding you together, through daily or regular reinforcement, this program doesn’t change over night — it can take months or years of slow, gradual change to re-program the brain to realize deeply that the drug is poison and no longer desired. The person can know this superficially early on, because they know that others around them believe the drug is poison and that they should believe this too,  but the deeper part of their brain is triggered by many cues to use the drug. To the person experiencing this trigger, it appears as if the compulsion to use comes out of the blue and has complete control, but this is an illusion.

In treatment, we teach clients how to begin changing their addict brain, how to reinforce recovery thoughts and actions on a daily basis. We teach clients how to quickly recognize triggers and how to combat the compulsion to use the drug (always remember that alcohol is a drug, too, so when the word drug is used, it also means alcohol). There’s a point between the stimulus (trigger) and the compulsion in which the person has the power, once they’ve learned how to access the power, to resist the compulsion and re-assess the stimulus.  As the person in recovery practices this techniques and uses the support of others who understand the process, the person’s brain begins to change from addict brain to recovery brain. The negative thoughts of I can’t quit, or I can’t cope without the drug, become I can cope without the drug — I can thrive without the drug — then it becomes I can ONLY thrive and flourish without the drug. This is recovery. If you want to learn more on relapse prevention, Google Terence Gorski and relapse prevention.

Relapse Prevention in Addiction Recovery

relapse prevention in addiction recoveryIf I had to state the fundamental goal of treatment, I’d say relapse prevention in addiction recovery is a vital piece that can’t be emphasized enough. A person in early recovery is often blindsided by so many cues to drink or use drugs because they aren’t prepared, it’s imperative that the person know what to expect and how to handle what we call relapse triggers. Triggers are things in the recovering person’s day to day life that can initiate craving for the person’s drug of choice, or some substitute drug.

An example is a recovering alcoholic in the early stage of recovery. She believes she can associate with her old friends in a neighborhood pub if she just tells them she’s in recovery and no longer drinking. She’s not aware how powerful sight, sound, smell and touch are, and how they bring back memories of previous times. Maybe this pub was where she first started drinking and met her first love. In the beginning, the drinking was fun and the atmosphere of the pub was relaxing, familiar and enjoyable. Her first love affair was exciting and exhilarating. All these associations are rooted deeply in her mind and tied to alcohol.

This pub is a dangerous place for her in early recovery, because it sets off dozens of relapse triggers — the smell, the sounds (laughter, billiard balls cracking, music, the voice of the bartender), the sight of friends and pictures on the wall, all these are triggers firing in her brain as she pretends to be strong willed. What usually happens  is the relapse triggers are too powerful and the person goes back to drinking. Maybe after she’s in recovery long enough to rewire her brain and build up a resistance to triggers she can go to the pub with no problems, but in early recovery the risk is great.

This is just one example. Returning to a toxic relationship in which the partner is drinking — cutting grass on a hot summer day thinking about how good beer tasted– there are many triggers. It’s not possible to avoid all these triggers, but the person in early recovery should be aware of what triggers will likely set off the desire to drink alcohol or return to the drug of choice. The person has to also know that just because a trigger is set off and there’s a desire to drink or use, this doesn’t mean they have to give in to the desire. Being prepared in recovery means understanding, more than likely, the desire to drink or use will return at times.

Knowing what to do and having a plan to prevent relapse is what recovery management is all about. Relapse prevention in addiction recovery is the obvious goal, but, what is obvious to the casual observer is not so obvious to the recovering addict. I’ll write more about this later in the week.

The Heroin, Opioid Problem

heroin, opioid problemThe heroin, opioid problem is devastating some parts of Mexico. Below is an excerpt from the linked Washington Post article:

Mexico provides more than 90 percent of America’s heroin, up from less than 10 percent in 2003, when Colombia was the main supplier. Poppy production has expanded by about 800 percent in a decade as U.S. demand has soared. The western state of Guerrero is the center of this business, producing more than half of Mexico’s opium poppies, the base ingredient for heroin. Guerrero also has become the most violent state in Mexico, with more than 2,200 killings last year.

I don’t know the total solution to this problem, but I know any fundamental solution has to include prevention and treatment. I hear a lot about law enforcement, but very little about treatment — however, I did see an AP article the other day about medication-assisted treatment (I don’t see nearly enough of these types of stories). But even proven treatment methods using medication that works is still controversial. Because addiction prevention and treatment haven’t been important enough to warrant the investment of resources, there’s no consistency in quality treatment and no consensus on best practices — there’s not even a good understanding of addiction itself.

A person seeking help might find someone who recommends total abstinence from all medications, regardless if there’s a need for medication, or they might encounter a therapist who doesn’t believe addiction is a disease, or a religious counselor who believes it’s solely a spiritual problem, or someone who recommends specialized addiction treatment using medication that stops the withdrawals and allows the person to enter treatment with a long-term recovery management plan (guess which one I recommend).

But even if someone enters a specialized addiction treatment program, there’s not always consistency. Some treatment programs are overloaded and poorly staffed, so the person doesn’t get the type of treatment and long-term recovery plan that’s necessary for a chronic brain disease. Until we can agree on best practices, find a way for all who need treatment to access quality treatment, and provide effective preventive measures to present to young people before they get into drugs, we’ll have drugs wars, hit and miss counseling solutions, inconsistency and confusion regarding treatment methods, and the heroin, opioid problem will not improve.

Recovery from Opioid Addiction

Recovery from opioid addictionI’ve written several times about recovery from opioid addiction, but it’s a complex subject and requires a great deal of explanation. Most people now have likely heard the horror stories of addiction, overdose and death, but not so much about recovery. The horror stories sell and recovery stories don’t. There are more and more recovery stories as opioid addiction treatment improves, but there are still millions who aren’t in treatment or don’t stay in treatment. The reason opioid addiction is difficult to treat is because of the way it’s been treated in the past. Methadone programs were once the major treatment for opioid addiction. As clarification, I use the term opioid to describe all opiate-like drugs, but, technically, opioids are synthetic.  It’s common now to talk about all of it, opium and opiates, as opioids. 

The hardest part of recovery from opioid addiction is withdrawal. The recovery rate for opioid addiction was low for a long time because addicts couldn’t get past the withdrawal or detox. Now there”s medicine like Suboxone to help ease withdrawals. The second hurdle is to get the chemically dependent person to understand the need for group therapy and counseling. Usually,  Suboxone does such a good job stopping the craving, the person doesn’t think they need further help. The problem is that addiction rewires the brain, and it takes a long time to reverse that process.

If the chemically dependent doesn’t receive some form of treatment, and doesn’t develop a long term recovery management plan, relapse is likely. There are certain triggers that set off psychological craving, and if a person doesn’t know how to deal with the overpowering desire to use again, the brain will become overloaded and the person will use opioids just to stop the madness. Addiction affects body, mind and spirit. It’s relatively easy nowadays to stop the physical craving for opioids, but spiritual emptiness an psychological turmoil are different and not so easy to make healthy and whole.

In treatment, recovery from opioid addiction is taught. The person in treatment is exposed to others who are in recovery, so they can learn from one another and support one another. Spiritual rejuvenation and psychological healing take time — recovery is about taking time to get better, understanding the addicted mind and finding ways to prevent relapse. It’s not easy, but it leads to amazing changes over time. Time is the essential for recovery from opioid addiction. There’s a saying around recovery groups- “Don’t give up before the miracle happens.”

 

Anxiety, Depression and Addiction

Often, chemical dependence presents itself as anxiety or depression, so someone having trouble with alcohol or some other drug might think that, say, anxiety is the main problem, when in reality the addiction is generating the anxiety. Sometimes anxiety and addiction can co-exist, but many times addiction is creating an anxious state of mind that tends to get worse and worse as the addiction grows out of control. It’s generally thought among the public that chemically dependent people are driven to addiction by some underlying psychological disorder or condition – this is not true. Addiction can happen to anyone, regardless of their psychological condition. Once a person starts moving through the stages of addiction, psychological problems often develop, but this is usually due to the nature of addiction and behavioral consequences that are at odds with reality. Addiction causes much confusion and emotion/mental turmoil.

The same thing goes for depression. In fact, alcohol is a depressant drug that initially has a stimulative effect. Most social drinkers don’t drink enough for the alcohol to become a depressant, so they enjoy a few drinks for relaxation or stimulation. The alcoholic, though, is often depressed from the alcohol itself and the consequences that attend alcoholic drinking. When an alcoholic goes to seek counseling, they’ll often minimize the drinking and highlight the depression. The alcoholic’s brain is slowly being rewired and he/she believes alcohol is vital to existence. The alcoholic protects the alcohol, concentrates on the depression, along with the magical thinking that maybe if they deal with the depression they’ll be able to drink without dire consequences.

Counselors trained in anxiety, depression and addiction disorders will recognize chemical dependence as the primary problem, if, indeed, the person is chemically dependent. The trained addiction professional will determine if anxiety or depression are likely caused by the addiction, or if there’s a long history of anxiety or depression. If it’s determined that addiction co-exists with either an anxiety disorder or a depressive disorder, then both conditions require treatment.

From experience, I’ve found that most people who’re chemically dependent don’t have problems with anxiety or depression after they’ve been abstinent and in recovery for a while. Then, there’s another possibility — a person might have an anxiety disorder or a depressive disorder, and the person might be misusing alcohol or some other drug to self-medicate, thinking that their drug of choice will alleviate their disorder. In this case, anxiety or depression would be the primary disorder — there would be no addiction diagnosis. The person’s anxiety or depressive disorder would require treatment, and the person would receive counseling on the dangers of self-medication. In order to straighten all this out, an in-depth evaluation is necessary by a trained professional who understands anxiety, depression and addiction. The key it to get good information, which is never easy. It’s always good if a family member attends the evaluation — then maybe the perspective is a little clearer.

Spirituality in Addiction Recovery

Spirituality in addiction recovery has been controversial at times,  especially among those with a more rational, scientific bent. Spirituality in addiction recovery was controversial all the way back to the beginning of Alcoholics Anonymous. The first hundred or so AA members had a split between Christian members who wanted a more religious tone and the agnostic-type members who wanted a clear separation from any religion. The compromise was a higher power of the individual’s understanding, even the power of a group with a common cause.

The underlying idea that made spirituality necessary at all, according to many who were working with alcoholics at the time, was that alcoholism can’t be beat by will power alone — they said it takes all the will power a person has, but it takes more than will power alone. They believed the alcoholic needed a power greater than themselves to overcome the insane obsession with alcohol. Even Dr. Carl Jung, the famous Psychiatrist, told a relapsing alcoholic who’d gone to him for help, and who had tried many sources of self-help and talking therapy to no avail, that in his (Dr Jung’s) experience alcoholics who recovered all experienced some kind of spiritual awakening, a deep desire for transformation.

Today in addiction treatment, for the most part, spirituality is still discussed in broad terms as an important part of recovery from addiction. The best addiction treatment techniques, the best counseling, the best treatment plan, are only effective if the individual in recovery can reach deep enough for inspiration to follow through. I guess it can be called many things, but spirituality is still a good term. Even if we can’t see it or touch it, most of us have experienced that deep stirring which comes from music, art, love, religious ceremonies, or other special moments or life changing events. Even though this deep, strong movement inside is not easily described, it’s powerful and real. And even if science discovers neurons and brain chemicals that are related to this “spiritual awakening”, it doesn’t change the fact that the experience is often transformational. Like Dr. Jung, spirituality in addiction recovery, regardless of what it’s called or how it’s experienced, is what I see that makes the difference between a return to drug addiction and long term recovery.

Why do I need Addiction Treatment?

Why do I need addiction treatment?Most people in the early stages of addiction will ask “Why do I need addiction treatment”? They ask for several reasons – one being they don’t think they’re in the early stages of addiction, and another reason is they most always think that individual counseling will suffice. The idea that alcohol or other drug problems are caused by underlying psychological conditions leads many addicts to try symptomatic solutions, and they never deal with the fundamental problem.

In the minds of most people in early addiction, they still believe they have power over drugs (alcohol is a drug, so it’ll be included where I write “drugs”). A person in the early stage of addiction still has some control, so they naturally think that if they talk with a counselor and resolve their depression, anxiety, anger issues, relationship problems, legal problems, self esteem issues, etc, then they can use their drug of choice without having problems. They think their depression, anxiety, life situation, whatever, is causing the periodic problems with misuse of drugs.

This might be true in some cases where the person is not in the early stages of addiction. But, if the person is susceptible to addiction, this chronic brain disease will not go away just because he/she becomes psychologically and emotionally healthy, if the person doesn’t understand and address the fundamental problem of addiction. A person who is not in any of the stages of addiction and simply misuses drugs periodically to deal with problems can benefit from individual counseling and self-improvement and can learn to drink or use their drug of choice responsibly, or stop using illegal drugs because it’s against the law and they realize it’s not worth the risk.

The person who’s going through the stages of addiction can also benefit from individual counseling and self-improvement, but this will not “cure” their addiction. Psychological and emotional problems are not the cause of addiction — they can complicate and intensify addiction, and addiction can complicate personal problems, but the person suffering from addiction most often needs more than individual counseling. They certainly need to know that if they continue to use drugs, the addiction will progress to middle stage then late stage and that premature death is likely. Addiction requires specialized care — it’s much more serious than temporary drug abuse/misuse. The answer to “Why do I need addiction treatment?” can be found when first the person understands addiction.