Obstacles to Addiction Treatment

Obstacles to addiction treatmentOne of the first obstacles to addiction treatment is stigma. Although society has made great progress accepting addiction as a medical concern that needs treatment, receiving addiction treatment can still cause problems with employers and a person’s social circle. Many employers are aware of Employee Assistance Programs and offer some version of this type of help — they’re the smart ones. But there are employers with antiquated ideas about addiction and they make it hard for employees to ask for help. If an employer is the second type, it might be time to find another job. And if a person’s social circle shames a person with an addiction problem, then that’s not a healthy social circle.

Once a person is past the stigma, then it’s usually the cost of treatment that becomes an obstacle. Inpatient treatment can be as much as 40+ thousand dollars for a month of treatment, but there are government funded facilities that provide treatment on a sliding scale according to ability to pay. Private outpatient will be around 4500-6000 for 8 weeks of treatment. There are also government funded outpatient addiction treatment programs to offset the cost. For someone with a fairly good income, the cost of treatment is a great investment, if the person is serious about treatment. The cost of active, untreated addiction is far greater, and the only return is destruction.

Whether inpatient or outpatient, or a combination of the two, treatment obstacles are easy to overcome once a person has committed. If a person’s willing, they’ll find a way to access addiction treatment. For some people, going directly into AA or NA is enough, although some form of treatment’s usually advised. The keys to addiction treatment and recovery are honesty, openness and willingness. Once a person has committed to treatment, a new world opens up. What seemed impossible is now achievable.

It’s amazing what a person can accomplish when they reach out for help and allow others to help them. When a person has isolated from others and is filled with shame, the sickness gets worse and there doesn’t appear to be a way out, but once the person reaches out it’s a new day and things begin to change. All obstacles to addiction treatment can be overcome with a little help.

Neuroplasticity and Addiction Treatment – Part Three

Neuroplasticity and addictionThis is the last in the Neuroplasticity and Addiction Treatment series. Recovery from addiction is a long term process. Recovery calls for intent, focus and repetition. The recovering person claims their intent — to stay sober and clean. In order to do this, the person has to accept that alcohol or the drug of choice will cause the same problems over and over if the person continues to drink or use. The recovering brain only half-believes this in the beginning. The old neural pathways told the brain alcohol/other drug is good and necessary, and these neural pathways are strong. These messages to the brain don’t disappear just because the drug has been removed.

The neural pathways of addiction weaken over time as the recovering person focuses on recovery, telling the brain that recovery is good and necessary, creating new neural pathways. One of the great benefits of attending AA or NA is that the recovering person receives positive recovery feedback over and over. The rewards in recovery aren’t as immediate, strong and reliable as the original rewards of alcohol/ other drugs once were, but they’re real and become increasingly more substantial. The drugs only worked for awhile, then they became more and more unreliable and less potent.

The recovering person is continuously working on a new life, a new way of thinking. Recovery is about positive change and growth. Although there are ups and downs in recovery, they’re nothing compared to the violent ups and downs of addiction.

In early recovery, the recovering person tries to stay away from alcohol/ other drugs, but as recovery progresses there’s a generative effect in which the person’s pulled forward to something good and fulfilling. Rather than expending negative energy to stay away from the drug, recovery creates more energy to move forward. If a person is just white-knuckling it in sobriety, they’ll wear down and likely give in to the desire to return to their drug of choice, but when the person is actively participating in recovery with the goal to improve and grow as a human being, then the energy spent in recovery is regenerated over and over, creating ever more energy and desire to recover. The addictive mind slowly changes — the addicted person now becomes a new person with a new life full of possibilities.

Neuroplasticity and Addiction Treatment: Part One

Neuroplasticity and addiction treatmentI firmly believe that the relationship discovered going forward between neuroplasticity and addiction treatment will greatly improve recovery outcomes. With addiction, although it might seem strange to someone who doesn’t understand addiction, the particular drug used is not so important as what happens to the brain when an addictive drug is taken by someone with a predisposition to addiction. The particular drug of choice will be important to the person in recovery because of environmental, social and emotional triggers that remind the recovering addict of a place, a smell, a friend or a feeling associated with their main drug of choice – understanding these triggers is vital to relapse prevention, but, otherwise, the brain reacts pretty much the same, in relation to addiction, to all addictive drugs. The neuro-chemical actions in the brain are different from one drug to another – however, the neural-pathways created by repetitive drug use are what make recovery so difficult. Because this is not a simple subject, I’ll write this in several parts.

Let’s start from when neural pathways are strengthened and make drugs seem necessary and good to the addict. The addict consumes a drug, dopamine flows, the midbrain remembers the quick sense of euphoria or well-being, and neural pathways are strengthened, repeat and repeat and so on. In most people who’re social drinkers, their brains never change to the point that craving a drug overwhelms reason and judgment. For the addict, brain chemicals make changes that create tolerance and the irrational craving for more and more of the drug. This vicious cycle continues until there’s treatment and a reversal of the process.

People on the outside who witness an addict go into treatment and come out with the drug completely out of his/her system are mystified when the person returns to the drug shortly after treatment. It’s usually because he/she stops doing anything further to promote recovery. After years of strengthening neural pathways that tell the brain a drug is good and necessary, these pathways are too strong to overcome with just a few weeks of treatment. In treatment an addict should learn that recovery is a long-term process. It takes a while to strengthen the neural pathways that tell the brain the drug is deadly, and that recovery is healthy and life enhancing.

If you’ve ever had to change your ideas about something that’s deeply ingrained in your brain, that you’ve reinforced for years, like eating fried food, or a long-term love relationship that you discover, after decades, has gone terribly awry,  you understand how hard it is to change the brain to see something you enjoyed immensely, loved or craved as harmful and something that you must resist. Now, take that understanding and multiply it and you’ll get an inkling of an understanding how hard it is to stay away from a drug that captured the body and mind for years. For years the addict could take the drug and, quickly, the strong feeling of euphoria or well-being was there on demand — the addict’s brain stored the powerful memory of immediate satisfaction deep in the midbrain and associated this memory with people, places and things that trigger the desire to use the drug — now the drug has turned on the person, but the brain still wants the relief, quickly, with power and consistency. It takes awhile to change this in the brain. The good news is that the brain can change and recovery is possible.

In the next few days, I’ll write more in detail about neuroplasticity and addiction treatment how the brain changes in recovery according to those doing research in this area.


From Addiction to Self Esteem

From Addiction to self esteemNathaniel Branden once described self esteem as the reputation you have with yourself. If you know someone who frequently lies to you, you usually think less of the person. If someone takes something from you by deceit, you don’t trust them. If someone’s always negative, you don’t like being around them. What if that “someone” is you? After a while you think less of yourself, you don’t trust yourself, you don’t even like your own company. When you don’t feel comfortable in your own skin, something’s terribly wrong. Moving from addiction to self esteem takes action, persistence, understanding and time.

A person living with addiction begins lying to defend against the consequences of constant drug use. People who become addicted sometimes steal, and this is not just common theft — executives in large companies might skim from their employer to cover the high cost of addiction. Addiction almost always negatively affects self esteem. The addicted person becomes undependable, and the idea of being a screw-up seeps in and is reinforced over and over.

I’ve heard clients in treatment say they don’t like themselves, don’t trust themselves and many don’t believe they can change. If a person’s trying to recover from addiction and doesn’t improve their self-esteem, they might grow restless and discontent in their own company because of bad memories and their poor self image. Recovery has a lot to do with forgiving ourselves for the past and making a plan to do differently in the future, changing things we messed up, if possible.

Once the recovering person begins taking action, changing the way they relate to others, making an effort to be honest, apologizing immediately for mistakes, repairing the past, but realizing no one is perfect, things begin to change – the person begins to realize they can achieve goals — they can follow through — they can become dependable and trustworthy. Self esteem improves recovery and makes a person want to continue in the journey from addiction to self esteem as confidence and self-respect grow.

Gratitude in Addiction Recovery

Gratitude in addiction recoveryThanksgiving always reminds us of gratitude. Gratitude in addiction recovery is a topic we talk about on an ongoing basis as one of the main principles of recovery. The idea behind the principle of gratitude is that recognizing the things for which we should be grateful is more mentally, emotionally and spiritually healthy than obsessing over the negatives. In recovery it’s easy to fall into the trap of self pity, poor me, oh why did this happen to me? In reality, recovery from addiction opens up a new world.

Back in the 80s when I started working in the treatment field it was common for people working in the field to be in recovery from addiction. Recovering addicts could relate to the addict coming into treatment and could reach them when others couldn’t. This is how I got into treatment, through my own recovery. I now realize that counselors who aren’t in recovery can be as effective as a recovering addict, but both have strength and weaknesses, all training being equal. I say all this just to write personally about gratitude.

Before I got into recovery, I was lost. I had reached a point where life was meaningless. I felt dead inside and even when I drank alcohol all I felt was some blah sense of “normal” — the “good times” had disappeared a long time before I sought treatment. I had known deep down  for a long time that I had a problem with alcohol, but thought I could handle it myself. I thought I could regulate my drinking if I tried hard enough. Nothing worked. I kept drinking more than I intended to on most occasions. The hangovers got worse. The relationships with my family and friends got worse. They tried to understand, but from their perspective drinking was more important to me than the relationships. I couldn’t argue with them. I couldn’t deny my alcoholism any longer and I sought help.

After being in recovery for a while, my mind cleared up and my emotions returned. Sometimes the emotions were confusing and chaotic, but I talked to people in my support group and made it through without drinking or using any other substitute drug. The desire to create a better life returned and my relationships improved a 1000%. Clarity of mind was the one of the things in the beginning for which I was grateful, but there were many things. I could have fun again with my wife and kids — I could be a friend — I could recreate again and enjoy the little things I had forgotten about in my alcohol fog. My job performance improved immensely and finances were no longer a daily worry. Spiritually, meaning and purpose returned and I started working with other alcoholics who were reaching out for help.

Thanksgiving has a special meaning for me. Gratitude in addiction recovery is very important. I hope I never forget all the things for which I should be grateful. Happy Thanksgiving!

Motivation in Addiction Treatment

Motivation in addiction recoveryThere are basically three types of motivation in addiction treatment. One is to avoid unpleasant consequences through compliance. These clients are usually pushed hard to get into treatment, and they’re the most likely to return to their drug of choice. Another form of motivation is calculation — a person has calculated the costs and benefits of drinking and using drugs and has concluded that stopping will be a better choice. The third form of motivation is existential — the person has committed to addiction treatment because life in addiction has become miserable, hopeless and precarious. These last two forms of motivation are stronger than the first with the last being the strongest.

Although addicts who’re forced into treatment by the courts, family, spouse, etc., can and do recover, they usually have to go through more trouble before the desire to change is deep and meaningful. I’ve seen clients who’re forced kicking and screaming into treatment turn around and realize they have a problem. Most of us working in the field for a lengthy period of time have come to realize that it’s almost impossible to tell who’ll recover and who won’t, but the odds are not favorable for the person who’s in treatment just because someone holds leverage over the person. You’ll often hear people say about addiction treatment and recovery that the person has to want to stop drinking or using some other drug in order to recover. A desire to stop is not necessary in the beginning. I’ve seen people forced into treatment with no intentions of stopping have an epiphany and recover long term, and I’ve seen people who desperately wanted to recover never stop for any long length of time and eventually die from their addiction. Nothing has hurt the addict more than for people to tell him/her that they aren’t trying hard enough, and that if they just put their mind to it, they could stop drinking alcohol or using cocaine or shooting up heroin.

The person who rationally looks at their addiction and decides the costs of using drugs outweigh any benefits are at least motivated, but if addiction recovery were as simple as calculation, most people would stop long before the late stages of addiction. Calculation can be strong enough to get a person into recovery, but there usually has to be something stronger keeping a person in recovery or they go back to the drug of choice after the bad memories fade and the calculation changes. Perhaps the person has bad fortune in recovery and loses their job in a bad economy — the person who’s only calculating the costs and benefits might say that recovery is not “paying off”.

The point is that a desire to stop is a good motivator, but not necessary to start the treatment process. Having a desire to stop, though, doesn’t guarantee recovery, especially if the person is quitting with the expectations that life will be trouble free without addiction. Addicts forced into treatment can and do recover, and addicts who initially decide to deal with addiction and recover can and do die from their addiction. What usually determines if a person recovers or not is their level of ongoing commitment to the long term process of recovery. The main form of motivation in addiction treatment that enhances long term recovery is internal commitment. When a person has truthfully admitted that addiction is a life-threatening problem and has committed to taking steps to achieve and maintain recovery, regardless of external circumstances or obstacles, then the motivation is real enough to sustain long term change and growth.

Truth and Consequences of Addiction

truth and consequences of addiction

Lost in addiction

In treatment, truth is vital. The addict has been living in a world of magical thinking, denial, rationalizations, lies, and deceit of all sorts, so in recovery we have to search for what’s real — no worse than what it is and no better than what it is, just what it is — the truth and consequences of addiction.

Sometimes the client in addiction treatment will wake up quickly and realize that change is necessary. When a person comes into treatment seeking the truth, it makes the process much easier, but, most often, the client entering addiction treatment is still in denial and wants to minimize the consequences and hide from the truth. The addict in treatment will usually admit that they have a problem, but they don’t always realize or admit the severity of the problem or connect cause and effect, and they aren’t quite aware of all the consequences caused by alcohol or some other drug.

Here are some of the effects of long term drug use (alcohol is included as a drug, of course) taken from DrugAbuse.net:

Among the most common long-term psychological effects of drug addiction are:

  • Depression. As an individual develops a tolerance to drugs, it will take ever-increasing amounts of the substance to get high. When the individual is unable to achieve their desired state of euphoria, they may become depressed. Chronic depression also occurs as the drug addict feels shame and remorse about her condition. This creates a cycle of addiction; the more depressed the feel, the more likely they are to continue to use drugs.
  • •Paranoia. Individuals with a cocaine addiction or marijuana addiction often report a feeling of paranoia over the course of their dependence. The feeling that “everyone is out to get them” is heightened by the fact that buying or using drugs is illegal and the belief that law enforcement is waiting around every corner. Over time, drug addicts tend to get more and more paranoid.
  • •Anxiety. While waiting for their next dose of drugs, many individuals will begin to feel anxious or unsettled. Friends and family report that their loved one has trouble sitting still or staying focused on a single task for any significant amount of time. This anxiety and lack of focus can cause them to slack on job responsibilities and even lose their job. Relationships are also negatively affected by drug-induced anxiety. These are just some of the ways anxiety permeates the life of the drug addict.

These are some physical effects:


  • The kidneys. The human kidney can be damaged by habitual drug use over a period of many years. Kidney failure is not uncommon among long-time users of crystal meth, heroin and other dangerous drugs.

  • •The liver. Liver failure is a well-known consequence of alcoholism, but it is also can occur with individuals using Vicodin and OxyContin habitually over many years.

  • •The heart. Cocaine addicts and stimulant users are doing significant damage to their heart each time they use the drug. The most common conditions among drug addicts are heart disease and heart failure.

  • •The lungs. Any individual who smokes the drug to which they are addicted is putting their lungs in jeopardy. Smoking crack cocaine or crystal meth damages the lungs with a ferocity that rivals long-term nicotine habits. Regular marijuana use also causes damage to the lungs.

When a client doesn’t make progress in treatment realizing the truth and consequences of addiction, we intervene and confront the client with the facts and prognosis. Timing of the intervention is critical. You don’t want to put too much on a person before they’re ready, but, at the right time, confrontation is very effective. If the client doesn’t hear the truth about the condition and realities of addiction, then they’ll likely continue fooling themselves, and this never ends well.

You can summarize a large part of treatment by saying that treatment is effectively conveying to the client the truth and consequences regarding addiction in such a manner they can hear and accept so that they’re motivated to take actions to recover long term.

Addiction and Self Awareness

Step 4

Self Awareness

Addiction and self awareness are closely tied in treatment and recovery. During the process of addiction a person can lose self- awareness, forget what they believe, what they truly want in life, the meaning of life — they can also lose awareness of what’s happening in their various relationships with others. There’s a certain amount of delusional thinking that goes on in addiction. Because the person’s life is so out of control, the addicted person attempts to “fix” it all. When the person realizes they can’t control their drinking or drug use, they pretend to be in control — this is where the delusional thinking comes in, and it’s easier to blame people, places and things for our problems than to take a close, objective look at ourselves.

The alcoholic or drug addict pretends so often and for so long, the difference between truth and make-believe becomes blurred. Often, a person in recovery believes some of the fictional stories even while sober, until one day they realize that what they believed to be true is not true at all. The person had told themselves the same fiction over and over until it became the truth in the craziness of addiction. In AA’s Step 4 — Made a fearless and searching moral inventory of ourselves — the recovering alcoholic looks back over his/her life and identifies the areas where self-awareness has become the most damaged. Is the resentment the person holds toward an employer really based on facts or alcoholic delusion? Is her husband really the culprit or was it her drinking and unpredictable behavior?

Some people in 2016 might cringe at the terminology — moral inventory — but AA’s steps were written in 1935, and no one should let the differences in terminology from 1935 to 2016 throw them off. The recovering person could just as well call the process “getting to know oneself”, cognitive behavioral therapy, etc. The point is that a person in recovery will have a better chance at maintaining recovery and growing as a person if he/she re-evaluates their life, thoughts, emotions and relationships with others openly and fearlessly.

Addiction Recovery Principles


Addiction Recovery Principles

What is a principle? According to Google’s dictionary, a principle is:

a fundamental truth or proposition that serves as the foundation for a system of belief or behavior or for a chain of reasoning.
There are addiction recovery principles that are based on years of treatment, information from AA and NA, research, recovery stories, etc. — these principles relate also to good living that date back to the first time humans decided to find the most effective ways to live and interact with one another.
Don’t get me wrong — people addicted to alcohol and other drugs aren’t necessarily bad people who need to be good — they’re sick people in need of recovery. However, the collective wisdom from those who deal with addiction recovery reveals certain principles we can describe as “good” living. Healthy living, nutrition, education, openmindedness, exercise and not putting toxins in the system, enhance recovery because they help clear the head, provide energy to take necessary actions, build self-esteem and prevent dangerous mood swings.
Meditation has become an addiction recovery principle. Meditation can mean different things to different people and it deserves its own blog post, which I will write soon. The basic benefit of meditation is that it slows down the process of stimulus/reaction to get a better understanding of why we sometimes feel like pinballs in a pinball machine, manipulated by outside sources we don’t fully understand. Slowing down the process of stimulus/reaction can help us understand why we react the way we do. An example is anger — someone might find themselves in recovery becoming angry over the smallest things. This person can continue reacting and making life miserable, or the person can stop and really give serious consideration to each incident anger arises. This person can talk to someone who understands the process of recovery and human emotions so that an objective perspective is presented. The point is that the more comfortable a person is in their own skin, the better chance they have to maintain long term recovery. There’s an old saying that’s repeated at AA meetings — The same man will drink again.
If a person in addiction recovery is angry and resentful, ashamed, dishonest, unwilling to become humble and admit that alcohol or some other drug is a serious problem that has taken control, then this person will likely drink again, or relapse to their drug of choice. In the treatment field we see it over and over — a person goes through treatment and quits drinking or using drugs for one reason or another, but says that this is all they’re doing, that they’ll still go to the bars they frequented, won’t make any big changes, won’t attend a support group, won’t follow up with their physician, won’t go to counseling with their spouse — by God, they’re doing enough by getting sober!
This is a defiant attitude that is not in tune with the principles of recovery. The person might remain abstinent from alcohol for a significant period of time, but it’s what’s called “white-knuckling” — this type of abstinence drains a person mentally and emotional — it doesn’t generate positive emotions and thought — it drains energy and creates resentment. The person likely still wants to drink or use their drug of choice, although they won’t admit it and deal with it, but uses all their will power to resist the urge. The person doesn’t understand or doesn’t accept that if they work a recovery program based on sound recovery principles, they’ll begin to enjoy sobriety and feel good about themselves. There’s a big difference between using all your energy to stay away from a drink or drug and being pulled toward recovery because you’re improving and making progress and changing in ways that enhance human flourishing. This is from AddictionandRecovery.org:

Your addiction has given you the opportunity to change your life. Changing your life is what makes recovery both difficult and rewarding. Recovery is difficult because you have to change your life, and all change is difficult, even good change. Recovery is rewarding because you get the chance to change your life. Most people sleepwalk through life. They don’t think about who they are or what they want to be, and then one day they wake up and wonder why they aren’t happy.

If you use this opportunity for change, you’ll look back and think of your addiction as one of the best things that ever happened to you. People in recovery often describe themselves as grateful addicts. Why would someone be grateful to have an addiction? Because their addiction helped them find an inner peace and tranquility that most people crave. Recovery can help you change your life.

After 5 years of abstinence relapse is rare. A study followed 268 Harvard University undergraduates, and 456 non-delinquent inner-city adolescents. The men were followed every two years by questionnaire, and every 5 years by physical examination. At some point during their lives, 55 (21%) of the college men and 150 (33%) of the inner-city men met the criteria for alcohol addiction.The study concluded that after 5 years of abstinence relapse is rare.(3)

The root cause of addiction doesn’t relate to whether a person is good or happy , but recovery does become more likely to last if a person is happy, healthy and growing emotionally, intellectually, psychologically and spiritually. Addiction recovery principles are based on what we’ve seen work — it’s hard to argue with that.