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.

Opiates and Politics

Opiates and politicsIn the last decade opiate use has risen significantly. Overdoses and deaths from opiate use are increasing at a frightening rate. Whether it’s opiates like heroin or morphine or synthetic opioids like Percocet or Oxycodone, there’s no difference when considering the consequences of addiction and misuse and possible solutions. When a person develops tolerance and addiction, the body doesn’t know the difference from heroin bought off the street or Oxycodone that comes from a pharmacy.

I’ll just use the term opiate for the sake of simplicity. Opiates like heroin and morphine are nothing new. This is from Wikipedia:

The Mediterranean region contains the earliest archeological evidence of human use; the oldest known seeds date back to more than 5000 BCE in the Neolithic age[8] with purposes such as food, anaesthetics, and ritual. Evidence from ancient Greece indicate that opium was consumed in several ways, including inhalation of vapors, suppositories, medical poultices, and as a combination with hemlock for suicide.[9] The Sumerian, Assyrian, Egyptian, Indian, Minoan, Greek, Roman, Persian and Arab Empires all made widespread use of opium, which was the most potent form of pain relief then available, allowing ancient surgeons to perform prolonged surgical procedures.[citation needed] Opium is mentioned in the most important medical texts of the ancient world, including the Ebers Papyrus and the writings of Dioscorides, Galen, and Avicenna. Widespread medical use of unprocessed opium continued through the American Civil War before giving way to morphine and its successors, which could be injected at a precisely controlled dosage.

Countries like China have had wars over opium, and the U.S. declared a War on Drugs in the 60s, when opiates were referred to mostly as narcotics. Opiate and politics are a big concern now, although the mindset of making war against opiates still prevails. All attempts to eradicate opiates have failed. Just recently government ordered a reduction in the production of synthetic opioids. Government, to its favor, has also called for treatment of opiate addiction, and government supports the use of Buprenorphine as a regulated replacement drug that allows addicts to get into treatment without overwhelming withdrawal symptoms — however, treatment resources and access to resources are sadly insufficient.

Our society seems to favor  symptomatic law and order solutions over long term, fundamental solutions like education, prevention,  treatment and ongoing support. Waging war against drugs has created drug cartels and deadly battles for domination. Addiction, drug misuse and the demand for illicit drugs are the fundamental problems. All efforts so far to change minds and hearts about drug use have come up short. As a society we’re confused about drugs. Thinking clearly and objectively about drugs would be a great first step. If we can remove the fear and stigma, maybe we’ll find fundamental solutions.

If all the resources wasted on waging war against drugs were channeled into education, prevention, treatment and ongoing support, we’d gradually experience a change. Fearing drugs and fighting drugs with weapons have not changed our relationship with drugs. I know it’s a huge problem with no easy solutions, but I have to believe that understanding the problem through real, comprehensive education and prevention efforts will lead us in the right direction.

The Presidential Election and Addiction

Presidential election and addictionI would like to think that whoever becomes our next President will have a good understanding of our nation’s problem with addiction, but I haven’t heard much at all about the subject from the candidates — they appear to have lots of other things on their minds. I’m not convinced the solution to addiction problems, such as the nation’s heroin epidemic, must necessarily come from government, and I tend to think that local communities might find better solutions than top down federal government solutions, but it’d be good if representatives making all the funding decisions in DC really understood addiction.

So much could be done to save lives if only government officials would handle fundamental problems with fundamental solutions rather than wasting money applying symptomatic solutions to symptomatic problems. It appears that most efforts to deal with addiction have created unintended consequences, like the War on Drugs. After decades of treating drug addiction as if it’s a part of an enemy plot to destroy America, the problem is arguably worse than when the “war” started. Locking up drug users along with drug dealers has only ruined the lives of many good people who could have received treatment and gone on to live productive lives. The money it costs to house drug users in prison where they learn criminal behavior is mind-blowing.

I don’t have much hope that the next President will do much that’s different from what other Presidents have done, but it doesn’t hurt to hope. Drug court programs are successful government efforts, although it’s more of a local solution. As middle class and upper class mothers and fathers lose children to heroin overdose, maybe the nation will wake up and pay attention to addiction in general, thus creating a path to apply fundamental solutions. We’ve wasted enough time, money, effort and lives battling drugs as if we can make an imaginary Drug Invader surrender. As along as the demand for drugs grows, the supply will follow. We need innovation, creativity and perseverance to find true, lasting solutions

If you have an alcohol problem…

seeking treatment

Do you have an alcohol problem?

Here is a simple test to determine if you have an alcohol problem, or if someone you know might have a problem.

Alcohol use disorder (AUD) is a medical condition that doctors diagnose when a patient’s drinking causes distress or harm. The condition can range from mild to severe and is diagnosed when a patient answers “yes” to two or more of the following questions.

In the past year, have you:

  • Had times when you ended up drinking more, or longer than you intended?
  • More than once wanted to cut down or stop drinking, or tried to, but couldn’t?
  • Spent a lot of time drinking? Or being sick or getting over the aftereffects?
  • Experienced craving — a strong need, or urge, to drink?
  • Found that drinking — or being sick from drinking — often interfered with taking care of your home or family? Or caused job troubles? Or school problems?
  • Continued to drink even though it was causing trouble with your family or friends?
  • Given up or cut back on activities that were important or interesting to you, or gave you pleasure, in order to drink?
  • More than once gotten into situations while or after drinking that increased your chances of getting hurt (such as driving, swimming, using machinery, walking in a dangerous area, or having unsafe sex)?
  • Continued to drink even though it was making you feel depressed or anxious or adding to another health problem? Or after having had a memory blackout?
  • Had to drink much more than you once did to get the effect you want? Or found that your usual number of drinks had much less effect than before?
  • Found that when the effects of alcohol were wearing off, you had withdrawal symptoms, such as trouble sleeping, shakiness, irritability, anxiety, depression, restlessness, nausea, or sweating? Or sensed things that were not there?

If you have any of these symptoms, your drinking may already be a cause for concern. The more symptoms you have, the more urgent the need for change. A health professional can conduct a formal assessment of your symptoms to see if an alcohol use disorder is present. For an online assessment of your drinking pattern, go to RethinkingDrinking.niaaa.nih.gov.

There’s nothing to lose by talking with an addiction professional to see if you have an alcohol problem, but everything can be lost if the problem is ignored. Millions of people need treatment for addiction, but few seek treatment. In the next post I’ll discuss some of the reasons why so few seek treatment.

Outpatient Addiction Treatment

Group therapy

Treatment works

So, what is outpatient addiction treatment? First of all, the lingo is changing in the addiction treatment field. Although most professionals in the field still refer to addiction as addiction, there are some organizations referring to addiction as Substance Use Disorder or Alcohol Use Disorder. These changes in terminology are for diagnostic reasons mostly, and I still prefer to distinguish between alcohol/substance abuse and alcohol or other drug addiction. With temporary alcohol/drug abuse, a person might be mishandling a divorce or a close death by drinking too much or using some other drug to deal with pain and lonliness. This is usually temporary, and the person might need short-term counseling to find better ways to cope — however, if signs and symptoms show that the person is in the early or middle stages of addiction, progressing toward late stage, full blown addiction, then this is a serious medical problem that requires some form of treatment.

When a potential client comes to NewDay Counseling for a free consultation, we gather enough information to determine if the person is temporarily abusing alcohol or some other drug, or whether the person appears to have a more serious problem and could be in the early or middle stages of alcoholism or some other drug addiction. We also determine if the person has insurance or the ability to pay for treatment. For some reason many people tend to think addiction treatment should be free, but we’re a private organization and receive no government funds. There are organizations that receive state and/or federal funds, and we refer to these treatment options if the person can not pay for treatment or doesn’t have insurance. When people receive other medical treatment, they expect to pay for it or have it covered by insurance — addiction treatment is no different. Addiction might be the most under-treated medical condition in the healthcare realm, costing society billions of dollars a year. Addiction also needlessly causes pre-mature death.

When the issue of money becomes a barrier to treatment, even for someone who can easily pay, we always do a calculation of how much the person is now spending/wasting on alcohol and other drugs and the consequences of drinking and doing drugs — like DUI costs or making bad financial decisions or days not working or loss of a job because of a drug screen or failure to get a promotion due to lack of motivation or trips to the emergency room because of an accident while drunk — and when the calculations are finished the cost of treatment looks like a very smart investment. For an amount equal to most payments for furniture, a big screen TV or a nice stereo, a person can make payments on something, treatment, that can turn the individual’s life around and enable the person to become prosperous and happy in the future — yes, it’s a good investment.

Once we’ve determined that a person has an alcohol or other drug problem that is serious enough to warrant treatment, we have to decide if the person needs to go inpatient or is appropriate for outpatient. Outpatient treatment is less expensive and, of course, less restrictive. In outpatient a person can continue to work and be with the family if there is a family. Our Medical Director makes the final decision between inpatient and outpatient. If a person is in danger of going into withdrawals, and it’s too risky to try detox medication on an outpatient basis, we’ll recommend the person go to an inpatient detox, then the inpatient facility will determine how long the person stays inpatient. It could be that the person stays inpatient for a week or so then is transferred back to us at NewDay Counseling to complete addiction treatment in outpatient.

If the person is going to receive addiction treatment with us in an outpatient program, we perform what’s called a Bio/Psycho/Social assessment which asks pertinent questions about the person’s drug use/drinking history, family history, medical history, emotional state, employment situation and history, etc. After gathering all this information, a treatment plan is developed. The treatment plan establishes treatment goals, objectives, and interventions to accomplish the objectives.

The person begins group therapy which is four evenings a week, Monday, Tuesday, Thursday and Friday, from 5:30pm to 8:30p. One hour of group is educational, regarding some topic pertinent to addiction or recovery from addiction, then the other two hours are process group therapy. Very real, powerful and therapeutic relationships are developed in group therapy if the person opens up and allows others to know him/her. When a group of people are working together toward common goals it’s a much more effective than going it alone or simply talking to a therapist once a week for an hour, especially when what you’re dealing with is something as powerful as addiction. The client receives at least one individual session a week, more if necessary, then family involvement as indicated.

The person in addiction treatment and their counselor work on treatment plan goals, and the counselors meet once a week, at least, with the Clinical Director and Medical Director to discuss clients’ progress and what adjustments are necessary. Referral sources, such as physicians, attorneys, employers, EAPs, if they are on the signed release of information form, receive updates regarding the clients’ treatment — the client has to agree to this update information, otherwise, the client’s treatment is confidential. Unless a client gives us permission to tell someone he/she is in treatment, we can’t tell anyone unless there’s a court order signed by a judge legally requesting the information, but even then it has to be a court order signed by the judge, not just a subpoena.

Near the end of treatment, the counselor and the client begin developing a discharge plan. I prefer to call this a Recovery Management Plan. This plan is very important and should address the long term goals of treatment. Addiction is a chronic brain disease and it takes a long time to clear up, gain insight, stabilize and develop the coping skills necessary to make changes. Then treatment becomes maintenance. We recommend that the client find a support group like Alcoholics Anonymous, Narcotics Anonymous, Rational Recovery, a recovery church group, or whatever, just support from others going through the same recovery from addiction and maintenance of recovery. After a period of time in a support group like AA, the person can begin helping newcomers coming into the group, and this is when recovery goes to a higher level.

Once an individual begins feeling good emotionally, mentally, physically and spiritually, making positive changes, developing purpose and meaning in life, and then helping others do the same, recovery becomes not a “staying away” from alcohol or other drugs, but a moving forward to a better life that improves as time goes on. Recovery can seem like something is pulling the person forward — this is recovery, and it has to be managed and maintained.

Getting into Addiction Treatment

Levels of addiction care

Getting into addiction treatment

Getting into addiction treatment can be confusing and scary. Accessing treatment for a problem with alcohol or other drugs should be a smooth, stress-free process. Yes, it’s stressful seeking help for an addiction problem, but the facility that does the intake shouldn’t create stress. If the process goes as it should, a person should find the appropriate treatment at the appropriate level of care without much trouble.

I’ll assume that the person seeking a treatment facility is the person with the problem. Making a phone call to set up a free consultation is the first step. Most facilities have staff doing intake who are experienced and who will patiently answer all your concerns. The consultation should be scheduled as soon as possible, because people change their minds and lose the courage to go through with treatment if they take too long to think about. If you’ve thought about it and you know you need treatment, then it’s best to move forward and act decisively. It’s ideal to do the consultation over the phone if the purpose is to get a good idea whether the treatment will be outpatient or inpatient and to verify insurance or ability to pay. If a person has no insurance or ability to pay for treatment in a private facility, a referral can be made to a state facility or to a private facility that receives government funds to treat clients without insurance or the ability to pay. This will save time and energy rather than driving to a facility only to find out private pay is needed.

For some reason most people think that treatment is funded somehow by outside sources, but most private treatment facilities don’t receive government funding and can’t survive without insurance payments or cash payments. These private facilities will often work out very reasonable payment plans, but they have to get paid for services to stay in business. It always surprises me that people will buy expensive stereo equipment or a big screen TV on time but won’t do the same to get treatment and potentially save their lives from gradual, or quick as a the case may be, destruction. Most outpatient addiction treatment is no more expensive than some of things people buy on time for entertainment.

Once the free consultation is complete, level of care is established (let’s say it’s outpatient) and the admission is approved financially, the person signs forms for confidentiality and release of information. The treatment facility staff can’t give client information to others unless the client signs a release of information to the individuals approved by the client to receive information, and even this information is controlled by the client as to what information is released. Treatment facilities take all measures possible to protect confidentiality, and federal laws punish all violators.

The client is then assigned a counselor who does an assessment to make sure that the client is appropriate for outpatient level of care. The financial approval was the first step, and now the clinical and medical staff have to verify that the client is appropriate for treatment in outpatient addiction treatment. The counselor performs what’s called a bio-psycho-social history that covers all areas of the client’s life, history of drug use, employment, culture, relationships, family history, spirituality/religion, etc. If the information confirms that outpatient addiction treatment is appropriate, the counselor recommends intensive outpatient treatment, IOP, or outpatient, individual counseling, and then the Medical Director sees the client to give medical clearance for outpatient. For this case, we’ll say IOP is recommended. There is blood work done, a urine drug screen, a Nurses assessment of past and present medical condition and a TB test. If the Medical Director approves intensive outpatient treatment, then the client goes through an orientation to treatment so that the client understands what to expect. The client is given a client handbook and is asked to read it. The client understands his/her rights, groups rules, who to talk to about complaints, etc.

Then the person enters group therapy and receives individual counseling at least once a week. Appropriate family members are consulted and recommendations are made for them to get a better understanding of addiction, treatment and recovery, and how all this affects the family. This is how people get into treatment. In another post, I’ll write more about what actually happens in treatment.