Easier, Softer Way

easier, softer wayIn Chapter 5 of the book Alcoholics Anonymous there’s a warning about alcoholics seeking an easier, softer way to deal with alcoholism. Often someone suffering from addiction will seek help through a friend, a pastor, their doctor, a family member or maybe an individual therapist. I won’t say that any of these forms of help can’t work. I do know that addiction treatment is usually required if there’s to be much lasting change at all. The tough decisions and commitment necessary to deal with a medical condition as powerful as addiction are not easy. Some people deal with the problem through non-professional methods, but most people who suffer from addiction require some level of specialized addiction treatment.

The mistake most people make when trying to help someone who’s addicted to alcohol or some other drug is to immediately assign psychological reasons for the constant drinking or use of drugs: She had a bad childhood – He lost his wife – She has never fit in. In addiction treatment, we deal with the medical condition first. Addiction is a medical condition, a chronic brain disease, with a strong genetic influence that’s complicated by social and psychological factors.

Treatment begins by stabilizing the medical condition — detoxification, medical assessment, and understanding the chronic brain disease. Medication might be needed for detox, but the ideal course of action is to become drug free as soon as possible. When dealing with opiate addiction, Suboxone might be prescribed for the early period of treatment, long enough for the client to get into treatment and establish a support network. If the client can’t detox on an outpatient basis, inpatient detox will be recommended, and perhaps a few weeks of inpatient treatment.

Once there’s medical stabilization and we develop a treatment plan, then we begin dealing with the social and psychological aspects of addiction. Sometimes, a person is depressed and anxious in the beginning, but this is common for someone who’s been living a life torn apart by addiction. In some cases the depression and anxiety might have preceded the addiction, so that these co-occurring conditions are addressed and treated along with addiction. Depression and anxiety are not known to cause addiction, but they can co-exist with addiction, and addiction almost always makes co-existing conditions worse. So, when someone says that they’re drinking because they’re depressed, they don’t understand that alcohol is a depressant (although the first few drinks might have a stimulant effect) and makes depression worse over the long run, not better.

The life of addiction creates or masks problems that are dealt with if a person is to have the best chance at recovery. If a person stops drinking and nothing else changes, they’re usually filled with chaotic emotions, guilt, remorse, anxiety, depression, resentments, etc. These lingering consequences of addiction can overwhelm a person, making them restless and discontent, so much so they that go back to their drug of choice. If the person resolves the social and psychological problems, though, this doesn’t mean that he/she can return to social drinking or recreational drug use. Once biological predisposition to addiction is established, active addiction will recur once the person starts drinking or using again. Addiction is a chronic brain disease and so far there’s no known cure. If the person remains abstinent, however, they can lead a normal, fulfilling life. It’s not just people with addiction who are filled with chaotic emotions and psychological scars, but the person recovering from addiction has a chance and a need to deal with these problems and gain peace of mind — who wouldn’t benefit from taking time out to assess our emotions and psychological state?

So, if a person with an addiction problem tries to deal with the symptoms of addiction with symptomatic solutions, they might miss the fundamental nature of addiction which has to do with how the drug affects the brain. Many people who’re searching to find help, want help that will allow them to one day drink and use drugs socially with no consequences — the easier, softer way actually becomes very hard and painful. Ironically, (paradoxically?) it turns out that, for the addict, the easier, softer way is abstinence and recovery management.

More on Medication-Assisted Treatment

Post-acute withdrawal

Suboxone

The current misunderstanding around Suboxone as a medication-assisted treatment, MAT, for opiate addiction is confounding. Addiction treatment professionals, whether federally funded treatment providers or private treatment providers, who ban Suboxone from their treatment have much explaining to do.

Addiction treatment is complicated in many ways. The job of the addiction treatment professional, though, is to deal with addiction as it is, with all its complications, not as how it should be or we think it should be. There are many, many opiate addicts lost in a maze of drug use and visits to doctors and clinics that never seem to put them on the right path to recovery. The anti-Suboxone addiction treatment professional who sees an addict in this opiate addiction maze can insist the addict detox and maintain a totally drug free life, but this is not likely a realistic recovery plan.

For one thing, most insurance companies will not pay for expensive inpatient detox from opiates, even if the addict has insurance. If an opiate addict had a perfect situation in which they could spend 10 days or so in detox, then another 40 or so days in inpatient treatment, then in a halfway house situation for up to 6 months, perhaps the detox and drug free plan might work — but, even if this ideal treatment situation is possible, it all depends on the opiate addict staying in treatment, and the history of opiate addicts following through with such treatment after an initial full detox is not a history of success.

The problem with opiate addiction is that the withdrawal is difficult and the post-acute withdrawal is difficult, too. There are therapeutic strategies to help with post-acute withdrawal, like nutrition, exercise, support groups, etc., but it’s unprofessional in my opinion to deny the need for medication for some individuals, and especially with opiate addiction. Recovery from opiate addiction takes a long time — the brain has undergone damaging changes during addiction and the brain has to heal, and this takes time.

Suboxone is a drug that has allowed opiate addicts the time and comfort to get into treatment and stay in treatment without leaving because, whereas without the Suboxone, they feel so depressed and uninspired they just don’t care about recovery.

Addiction treatment professionals treat addiction, and addiction is complicated. Denying treatment to someone who is either taking Suboxone or seeking to take Suboxone just because there’s a bias against Suboxone flies in the face of all the evidence that Suboxone is a very effective MAT for many opiate addicts – denying therapeutic evidence that Suboxone enables recovery whereas before recovery was absent makes no sense in the realm of addiction treatment.

Medication-Assisted Treatment

Treating a disease

Individualized treatment

I can’t believe there’s still controversy over medication-assisted treatment when dealing with addiction, but there is. The argument against medication-assisted treatment has to do with the idea of using drugs to treat addiction to drugs. On the face of it, it does sound like a contradictory practice.

The critics of medication use in the treatment of addiction also claim that detox/maintenance medication interferes with recovery progress because the client is not fully in touch with their emotions.

The issue is more complicated than taking a side — medication-assistance or no medication assistance — addiction or abstinence — feeling and recovery or no feelings and no real recovery. If a physician is assisting someone in recovery, they should know about addiction and recovery. If the physician or psychiatrist understands addiction, then they’ll use medication assistance only when it’s deemed therapeutic to an individual’s treatment — the operative word is individual.

Not all clients are in need of medication assistance, but some clients might suffer from anxiety and depression and need medication assistance in order to stay in recovery long enough to make the necessary changes. Emotions, when they are painful emotions related to debilitating anxiety or depression caused by a brain chemical abnormality, are not conducive to recovery. Telling a client to suffer through debilitating anxiety in order to have a “pure” recovery is not helpful. It’s best if the client can use a medication to alleviate the painful anxiety or depression so they can concentrate on recovery and change. Maybe down the road, the client can stop the medication after their brain has healed in recovery.

When I first started in the addiction treatment field, the use of medication to help people in recovery was frowned upon, but I counseled a lot of clients who couldn’t make it because they couldn’t get through the anxiety or depression from a natural lack of brain chemicals or years of alcohol damage to the brain, or the awful withdrawals from opiates.

The point is that treatment is individualized, and each client has different needs, even if many principles of recovery are the same for everyone. Understanding a client’s individual needs entails a thorough evaluation up-front. Medication, in and of itself, is not bad. If we believe in the disease concept of addiction, then the use of medication to assist in treatment of addiction is no different than medication used in the treatment of other medical conditions. It’s up to medical professionals to understand addiction and to know what medications truly assist a person into recovery, and which medications are counterproductive.