The Art of Addiction Recovery

The Art of RecoveryWhy not the art of addiction recovery? There’s The Art of Motorcycle Maintenance, The Art of Zen, The Art of Love, The Art of War, on and on. I admit, The Art of Addiction Recovery is not as catchy, but, hey, it might catch on (I’m not the first to coin the phrase, I’m sure, but Google doesn’t reveal a book by that title). In a sense, as in the other endeavors mentioned, there’s art to recovery. When addiction recovery becomes important, and when the recovering person begins to give serious thought to recovery, they learn it’s more than not taking the first drink, the first shot, snort or smoke. Solid, comprehensive addiction recovery entails nutrition, exercise, emotional health, mental stimulation/learning, practice and, yes, imagination and innovation.

I’ve witnessed the recovery process thousands of times, and each recovery is unique. One of the ironies of addiction is most addicts think their drug makes them unique and interesting (in their heads, at least), but the cruel truth is most addicts take a predictable route with common consequences. As the addiction progresses, the person becomes less interesting and more limited by the demands and restrictions of addiction — they usually aren’t growing as a person, aren’t paying attention to relationships, and becoming predictably erratic and nonsensical when under the influence. When we look for signs and symptoms of addiction, it becomes obvious how addicts take common paths to their bottoms. In recovery, the art of recovery, if you will, the recovering person discovers what they buried, the good and the bad, and they’re then free to become a unique individual — they become open to positive, imaginative, innovative change.

The art of addiction recovery might sound strange, and it might sound like hyperbole to say recovery is enhanced (manifested?) by imagination and innovation, but when a person starts seeing possibilities, imagining different ways to make recovery interesting and stimulating and growth oriented, then it becomes personal. Recovery becomes a quest, a challenge, a series of actions that’re well-thought out, made stronger by support from those who’ve recovered, and made real by diligent, wide-awake effort. The Art of Addiction Recovery sounds okay to me — if I had the time or the ability, I might write  book (now that’s imagination!)

Healthcare and Addiction

Addiction and healthcareHealthcare and addiction, in reality, are closely connected – in obvious ways and not so obvious ways. I want to address the hidden costs of chemical dependence/addiction. Our healthcare system treats mostly symptoms of addiction. One of the problems is often with addiction the effects are so far removed from the cause in time it’s hard to follow the path from cause to effect. If early healthcare costs could be immediately associated with addiction, then maybe the fundamental problem could be treated, thus, in the future, saving billions upon billions, not to mention quality and length of life in general.

The healthcare system, like many systems in business, especially when it comes to addiction, is driven primarily by short term financial concerns. This systemic drive to cut costs rejects proposals to treat fundamental problems so costs are significantly lowered in the future. If there’s not a short-term financial benefit, then most healthcare concerns will not properly treat addiction today to save money in the future. Most healthcare concerns don’t even identify addiction as a significant cause of current healthcare costs when it’s obviously a fundamental problem. Emergency rooms are filled with addicts who get bandaged, stitched and temporarily fixed up then sent back out to return over and over. Who’s following the dots from early addiction to death and recording the consequences in between? I’ve worked in the addiction field long enough, since 1983, to see clearly causes and effects related to healthcare and addiction. 

Research shows that long-term quality treatment is effective for many addicts. Some addicts can recover through shorter term treatments, and some alcoholics can go straight into Alcoholics Anonymous and do well. But, most addicts require treatment, and long-term treatment is the most effective means to establish long-term recovery. The problem is in the present healthcare system there isn’t a desire to fund long-term treatment. The main reason long-term treatment is not funded is because it costs too much money — this is what you’ll hear over and over. Insurance companies will officially say it’s not medically necessary, but the reason they say this is to cut costs short-term (am I too cynical?). Never mind the insurance company will pay for the addiction in other ways — accidents, liver disease, gastritis, gun shot wounds, heart disease, stress related illnesses, etc.

Also, when we talk about the effectiveness of addiction treatment, we’re talking about addiction treatment that’s never received the funding or resources equivalent to other major healthcare concerns. There are many professionals in the healthcare system who don’t believe addiction is a chronic brain disease requiring treatment, although this has been established in medicine and science for many decades. There has never been a concerted nationwide attempt to consistently treat addiction as a serious medical condition that requires major resources and expertise. You don’t hear young people going to college saying they are going to start a career in the field of addiction treatment. Healthcare and addiction have been loosely associated, although in reality they are closely connected, and addiction treatment has been haphazard. Once addiction is accepted as the major health concern it is then, perhaps, insurance companies and others involved in the healthcare system will follow the dots from early addiction to all the consequences that follow.

Addiction – Reaching Out for Help

reaching out for helpMost drug addicts, including alcoholics, don’t receive treatment — in fact, only about 10% receive treatment. This is astounding. Reaching out for help is difficult, but that’s not the only problem. Once an addict decides to get help, it’s hard to access treatment. Even though new insurance regulations say that insurance companies must provide coverage for addiction just the same as any other medical condition, deductibles and co-pays are so high many addicts can’t afford to enter treatment.

There are state funded programs for those who don’t have insurance or the ability to pay, but if everyone who needs treatment suddenly sought out treatment, there wouldn’t ne nearly enough specialty treatment facilities to deal with the problem. Our society has done a poor job of dealing with addiction — this is from the above linked NYT’s article:

It estimated that the annual economic toll related to alcohol is $249 billion and that the toll related to drugs is $193 billion.

The majority of people who misuse substances do not develop a use disorder, the report said. But roughly one in seven Americans — 14.6 percent of the population — are expected to develop such a disorder at some point.

Only about 10 percent of people with a substance use disorder receive any type of specialty treatment, the report said. And while more than 40 percent of people with such a disorder also have a mental health condition, fewer than half receive treatment for either.

At one time employers were using EAP services to help employees reaching out for help access treatment, but managed care has weakened most EAP programs to the point of being ineffective. There’s still widespread resistance to treating addiction as a medical concern. Many still consider addiction a personal choice and a matter of will-power — they don’t think treatment is necessary and they don’t believe it works. Few resources have gone into quality addiction treatment in the past few decades. The 90s saw the closure of treatment centers across the nation. It’s true that some facilities began to overcharge and treat patients at the highest level of care whether they needed that level of care or not, but the reaction to this problem was far too drastic.

Now that addiction treatment has improved levels of care, it’s time to create more quality, accessible specialty treatment for addiction. When addicts are reaching out for help, there should be good treatment available. I have worked in the field long enough to know that treatment works, but only if there are quality, dedicated, well-paid, educated professionals working in the field using best practices. Quality treatment that uses the practices and preaches Recovery Management principles is effective — it will be more effective if more people learned the facts about addiction.

 

Individual Counseling and Addiction Treatment

addiction treatmentWhen it comes to individual counseling and addiction treatment for chemical dependence, I recommend addiction treatment, intensive outpatient or inpatient or a combination of the two. I would never minimize the importance of individual counseling for issues such as anger management, anxiety, relationship problems, depression, grief, etc. — counseling is life-saving in many incidences. There are many people who’re confused and lost and need help getting on track and figuring out the complexities of life. Just understanding what can go wrong with the brain is at times terrifying. It’s nothing to be ashamed of and almost everyone goes through a period in which they could benefit from counseling. It’s been my experience, though,  listening to the stories of addicts, too many to count, that individual counseling for addiction isn’t that effective. If a counselor/therapist has specific training in addiction disorders, then individual counseling is likely to be much more effective, but, still, most addicts need specialized addiction treatment that includes group therapy.

One of the main stories I hear from addicts is that they were ashamed of the addiction label, so they convinced themselves it must be emotional problems causing the insane drug use. To the addict it was more respectable to see a therapist for depression or stress than to check into an addiction treatment center. The addict would minimize their alcohol or other drug intake and talk to the therapist about their stressful job or dysfunctional marriage. This type of counseling almost always makes an individual feel better and gain insight into the particular problems they address, but in the case of addiction, the problems dealt with are symptomatic problems. The fundamental problem of addiction wasn’t addressed.

So the addict would go on drinking or using some other drug, and the problems became worse and worse. Until the fundamental problem of addiction is addressed, it’s like taking cough syrup but not dealing with the cause of the cough. The difference between individual counseling and addiction treatment is a matter of focus and understanding the fundamental problem that must be addressed first. For addiction, I recommend addiction treatment that includes group therapy — this way the person has to face and deal with the addiction. After dealing with the addiction and gaining stabilization there’s always ongoing counseling issues that individual counseling can help, but as long as the addict is drinking alcohol or using some other drug, individual counseling will be sabotaged by the addict.

Heroin Deaths Continue To Rise

heroin deaths on the riseDespite the fact that heroin deaths continue to rise, the public and media are losing interest. For a while opiate overdoses were a news item, but now it’s difficult to find a story. Political craziness pretty much dominates the news. Why should the average person care?

Addiction is a national problem that can affect anyone. Just about every family has someone who’s battling with a drinking or drug problem – a cousin, an uncle, a grandparent, etc. A problem such as addiction does great damage to society. Even if you don’t know anyone who has a drug problem, you’re likely paying higher insurance and health care costs due the effects of untreated addiction. The more we know about addiction the better able we’ll be to find solutions. Here’s a few statistics:

 

  • Nearly 23 million Americans—almost one in 10—are addicted to alcohol or other drugs.
  • More than two-thirds of people with addiction abuse alcohol.
  • The top three drugs causing addiction are marijuana, opioid (narcotic) pain relievers, and cocaine.

Heroin has recently become a major problem, again. Overall, there’s been a reduction in young people using drugs, so maybe we’re on the road to finding solutions, but as the statistics show, addiction is still a huge problem. Heroin is problematic because the addiction to heroin is so profound, and everyone who uses it is at high risk of overdose and death. Despite the fact that heroin deaths continue to rise, there’s still a lack of access to quality treatment. The effects of managed care blocking access to treatment decades ago caused many treatment facilities to go out of business. Even the facilities that are still in business have a hard time finding quality therapists who’re entering the field.

Until addiction is treated like the medical condition it is there’ll be a lack of quality treatment. But until people have a good understanding of addiction there won’t be a push to treat it as a medical condition.

 

Responsibility and Alcoholism

There’s always been a controversy regarding responsibility and alcoholism. I’ve had this conversation over and over through the years. Many see the disease concept of alcoholism as a cop-out. This side of the argument says that we’re all responsible for our actions, and calling alcoholism a disease doesn’t excuse the behavior or consequences. Another side says that no one sets out to be an alcoholic. This side of the argument states that alcoholics gradually lose control of their drinking and that the mental compulsion to drink is beyond their control. Science doesn’t take a side when it comes to responsibility. Science simply states that alcoholism exists and it affects about 1 in every 10 who drink alcohol.

I try to take a nuanced approach to this argument. Yes, we’re all responsible for our actions. If someone is an alcoholic and while drinking they murder someone, to use an extreme example, then they should face justice in court like everyone else. The alcoholic’s lawyer can make a case, and the prosecution can make a case, then a jury decides. But this is an extreme example. Let’s look at a more common example. An alcoholic gradually loses control of her drinking, the drinking affects her job performance and her boss has to make a decision. Does the boss fire her straight out because of her deteriorating job performance or does the boss confront her and demand she seek treatment, giving her a chance to solve the problem and return to her previous good work?

It’s situations like this that are most common when dealing with alcoholism. Research has shown that companies which have an Employee Assistance Program that deals with employee problems like alcoholism pays off in the long run. Given a chance many employees who receive treatment come back to work with an attitude of gratitude and do a great job going forward. It’s better to address and treat a problem like alcoholism than to ignore it or punish it. Most large employers have found out that simply firing people with alcohol problems isn’t helpful — retraining and losing experience has consequences too.

In general, the way I look it is that once a person realizes they have a problem with alcoholism they must face all the consequences and never use the disease concept as a crutch or an excuse. Once an alcoholic realizes they have a problem it’s their responsibility to do something about it. As far as dealing with someone who has an alcohol problem, well, each person has to decide — do they try to understand, or do they judge and punish? There’s an old saying about casting the first stone that often helps when trying to decide. There’s also another saying — Judge and prepare to be judged.

Teens and Drug Use

Teens and marijuana useParents don’t read much good news when it comes to teens and drug use. Media, no doubt, highlight deaths from overdose when it’s a young person involved who no one would suspect of having a drug problem. It can seem like young people are going wild with drugs and that it’s always getting worse. Make no mistake, every teenage death from drug overdose is tragic, and far too many kids are using powerful mind-altering drugs, but facts are facts, and drug use, according to reports from teenagers, is declining, even opioid drug use.

There’s hope that young people are realizing drug use is a dead end street. Many of the opioid overdose deaths we hear about in the news are adult deaths, not teenagers. While this is good news about teens and drug use, teenagers become adults — hopefully the new trend of less drug use will follow today’s teenagers into adulthood. Even marijuana use has dropped, although attitudes about health risks related to use of marijuana have changed. Most young people don’t think there are major health risks associated with regular marijuana use even though fewer young people are smoking marijuana. This could lead to increased use in adulthood as more states legalize marijuana, but maybe not. It’s true that science hasn’t discovered any confirmed, major health risks from marijuana; however, it’s been established that long-term use does negatively effect memory and learning capability.

Alcohol use and binge drinking have also declined among young people. This an excerpt from DrugAbuse.com — 

Alcohol use and binge drinking continued to decline among all grades and for nearly all time period measures. Past-year use of alcohol was reported by 17.6 percent, 38.3 percent, and 55.6 percent of 8th, 10th, and 12th graders, respectively, compared to 26.9 percent, 49.8 percent, and 63.5 percent in 2011. Daily alcohol use decreased significantly among 12th graders to 1.3 percent, and binge drinking (consuming five or more drinks sometime in the past 2 weeks) declined among 8th graders to 3.4 percent.

Graph of percentage of students reporting use of alcohol in past year, by grade. Results described in main text of publication.

The percentage of high school students who reported ever using alcohol dropped by as much as 60 percent compared to peak years. This year’s survey found that 22.8 percent of 8th graders reported ever trying alcohol, a 60 percent drop from a peak of 55.8 percent in 1994. Among 10th graders, lifetime use fell by 40 percent from 72.0 percent in 1997 to 43.4 percent this year. Among 12th graders, there was a significant 25 percent drop in lifetime alcohol use from 81.7 percent in 1997 to the current 61.2 percent.

This is good news about teens and drug use — now we need good news about adults and drug use. We need good news all around when it comes to drug use. Maybe kids today are smarter — I certainly hope so. 

Addiction and the Family

Addiction and the familyAddiction and the family is an important topic, because often the family is severely affected and vital to recovery. How do family members deal with addiction? After years of knowing someone one way, lovingly, like a father, brother, sister, mother, etc., the person begins changing as the addiction progresses and the behavior becomes more bizarre. Often the addict will behave in ways that appear cruel and indifferent, and this hurts loved ones who don’t understand why the person is changing in such a horrible and frightening way. Until a loved one understands addiction and can begin gaining perspective and objectivity, it’s difficult to not take the strange changes personally.

To the family member it seems as if the person addicted doesn’t love them anymore — they begin questioning themselves to see if they’ve done anything to create these changes. It’s a confusing time, especially for children. When an addicted mother, as an example, no longer spends quality time with her 10 year old son, it creates confusion and sadness in the child and quilt and shame in the mother. This creates a downward spiral as addiction progresses. The mother might try to deal with the addiction herself, making promises that things will be better only to relapse and making things worse. The child doesn’t understand why his mother can’t just do what she says she’ll do. The child might wonder what they’ve done wrong — this is an awful, heart-breaking situation, but it can be resolved.

Understanding addiction and the family is to understand that the addict must receive help. Deteriorating relationships become overwhelming, and when the family unit tries to get back to normal, the crazy behavior of addiction keeps tearing the unit apart. A 10 year old will not likely have the resources or understanding to deal with such a complex problem, but an adult, the husband, a brother, a mother, someone must step forward and address the addiction.

Understanding addiction and recovery is vital, then family members can use their leverage to get the addicted family member into treatment. There are professionals who know how to intervene in addiction with good results. The first step is the admit there’s a problem – the next step is to ask for help. Often when people come into treatment here at NewDay, it’s a family member who initiates the admission. Someone has to take the actions and understand it’s a medical issue and nothing to take personally. The addicted person is not in their right mind — they need help. Addiction and the family go hand in hand, and often family members need professional help also, or a support group, to deal with the confusion and emotional turmoil. If the family works together, they can usually heal and recover. And the good thing about children is their resilience — they just want their mother or father back — they eagerly forgive when there’s real change.

Alcoholism and Opiate Addiction

alcoholism and opiate addictionAlcoholism and opiate addiction are similar in many ways. The reason alcoholism and opiate addiction have been so difficult to treat is that both forms of addiction are what I’ll call ingrained. Some might think “ingrained” is not a useful description when addiction creates that implication, but alcohol and opiate addiction are different from, say, cocaine addiction. Cocaine and meth are bingeing drugs. The brain changes caused by cocaine make it difficult for the cocaine addict to not return to cocaine after a period of abstinence, but the human body can’t tolerate sustained, daily use of cocaine. Because cocaine and meth damage the body so quickly, cocaine/meth addicts usually reach a bottom fairly quickly.

However, with alcoholism and opiate addiction, a person can use the drugs on a regular basis for decades. The alcoholic and opiate addict usually live with the drug closely and intimately for a long time before there’s physical damage. Because alcohol or opiates gradually become normal for the addict, it’s difficult to treat. The drug becomes such an important and steady part of day-to-day living, trying to live without it is often overwhelming. The current plans to deal with the opioid crisis lack true understanding of what it will take to deal with the problem. Throwing money at the problem and locking dealers up will not solve the problem — and ignoring alcoholism while focusing totally on opioids misses the larger crisis of addiction in general.

Addiction is not about which drug is legal or socially acceptable — addiction is a medical issue that unless treated by medical professionals will continue to get worse. Yes, there’s a psychological component, and morality/spirituality is even a topic of treatment, but unless the science of addiction is understood as a medical issue there’ll be no progress finding solutions. The demand for drugs, alcohol, opiates, etc., will ensure a supply. We found out in the 20th century that prohibition efforts don’t work. Also, stating that if people never use drugs they won’t get addicted is so naïve it doesn’t deserve a response. The reality is that alcoholism and opiate addiction will grow worse unless there’s access to quality, long term treatment, along with widespread understanding of addiction among all healthcare and insurance professionals. It will also help if employers gain a good understanding of addiction, from the social/economic impact side of the issue. Our society is bleeding resources like never before mainly because addiction is misunderstood and mistreated. The worst part, though, is all the broken homes, suffering and preventable, premature deaths — we can deal with the problem, but not unless it’s understood.

Opiate Overdose

opiate overdoseBecause of the increasing opiate overdose deaths, I want to post these warning signs. This is from www.Drugabuse.com :

Depressant Overdose

Opiates and benzodiazepines (heroin, Oxycontin, Valium, Xanax) are all depressants, meaning they significantly slow your breathing and heart rate. When an overdose occurs, the victim runs a significant risk of respiratory failure, which could lead to a coma, permanent brain damage and death.

Signs of a depressant overdose include:

  • Shallow breathing or not breathing at all
  • Blue lips or fingertips
  • Severe disorientation
  • No response or the inability to be waken
  • Snoring or gurgling sounds

We still see patients come to our clinic who are using both opiates and benzodiazepines — this is a deadly combination. This excerpt is from American Addiction Centers website:

Opioid painkillers and benzodiazepines are two of the most frequently abused prescription drugs in the world, although they are frequently prescribed together. Medical researchers have been concerned about this combination since the 1970s, when the trend began to surface. A report from the Drug Abuse Warning Network shows that combining opioid medications and benzodiazepines increases the risk of overdose leading to emergency medical care. Another report published in the British Medical Journal suggests that, while some of these emergency room visits involve prescribing practices that accidentally mix benzodiazepines and opioids in dangerous quantities, some patients take more of these drugs than prescribed, or they get a “high” off taking higher doses than prescribed of both medications. They noted that benzodiazepines enhanced the effects of opioid painkillers, which means this drug combination has a high potential for abuse.

It’s never safe to combine such drugs, and when you add alcohol, it’s even more dangerous. Below are suggestions if you see someone overdosing:

Step #1 Check Responsiveness

If someone is unconscious with shortness of breath or not breathing, rub your knuckles hard over their chest bone. If they are still unresponsive, call 911 immediately.

Step #2 Perform Rescue Breathing

A majority of overdose deaths are due to respiratory failure, so rescue breathing is crucial when dealing with an overdose. Tilt the head, lift the chin, and pinch the nose. Seal their lips and give two quick breaths into their mouth. Then give one long breath every five seconds.

Step #3 Administer Naloxone

Naloxone (Narcan) is a life-saving drug that reverses the depressing effects of opiates on the central nervous system. Naloxone kits are available in two forms: intranasal and injectable.

Intranasal Naloxone: Pry off yellow caps on the plastic delivery device (needleless syringe), and pry off the red cap of the cartridge. Screw the naloxone cartridge into the barrel of the syringe. Tilt head back and spray half of the naloxone (1cc) into each nostril.

Injectable Naloxone: Pry the orange top off the naloxone vial. Draw 1cc of naloxone into syringe and inject into a major muscle (buttocks, thighs or shoulders).

If need be, continue rescue breathing while the naloxone takes effect. If the person is still unresponsive after three to five minutes, administer another dose of naloxone.

Unless you have a reason to keep Naloxone on hand, you probably wouldn’t have it ready, but if you have a family member or friend with a problem, you might want to keep this drug handy. Opiate overdose is a huge problem, and knowledge of what to do when it happens can save lives.