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.

 

Realistic Addiction Recovery

Addiction recoveryThere’s so much negative news about active addiction and its consequences it helps to balance that out with stories of recovery. Most people don’t hear about addicts in recovery because it’s not news worthy. I’m always careful when talking about addiction recovery — I try to talk about realistic addiction recovery. Too many times, even when someone hears a story about addiction recovery it’s either too dramatic, too flowery or just too unrealistic. The person who hears these stories doesn’t believe them because they appear to be sensationalized — too many stories of wild escapades and not enough description of tortured mental and emotional states. There’s no need to dramatize stories of recovery. The point of the story is to show recovery is possible, although difficult and not always a neat story of tragedy to triumph.

All recovery stories have similarities, yet they’re all unique. Some young people used drugs only a short period of time, but it was enough for them to stop and choose a drug-free life. Some stories are about decades of drinking alcohol, opiate dependence or ups and downs of addictive cocaine use. Simply describing the use, the consequences and the eventually realization of addiction is enough to get a message across. I find it helpful, though, if a person describes their mental states at different stages of addiction.

To use alcoholism as an example, in the beginning a person doesn’t realize they’re susceptible to alcoholism and are in the early stages of alcoholism. No one wants to be an alcoholic — most people who start drinking alcohol just want to be like everyone else — drink and have a little fun, companionship and relaxation. If the drinking becomes heavier than most, it’s easy to justify it by saying you have a high tolerance — it’s even a bragging right to show you can hold your booze. Then when consequences happen, the advancing alcoholic blames stress, or tragic early events, or an overbearing spouse, or bad luck, or whatever. By this time alcohol is something that’s very important to the alcoholic. The alcoholic senses something’s wrong but tells himself he can handle it, that he’ll cut back. 

Then comes the steady decline of breaking promises, shame, anger at losing control, fear of the chaos and regret for the broken relationships, free-floating anxiety that something awful is happening and not knowing what it is or how it will end. These are mental/emotional states that addicts go through in one form or another. This isn’t drama, it’s a realistic decline, a chronic brain disease that takes over a person’s life. It kills many addicts. Most addicts die a premature death due their addiction. The realistic addiction story is a story of hope — it’s a message that the addict doesn’t have to live a tortured life and die prematurely. Recovery can happen.

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.

Addiction Recovery and Freedom

Addiction recovery and freedomThe topic of addiction recovery and freedom aren’t often discussed. Many even think of recovery in terms of loss of freedom — the person in early recovery complains that they can’t go to nightclubs for a night on the town, can’t have that glass of wine that makes good meals even better, can’t go to tailgate parties, can’t attend that weekly women’s night out on Thursday, etc. Yes, in the beginning certain activities are best avoided if they put recovery at risk, but this is in the beginning.

As recovery grows, the recovering person’s world expands, then, looking back, addiction is seen as the lack of freedom it had always been. The addict in the middle of addiction holds on to the false idea that liberty is found in a mood-altering substance. In reality, the addict makes her world smaller and smaller, controlled more and more by the drug. The addict loses old friends who don’t like the drinking/drug using lifestyle. The addict doesn’t go to places anymore that would highlight their addiction. The addict gives up hobbies that were once pleasurable as addiction takes more time and effort. The addicts world gradually shrinks, and any idea of freedom exists only in make-believe fueled by an artificial stimulant, and then even that fantasy fades. The addict eventually loses all sense of freedom and struggles each day to reach a state of “normal” that becomes more elusive as time goes by.

Addiction recovery and freedom are synonymous. Once recovery’s established, the person’s world opens to many new possibilities. Go back to school — get a new job — enrich relationships — revisit old recreational interests and discover new ones — go where you want to go without fear — enjoy clarity of mind –experience life in all it’s realness, fullness and uniqueness. In early recovery this all sounds like flowery talk, but the addict who reaches true recovery doesn’t think so — all of this becomes a way of life, and true freedom is experienced on a daily basis. The addict who finds this freedom in recovery is grateful and humble, and, given the opportunity, usually wants to help others to find this same transformation — not through promotion, but through attraction. Witnessing someone make the journey through addiction recovery and freedom is inspiring. 

 

 

Addiction As A Disease

Addiction as a diseaseThere’s still confusion about addiction as a disease. Old ideas persist contrary to the chronic brain disease concept. There’s a lingering idea that to call it a disease let’s people off the responsibility hook. I hear this often – “No one forced them to drink alcohol or take other drugs, so it can’t be a disease.” If we went by that logic, then diabetes wouldn’t be a disease, and you can also say that heart disease is partly due to lifestyle and what we eat. The point is not how the person started using drugs (alcohol is a drug), but what happens to the person’s brain/body when addiction occurs. The progression of addiction meets all the criteria for disease. Below is what Terry Gorski wrote about addiction as a disease:

 

To intelligently discuss the issue of whether or not alcoholism is a disease, we must first define the term “disease”.       To do this I turned to the 24th Edition of the Stedman’s Medical Dictionary which provided the following definitions.

  1. A disease is a morbus, an illness, a sickness that causes an interruption, cessation, or disorder of bodily functions, systems, or organs
  2. A disease is an entity characterized by at least two of these criteria:

(1)       a recognized etiologic agent (or agents);

(2)       an identifiable group of signs and symptoms;       or

(3)       consistent anatomical alterations of known body systems.

To determine if alcoholism is a disease, we must see if it meets this definition.

My position is that alcoholism is a disease.       This position is shared by many prestigious organizations including the World Health Organization (WHO), the American Medical Association (AMA), and the American Psychiatric Association (APA).       The Congress of the United States of America formally acknowledged that Alcoholism was a disease with the passage of the Hughes Act in 1970.       The National Institute on Alcohol Abuse and Alcoholism (NIAAA) was created to promote research on the nature of this disease.       A major thrust of NIAAA has been on the biomedical aspects of this disease and much progress has been made in understanding its etiology, symptoms, and treatment.

Society can debate the moral issue of using drugs, and society can hold a person responsible for taking the first drug, but society can’t ignore scientific facts, without consequences, and what we’re faced to deal with is addiction when it happens and causes legal, relationship and medical problems that cost society billions every year.

Most people aren’t moralistic about using drugs, especially alcohol. The majority starts out drinking alcohol or smoking pot or whatever because it’s acceptable in their social circles. No one starts out to be an addict. Some people are susceptible to addiction because of their brain chemistry, and it can happen to anyone. When addiction happens in a family, people usually develop a different, understanding perspective — they know how the family member was before addiction, so they understand something powerful is driving the destructive behavior. Addiction as a disease begins to make more sense. They also realize that shaming the family member only makes it worse.

It does no good to take a moralistic stance when someone is addicted, but once the person knows about addiction as a disease and that recovery is possible, then the person becomes responsible to make the changes necessary to recover long-term. Recovery is not punishment for bad, addictive behavior.

Recovery is about transformation, about rewiring the brain and thinking differently, about taking responsibility to mend what was damaged and go forward clear headed and free from addiction. Recovery is about embracing life and health, while addiction is about sickness and destructive behavior. In treatment, we teach recovering addicts that abstinence and time are their best friends. It takes time for the body and brain to heal. Treatment for 8 weeks or so is a bare beginning — it can years before the healing is complete and the desire to use drugs is gone. But, recovery does happen. Yes, responsibility comes in when a person knows that addiction is deadly yet refuses to try recovery. Like I wrote above, no one starts out to become an addict, but once it happens the person doesn’t have to slowly die from it. Addiction isn’t a choice, but recovery is.

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