startfinishIn addiction recovery, “almost” is never good enough.

No issue in addiction treatment is of greater importance than the prevention of relapse.  Sobriety is never an optional goal.  It is the “finish line” that justifies the time, expense, and constant effort.  Anything less may not represent failure — for there may be signs of significant progress, personal growth, and emotional healing – but only substantial clean time constitutes a “win.”

Unfortunately our system of healthcare and insurance reimbursement focuses primarily on inpatient and outpatient treatment.  Without question, treatment is critically important, but it represents the beginning of the journey we call “recovery,” not the middle, or the end.  I shake my head with frustration when I see rehab facilities publishing a “success rate” based on whether an individual finishes their program.  It’s easy to declare victory if you move the goal posts, but only those who believe that addiction can be cured are fooled by this statistic.  Success in addiction treatment is found in aftercare, the activities that support the addict or alcoholic as they change their lives — and learn to “be in recovery” and “live in recovery.”

All too often the addicted person is the loudest voice behind the misconception that all is well.  They have been clean and sober for 30 days.  Heads are clearer and life seems so much better.  It is only natural that they want to move on and get back into living.  However, lost in their enthusiasm is a willingness to embrace the reality that addiction is a chronic disease, for which treatment never ends.  There must be an ongoing effort to stay sober. Changes must be made, new “tools” learned in treatment must be practiced — over and over – until recovery becomes the way of life.  Aftercare can never be an afterthought!

When considering what a strong aftercare plan looks like, we should review the study published in the 2009 Journal of Substance Abuse Treatment.  Robert DuPont and his colleagues studied 906 patients, more than 90% of whom had no indication of substance abuse 5 to 7 years after reporting a problem and beginning treatment.  In an industry were “success rates” are sometimes cited as less than 20%, these findings are dramatic home runs.  The aftercare programs provided for these individuals (by various providers at dozens of different locations) were critical to their strong recovery, and should be seen as the foundation upon which others can build.

Because the patients in this study were doctors, it is easy to dismiss the results with explanations such as “they are so much smarter,” or, “they had so much to lose if they failed.”  While these comments are not without some merit, they do not justify dismissal of the findings.  The disease of addiction has no favorites. It is no less severe for one group of people, and it changes the brain of a doctor in the same way that it affects the brain of a factory worker.

So let’s review the aftercare lessons from this study that should be considered by everyone striving to break free from the destructive power of addiction.

  1. Abstinence.  The goal is to never again use drugs or alcohol.  There are no gray areas.  (It is interesting to note that only 1 doctor out of 906 used a medication such as Methadone or Suboxone to help their recovery.)
  2. Longer treatment.  The “treatment” phase of recovery should be 90 days.  If the inpatient program is 30 days long, it should be followed by counseling, an IOP, or other formal treatment options.
  3. Support Groups. Participation in regular support groups is not an option.  AA, NA, Celebrate Recovery, or other 12-Step groups should always be part of the aftercare plan.  The strong message is that recovery cannot be accomplished alone.
  4. Accountability.  There must be a process of accountability with regular drug and alcohol testing.  The lying, denial and manipulating behavior of addiction cannot be given a place to hide.
  5. Family engagement.  Families need to learn about addiction and how to support without enabling the addicted person.
  6. Health issues addressed.  Issues of mental and physical health need to be assessed and resolution sought. Continued counseling is encouraged.
  7. Relapse response.  If there is a relapse, the rapid spiral into addiction must be quickly addressed.  A plan to stop a relapse if it occurs is always ready.
  8. Extended care.  There is no allusion that recovery comes quickly or easily.  Professional support needs to monitor and assist the addicted person during the first 5 years of their recovery.

All of the action steps described are available to everyone in recovery, and they need to be part of every aftercare plan.  Fortunately, help is more accessible than just a few years ago.  The proliferation of “apps” to help people in recovery, the ability to attend meetings, counseling sessions and IOPs online, the new parity and healthcare legislation that expands benefits for substance abuse, all help make the tools of recovery available.

The bottom line is that we cannot ignore the importance of aftercare.  What happens when someone leaves rehab will determine the success of their recovery.  As treatment providers must do all that we can to prepare our residents for recovery, and be ready to support them as they strive to establish long-term sobriety.  Families also need to become invested for the long-haul.  But most importantly, the addicted person must realize that they are in a lifelong battle to keep addiction from destroying their lives – and keep fighting the good fight.  Winning comes by successfully reaching the only finish line that matters – the end of a life well lived!

Michael Campbell, Co-Founder & President of St. Joseph Institute

 


Chicken or the EggIf only life was a true reflection of the fairy tales our mothers read to us as small children.  There was a problem, with courage and determination it was overcome, and everyone could then live happily ever after.  The illusion was that there was only one problem, and that if it was resolved, everything else would be perfect.  Unfortunately, the myth does not mirror reality, and it certainly does not describe recovery from addiction.

It is often appropriate to ask whether addiction is the problem, or the symptom of something else.  This question does not discount the fact that addiction is a chronic disease, but acknowledges how other issues are often the triggers for drinking and using.  If these “co-occurring conditions” are not recognized and addressed, recovery is hard to achieve.  It is for this reason that St. Joseph Institute believes that “treating” addiction without an equal or greater emphasis on addressing these other issues in a person’s life is poor healthcare practice.  It is like placing a Band-Aid on a wound that has not been cleaned and medicated.  In the end, the patient does not get better and the condition may get far worse.

Not every issue that triggers the desire to use drugs and alcohol is a mental health condition that can be diagnosed and classified.  That is not what is important.  What matters is that something is causing pain or distress – both of which become invitations to self-medicate.

Listed below are some of the common “companions” to addiction that need to find resolution, so that recovery can become easier, and the temptation to use again lose some of its power.

Depression. Escaping feelings of sadness are a common reason to drink and use. Ironically, drugs like alcohol only make depression worse.

Anxiety. Studies on university campuses show the strong link between the social anxiety that accompanies modern life and the use of drugs and alcohol.

Pain.  Human nature drives us to escape pain with all possible haste, rather than learn ways of reducing pain through lifestyle changes or natural means.  Our aversion to pain has made the United States the world’s largest consumer of opiate medications.

Relationships. Nothing creates more emotional distress than relationships that are not working well. Rather than learning to build better boundaries, communicate effectively, or resolve conflict, many people simply medicate their relationships.

Bipolar. Some mental health conditions cause distress and the best medications are still imperfect.  Millions of America’s use their drug of choice to self-medicate their mental health issues.

Stress. Managing the stress of daily living should never be an optional activity.  However, all too often we let it build to unhealthy levels, and allow stress to feed addiction.

Boredom. A surprising number of people use drugs and alcohol to cope with boredom, rather than find activities, hobbies and other outlets for their pent up energy and frustrations.

Sex. For many addicts and alcoholics, their drug of choice has been an integral part of their sex lives.  Concerns about the impact of sobriety on inhibitions, performance, and the quality of the experience need to be resolved.

Self-worth. Guilt, shame, a lack of validation, rejection, are issues that can drive addiction in the hope that using will fill the mental void.

Trauma.  The deep “psychic” pain that comes with abuse, PTSD, and other forms of trauma become fertile ground for addiction.  Without resolution, these hurts often become the “justification” for using drugs and alcohol.

We must realize that addiction does not live in a vacuum.  It is fed by the events in life.  If the issues that have a powerful impact on our lives are not addressed, they become the constant “siren’s call” to use again.  Attempting to treat addiction in isolation is often a futile exercise.  Is it the “problem” or the “symptom?”  I suggest the answer doesn’t matter.  To find wellness the addicted person must deal with both the chicken and the egg.

 


Addiction treatment can be discouraging.  As a healthcare professional you can invest huge amounts of energy and passion into helping someone enter into recovery, only to see them fall back into the old patterns of using.  The addict or alcoholic comes to understand their disease, learning techniques to manage their urges, triggers and weaknesses. You help them build a support network and emphasize how important it is to reach out to others in times of trial.  Yet, even though they have the tools, they often fail to use them in times of crisis, or resist making the changes necessary to create a life where it is easier not to use.

There are many reasons why people relapse and the outcome of treatment is not under the control of the provider.  However, that does not exempt the rehab program from ensuring that it is doing its best to lay the foundation for a strong recovery.  In this regard, there is a need for addiction treatment to be holistic, focusing on the whole person and the many reasons why they use drugs and alcohol.  There are times when it is not inappropriate to view addiction as the symptom, a means by which the underlying problem is being medicated. If treatment does not address these deeper issues, recovery from addiction is significantly impeded.

The co-occurring conditions must be addressed.

It is estimated that more than two thirds of the people with an addiction have a diagnosable co-occurring condition.  Our experience at St. Joseph Institute would confirm that statistic, and encourage the search for other underlying conditions which might not merit a diagnosis, but nonetheless are important issues that must be addressed. Listed below are ten of the “companions” to addiction that we frequently encounter.

  1. Anxiety. Studies of drug and alcohol use on university campuses highlight how often addiction grows out of a desire to lower anxiety.  Treatment must recognize the importance of equipping the individual with techniques and strategies to manage anxiety without self-medication.
  2. Depression. Sadness is a feeling that we want to avoid and too often drugs or alcohol become the answer.  Depression must be treated if the cycle of addictive behavior is to be broken.
  3. Bipolar Disorder.  Many people affected with bi-polar dislike the way they feel when taking prescription medications for their condition.  Drugs may offer relief from the symptoms, but lead them down a destructive pathway.
  4. Pain.  Addiction is all too often the result of pain medications that were prescribed by a physician.  Natural ways of managing pain must be taught if the dependence on narcotics is to be broken.
  5. Relationship problems.  Nothing creates more “psychic pain” than relationships that are not working well.  Learning to build better boundaries, resolve conflict, and establish trust are important for everyone, especially those who are tempted to self-medicate when relationships become hard.
  6. Stress. Too often managing stress is considered an optional activity.  For people with addiction, finding ways to keep their stress at a low level is a mandatory part of recovery.
  7. Boredom.  A surprising number of people use drugs and alcohol to cope with boredom.  For this group, finding new hobbies, outlets, and ways to get involved is an important part of the healing process.
  8. Sex. Many addicts have used drugs or alcohol as part of their sex lives for as long as they can remember.  They are afraid of the impact of sobriety on their sex lives, because of inhibitions, or because they fear the performance or the experience will change.
  9. Self-worth.  Some many people treat their feelings with drugs and alcohol.  When they have been hurt by others, or are unable to forgive themselves, addiction becomes a place of safety.
  10. Trauma, abuse, PTSD. It is estimated that 1 in 4 women addicts has been sexually abused.  Addictive behavior has become a way of coping, and recovery demands that these underlying issues find resolution.

These are but some of the reasons why people become attached to their drug of choice and are reluctant to let go.  If we are to treat these people, and help them break free from their addiction, we must help them address these driving reasons and adopt new behaviors.  If we treat the addiction, but ignore the co-occurring conditions that provide its fuel, we will almost always witness failure.  Recovery demands that the whole person find healing.  As healthcare professionals, we can offer nothing less.

 Michael Campbell is Co-founder and President of St. Joseph Institute for Addiction, a rehab center located near State College.


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