Methadone

Inpatient Detox v. Outpatient Detox

In order to understand why outpatient detox for drug addicts and alcoholics rarely gives satisfactory results, we have to review a couple of things about addiction.

Addiction is a compulsion to use a substance or behavior to alter the way we feel. However, it is more than that: it is a physical and emotional way of living our lives that, over time, becomes ingrained and seems to be the normal way to live. Addiction makes changes in our brains that cause us to believe that we need the drug or mood-altering experience — be it a prescription medication like Xanax, an illegal drug such as heroin, multiple sex partners, alcohol (the most commonly-abused drug of all), or something else. We believe that we need it to feel normal, to be comfortable — to live — and every time we try to get the monkey off our backs we have those beliefs reinforced by the discomfort of withdrawal.

Living like this for long periods, we begin to view it as normal. No creature willingly goes from situations that seem normal into those that seem different, at least over the long term. We may step out of our comfort zone briefly, but we always try to duck back in. We instinctively hate change. We seek conditions in which we feel most comfortable — not necessarily good, or happy, but whatever is “normal” for us — and we attempt to keep things that way. Scientists call this “homeostasis,” which means, roughly, “standing still.”

It is a natural thing for all creatures to attempt to maintain homeostasis. Even an amoeba in a dish will remain in one spot, assuming that it has something to eat and comfortable conditions. If we apply heat to the part of the dish where the amoeba is resting, it will remain there, despite the increasing heat, until the water becomes so hot that it has no option but to move. Only then will it make its way to the other side of the dish.

So, consider us addicts, who are — almost by definition — people who don't know that it's OK to feel uncomfortable occasionally. We may not be happy in our addiction; our lives may be falling apart around us as our little dish heats up, but still we resist changes. We may move to another part of the dish where things are more comfortable, but if conditions there aren't totally to our liking, we tend to move back to our comfort zone after the heat has dissipated. Sound familiar?

That's the problem with outpatient detox. We're being asked to move out of a place where we know how to function and continue to feel good (or at least feel less bad), and we're being asked to do it permanently, without much support, and under conditions where it's all too easy to move in the other direction.

We've taken our Suboxone, or methadone, or Valium, and the craving for (whatever) has temporarily dissipated, but what else has changed? We're still headed home through the same old neighborhood, seeing the same folks standing on the same old street corners, the doors to the same old bars, and moving in the direction of the same old problems.

Nothing has changed, except we are feeling a bit odd, and temporarily have no physical craving to use. But what is going to happen the first time something comes along to stress us? A grumpy spouse who thinks we should suddenly be “fixed.” A notice to appear in court. A car that won't start. A job interview that goes badly. All of these are wonderful excuses to relapse. In fact, it's not even really a relapse, because we have been given few or no tools to cope, and are thus not actually in recovery.

Inpatient detox provides the opposite. There is medical care if needed, and experts are constantly monitoring us to be sure that we are reasonably comfortable. (There is no such thing as a perfectly comfortable detox, no matter where you get it.) There are other folks to talk to who are going through the same stuff at the same time. There is good food to help get us back on our feet. There are group and individual therapy sessions, with treatment experts who, most of them, are recovering alcoholics and addicts just like us.

Most of all, there are no pressures. If we allow ourselves to do so, we can relax, be as comfortable as possible, chill for a few days, get our feet under us as the drugs clear from our systems, and become able to make some  sensible decisions about the future.

Which of those scenarios sounds like it has the best shot at working? This isn't about our families. It's not about our bosses, or our careers. It's about getting us ready to function in the real world, instead of the shadow world of foggy thinking and perceptions that we've been living in. If we can't learn to take care of ourselves, then all those other things aren't going to matter much, are they? We need the best shot at staying clean that we can possibly get. Outpatient detox is not the answer.