treatment

Why Treatment? Why Meetings? Isn’t Family Enough Support?

This is the thirteenth in a series of posts in which we hope to acquaint our readers with some of the details surrounding the programs that we recommend.  There are a variety of programs, but because we and most other facilities shape our treatment plans around the 12 Step fellowships, those are the ones on which we will concentrate.

People in early recovery sometimes face resistance from family and significant others. It often takes the form of questions like, “You have us for support; why do you need those meetings? Aren’t we enough?” Another approach (that addicts often ask themselves) is “You’ve spent all that time away from us, and before that you neglected us. Isn’t it time you suited up and made up for all the time you missed and the ways we needed you?”

The reality is that we can’t “make up for” anything. All we can do is try to keep it from happening again, and live the rest of our lives looking forward, not backward. But those are perfectly reasonable questions from loved ones who don’t understand the dynamics of addiction and recovery. They’ve been neglected, emotionally deprived and abused. They’ve spent uncounted hours worrying about someone vitally important to them, their addict has cost them much pain, and they’ve paid a huge price in a variety of other ways.

Now their loved one tells them that they’ll be going to treatment, living in a halfway house, going to meetings, and perhaps staying in another part of the country for months. They feel disappointed, angry, rejected, taken advantage of once again — but mostly rejected. The person they thought was going to be returning to them has other ideas. Why does the addict need other people? They know her best, what better support could she need?

The answer is completely summed up in the previous sentence: “They know her best….” The people who know us best are almost never the best supports — at least in the beginning. Why? Too much emotional static. Too many recent hurts. Too many old resentments. Too many habitual ways of reacting to each other. In short, too much history.

We talk about folks “pushing each other’s buttons.” Our families and friends are the people who hard-wired our buttons, and we wired theirs. We can play symphonies on one another’s buttons, and we do — through habit, through anger, through frustration, through simple thoughtlessness. We know how to get under each other’s skin, and the closer we are, the easier it is.

These are dangerous waters for people in early recovery, because the buttons that urge us to take a drink or have some other drug are hard-wired as well. Research has shown that a picture of a guy standing on a street corner can trigger the urge to use in a crack addict. Just a photo of a guy who may have some drugs to sell! Other research has shown the same responses to liquor stores, places where the addict drank or used, pictures of drug paraphernalia, and so forth. Addicts in early recovery have not learned the skills that allow them to deflect these urges and bypass these temptations.

It’s been just short of 20 years since I used tobacco. A couple of months ago, during a routine but stressful, situation, I found myself patting my shirt pocket where the pack of cigarettes used to reside. I had to laugh at myself. It’s been a long time, I have healthy habits that kick in in those sorts of situations, and I understand the psychological and physical responses that lead to reactions like that, but would I have lit up if there had been a pack there? I don’t think so, but I’m not going to start carrying one around to find out.

Stress, in its various forms, is a major cause of relapse. Addicts who have relapsed and survived tell us that those are the sorts of situations that triggered their use. Not great tragedies, but the little things: the everyday tensions, marital spats, seeing friends drink or use other drugs, driving through the old neighborhood. These things trigger our addictions because they are familiar solutions, and we don’t yet have other habits to replace the old stuff. It takes years to get rid of those unexpected urges (or to learn to laugh at our addict thinking and ignore them). While we’re learning, stress is not our friend. And who/what are the best things to trigger stress in a newly-recovering person? Old “people, places and things.”

Treatment, halfway houses and meetings are places where we are accepted unconditionally, without regard to what we have done in the past, but with support for what we are trying to accomplish in the present. There we are surrounded by people who have slogged many long miles in our shoes. We are safe there, free of the old triggers, while we slowly learn the new habits of sobriety that will replace the deeply-ingrained habits of addiction. Families can help by understanding this, and by the willingness to delay their wants a little bit longer. That will help improve the chances that their addict will return to them for for the long run, not just until the next run.

Thoughts About Independence Day

Independence Day has a special meaning for those of us in recovery, and that's such an obvious connection that I'm not going to belabor it further. I do want to mention, however, that despite all our advantages here in the USA — and in Western civilization as a whole — there is still a lot to be done with regard to addictions of all kinds, from alcoholism to the currently popular prescription drugs.

One of the things we need to improve is the judgmental attitude of many Americans when it comes to addictive disease. This has changed for the better over the years, but we still have a long way to go educating people that addiction is a disease and that, regardless of our reasons for drinking alcohol or using other drugs initially, we did not choose to become addicts, nor to ruin our own lives or those of others.  It is perfectly natural for folks who have been impacted by the behavior of alcoholics and other addicts to resent us.  We leave trails of wreckage behind us in most cases, and there are few people in America who haven't had their lives or those of loved ones affected by addiction in some way.

But did I choose addiction? Did you?  I didn't, and I've never spoken with anyone who did. Did I choose to drink and use drugs?  Yes, but millions of people do that without problems, and I had no reason to think it would be any different for me.  Did I feel that I had no choice but to continue using alcohol and other drugs after I was addicted? Absolutely. I was convinced that I would die an addict, but that I would also die if I tried to quit using — a classic “double bind,” shrinks call it.  It's as close to a miracle as I could want, that the right combination of things happened to get me on the road to recovery.

The reality of addiction differs from what many believe. It is absolutely imperative that we get the people who consider addicts to be morally corrupt to understand the reality of the disease.

Major changes need to be made before we can approach the goal of getting the addiction epidemic under control. We need changes in the criminal justice system, so that addicts get the treatment they need instead of being incarcerated and then put back on the streets with no prospects. That's no way to keep people from using again and returning to criminal lives.  We need to throw a lot of money into research. We need sensible regulation of legal drugs that are addictive. The mish-mash of treatment protocols needs to be studied with an eye to determining best practices. And, while I am a rabid supporter of the 12-step model of recovery, we also need to develop continuing support systems for those who believe, for one reason or another, that the various fellowships are not for them.

My purpose on this Independence Day is to applaud and thank the many people in Federal, State, and even local government who are advocating for this critical health issue.  Addiction, including nicotine addiction is, by far, the primary cause of preventable death in America.  There is an overwhelming body of evidence to the effect that treatment is much cheaper than dealing with the results.  We can't afford to waste money on ineffective measures in this economy, and the waste in human lives lost and ruined is disgraceful in a country that aspires to be the best of the best.

Writers like me can only do so much.  We are preaching to the choir, since our audience is composed primarily of recovering people and addiction professionals.  I want to encourage you to get involved in these issues. Educate yourself about the politics of addiction. Advocate with your governmental representatives. Support any efforts toward dealing with this disease that you can. Spread the word, in a gentle way and by example, that we are good people. You are the only addiction educator that most people will ever meet, and are also the people best equipped to influence the actions of legislators and their advisors.

The recovery community stepped up when we needed help. Now it's our turn.

What Percentage Of Recovering People Never Relapse?

What percentage of recovering people never relapse?

This is one of those questions that we would love to be able to answer, but we can't.  It would be great if we could keep track of people's successes, because the ability to do so would be useful not only in evaluating treatment programs, but also for developing a better understanding of addiction itself.  Relapse is very much a part of addiction.

There are programs, and a variety of other sources, with figures that range from 15% to 75% for eventual sobriety — not necessarily on the first try.  However, there are several factors that tend to make us look toward pretty low figures for sobriety without a relapse.

One of those is simple observation.  While perhaps not statistically valid, all of us who have spent time around the 12-step rooms and/or worked in the treatment field have seen the number of folks who come in looking for help, contrasted with those who are around a year or so later.  Although those who have been through treatment seem to fare better than those who have not, it is also true that the folks with forty and fifty years clean and sober have rarely been through what we would call “treatment” today, simply because it didn't exist back then.

Another indicator is the number of people who repeat detox and other treatment.  Again, this is not statistically significant because we don't know what happened to those we never saw again.  Did they stay clean?  Did they relapse?  Did they die?  And if they didn't stay clean, how long were they abstinent before using again?  Did they get clean again?  We simply don't know, unless they tell us.

Equally, the rooms of AA, NA and the other recovery groups are not useful for gathering information.  It's that doggone “A.”  How do you track people who are in anonymous programs?  The 12-step programs don't even keep track of membership, beyond the occasional list of (voluntary) phone numbers.  If you're clean, and going to meetings, you're a member.  You resign when you leave.  If a person who has been attending meetings disappears, they may have relapsed — or they may simply be going to a different meeting.

Finally, there's the question, “What is relapse?”  It's not correct to say that it's simply picking up a drink or other drug.  It occurred before that, or we wouldn't have picked up.  Using just makes it official.

So there's no way to answer that question with accuracy — in numbers.  But I can tell you who is least likely to relapse.  It's the person who wants sobriety and recovery more than anything else in the world.  Because recovery isn't about abstinence, it's about dealing with life without using, and those who aren't willing to work at learning those skills are unlikely to make it in the long run.

How long am I required to stay in rehab?

Q. How long am I required to stay in rehab?

Assuming that you have not been court-mandated into treatment, you are usually free to leave rehab at any time — against professional advice.  Assuming that you use good sense and stay, the answer varies depending on a variety of factors.

Getting the alcohol and/or other drugs out of our system is only the first of many things that need to happen in order for us to have a decent shot at long-term sobriety. Getting clean and sober (and staying that way) requires time.

I’ve written here often about the physical changes in our brains that cause us to be unable to function without drugs. Until our brains have had time to heal themselves, we are at great danger of relapse, because cravings can return at any time. Along with that danger goes the issue of how we feel physically and emotionally while the repairs are taking place. Post-acute withdrawal can be a bear, and it can last for quite a while. Without a plan and good support, that alone can make us uncomfortable enough to want to use again.

Psychological and emotional damage from our period of active addiction — and perhaps even before we first used, need to be addressed. Getting clean does nothing to deal with those issues, and ignoring them puts us at great risk of using simply to make the bad feelings go away again.

There are social and legal issues to be considered. Getting clean does not prepare us to go back to work immediately, repair damaged relationships with family, friends and perhaps employers, clear up financial and legal problems, and deal with the other situations surrounding our addictions. Only time, along with some support and work on our part, can prepare us to deal adequately with those things.  One of the prime targets of rehab is to help clients develop a plan, a support system, and learn how to use them.

Some help and support for family members and significant others is needed. Therapy, or at least a support group, is highly desirable for them because living with an addict is traumatizing. This is easier to arrange if we are under the guidance of people who know how to help our families and friends begin to heal too, because us telling our family that we think they need help is pretty much a non-starter.

Finally, we get to the addict behavior that we need to change. When we used, we developed behavior that protected our addictions.  Over time it became ingrained. (I like to use the example of putting Kobe Bryant in a basketball game, but telling him he can do anything he would normally do except try to score. How long would it take Kobe to blow that assignment, after spending most of his life working to do nothing but score? His instinct to shoot when the opportunity arises would trip him up, sure as taxes.) The point is, until we develop habits of thinking and responding to the world like a sober person, we are likely to respond to stressful situations just as we did in the past. More than one addict has come back saying, “I don’t know what happened — one day it seemed like a good idea and I just picked up!”

So there’s no way, really, to give a simple answer to this question. A safe one would be “Stay in rehab as long as possible.” Of course we all know that other factors can stymie a plan like that. Best answer: consult with the experts who are handling your rehab, and take their advice if possible. More rehab can’t hurt.  There are very few problems that can be solved if we don't have the skills to tackle them, and if we relapse — well, let’s just say that’s not the best way to remain out of rehab.