“If one oversteps the bounds of moderation, the greatest pleasures cease to please.” – Epictetus
Today’s installment is about Rehab, Recovery, and Treatment. There are many people more knowledgeable on these topics than I, but I have several thoughts and experiences that I would like to share. I had intended to discuss what addiction is like, but I feel that I should gather more information before I address that topic. Recovery is a lifelong journey that tests individuals to their limits in the earlier phases but can lead to a rewarding life of understanding and compassion. This post will only scratch the surface of this topic, so I welcome your thoughts and experiences.
What are We Fixing in Rehab and Recovery?
The addict, in the words of the warden in Cool Hand Luke, needs to “get their mind right”. What specifically does this mean? As we discussed in the science of addiction posts, the addict’s brain has been changed as a result of the addiction. Conditioning has caused the addict’s brain to change such that the parts of the brain that reinforce addiction have been strengthened and those parts that would stand in the way of addiction have been diminished. Therefore, we need to help the addict avoid the drug and focus on the morals and ethics that have been ignored. To bring back the analogy that I used before, the addict needs to avoid the highway (neural pathways) that has been built and reinforced by the addiction and rebuild the neglected roadways of their former self. Before the addict can accomplish this task, there are many dragons that they must slay.
Withdrawal and Detox
When an addict enters rehab, the first aspect of rehab is called detox, short for detoxicification. Detox involves the physical withdrawal that the addict must get through before the real work of recovery can begin. Trying to avoid the experience of withdrawal is one of the things that keeps an addict returning to the drug or at a minimum replacing the drug with another. Most drugs to which you can become addicted cause both a physical and psychological addiction. Both of these aspects of addiction are horrible and while the physical withdrawal takes a terrible toll on your body, it is acute, short-lived.
When your loved-one goes into a facility for rehab, you are usually expected to attend a seminar at the facility. Much of this seminar focusses on the need to help and support your loved-one without facilitating their addiction (more on this later in this post). There was, however, other information in those seminars that I found interesting. One statement that particularly struck me was that physical withdrawal from alcoholism can kill you. Heroin withdrawal won’t kill you, but it will make you wish you were dead. To some degree, the physical effects of withdrawal are the opposite of the effects that the drug induced. This is because your body has developed a tolerance for the drug and then it doesn’t have it anymore. For example, when opiate use that calms and relaxes you is halted, you are agitated and full of anxiety, to the point of panic attacks.
Our son fought our attempts to get him in rehab for a long time for reasons that he would not share with us. Finally, one night he overdosed (just shy of killing him) and I sat up with him all night as he nodded. Through much persuasion (otherwise known as nagging) we got him to understand that he was not going to survive if he kept on using and he agreed to enter rehab. He was terrified of the physical withdrawal that he would experience during detox. We never discussed what he experienced in detox but before he went in to rehab for the first time, he told me what he had heard from others. In Nate’s words, “you lie in bed for a few days in tremendous pain throughout your whole body, chills, cold-sweats, shitting and puking on yourself.” No wonder he was scared. No wonder addicts will do anything to avoid withdrawal. Before an addict will be able to take this on, they must genuinely want to get clean.
Oftentimes, addicts are given opiate replacement drugs, like methadone or suboxone, to ease some of the symptoms. With or without therapeutic drugs, detox is a horrendous experience for everyone. While battling the overwhelming physical withdrawal, the addict has to deal with the psychological effects, as well. One of the worst experiences we had as parents occurred the second time that our son was in rehab. This particular facility allowed patients to make outside phone calls. We and other son experienced almost a week of nightly phone calls where our son, in sheer panic, was telling us he had to get out of the facility. He thought that he couldn’t stand the confining nature of rehab, but we knew it was his “drug-brain” panicking because it could not get what it knew it needed to survive.
Recovery and Treatment
Treatment for addiction after the detox phase is completed can be done on an outpatient basis, short-term rehab or long-term rehab. In addition to therapy, one of the primary purposes of inpatient rehab is to keep the addict away from their drug of choice. Probably the most common treatment is a short-term (30 days or more) as a continuation after detox. The most effective treatment is a long-term stay of 6 to 12 months. This long-term stay gives the addict more time to focus on recovery without distractions. Unfortunately, the cost of long-term housing, therapy, and the lack of income causes this option to be out of reach of most individuals. Given the scale of the drug abuse epidemic, society as a whole could not even bear the economic impact of getting all addicts into long-term rehab.
Treatment of addiction can take many forms. The addict may choose to use a therapeutic replacement drug such as methadone, buprenorphine (suboxone), naltrexone (vivitrol) and others. These drugs reduce the symptoms of withdrawal and reduce the cravings to use. This treatment is most effective when combined with cognitive behavioral therapy. While the use of a replacement drug is frequently not condoned by 12-step programs, it appears to be the only way that some addicts can remain clean. Another form of treatment usually involves cognitive behavioral therapy also referred to as talk therapy. Cognitive behavioral therapy helps the addict in recovery to explore behavior and thoughts that led to drug use, explore the impacts of their addiction and find coping skills to remain clean. I include 12-step programs such as Alcoholics Anonymous (AA) in this heading even though AA offers much more support than just discussion.
For an addict to remain in recovery for the long haul, I believe that the addict must address the underlying issues that may have helped lead to addictive behavior and must rebuild the person that they once were. This is the role of cognitive behavioral therapy and 12-step programs.
The process of becoming an addict was the result of extremely powerful conditioning that caused extensive changes in the addict’s brain. The addiction occurred rapidly because of strong, active forces in response to the drug, whereas, recovery is a long slow process because the brain is being changed back by the much less powerful force of cognitive behavioral therapy.
Facilitating Addiction
One if not THE greatest challenge for the friends and loved-ones of an addict is to walk the very fine line between helping and supporting the person, while not helping or supporting their addiction. As parents, we had to make very difficult choices such as:
– Do we allow access to a car so that he could work, knowing that same car may be used to go meet “his man”?
– Do we allow him to have a cell phone which we all seem to need these days, knowing that the same phone could be used to arrange a buy?
– Do we allow him to live at home, knowing that home is where he frequently used and so it may be a trigger for him to use again?
– And too many other questions to list.
The answers to these questions depends on the addict’s state of mind. You may also think that it depends on your relationship with the addict but be careful, addicts are great manipulators. The advice that we were always given was to error on the side of being too tough rather than too easy. If you are too tough, the addict will eventually see that you did this out of love for them as he/she advances on recovery. But too easy and it is unlikely that the addict will stay in recovery.
Do you have thoughts to share? Please comment.