Dealing with Drug Abuse
There are a lot of views and methods on how to deal with drug abuse and addiction. And, there are a ton of books and people proclaiming they have the right answer if not “the cure”. Anyone saying they have a cure for addiction is full of crap. I still often see those late night commercials pop up from time to time. It reminds me of watching old westerns on TV when a highway man would roll into town in his covered wagon selling that “special elixir”. Hence, I would be completely dubious of anyone stating they have the cure to substance abuse and addiction. As a consumer advocate, let me say there is NO Cure for addiction. It is like the advertisement stating “Lose 50 pounds in 50 days.” Completely ludicrous, yet there will be people out there willing to spend money on the hope that maybe it would work for themselves or a loved one. There are charlatans out there that will feed off of anyone's desperation to repair the damage caused by addiction.
I have been active in the field of addiction and recovery for over 37 years and have seen highwaymen and charlatans prey on desperate individuals and families claiming to have all of the answers to addiction. There is no special pill and there is no cookie cutter approach to addiction treatment. Sorry to say, but science is not that advanced when it comes to addiction. Someday maybe, but not today. So far, what we have is a trove of ideas, models, and philosophies that could help us stack the odds on a long lasting recovery process.
Please note, I do not have all of the answers myself. Addiction is so complicated because there are many variables why an individual is unable to function properly when they are using drugs or drinking alcohol. Some people can easily quit their substance use problems without much treatment or intervention. Yet, there are others who can not stay clean and sober without some kind treatment and structure. And sadly, there are those whom are unaffected by any kind of help or intervention. We really do not know what will work for any individual. However there needs to be some kind of assessment and/or evaluation.
Before you continue reading, let's make something very clear: I will speak to addiction as a disease. You can go to some websites that say addiction is a choice. I have read most of these sites since I believe it is important to read everything written about addiction. I do not want to debate who is right and who is wrong. I will say that in all the years I have been in practice treating thousands of people suffering from addiction, the ‘Choice’ side has not panned out well for treating drug problems and long term recovery.
Note that whatever one does in the beginning phases of their treatment and recovery may change over time. You can’t stay in a 28 day treatment facility forever! Nor is attending an AA meeting twice a day everyday feasible down the road. And there is no “One Way” to recover from what is now currently called Substance Use Disorder. That is the latest diagnostic term from the Diagnostic Statistical Manual (DSM 5) regarding addiction (I still use the terms Drug Dependence and Drug Abuse).
So what is going to work for someone dealing with addiction?
Let me present some of the modalities often used when treating addiction:
The Lowest Level of Care.
Let us assume you call a therapist or a substance abuse facility to discuss treatment for yourself. During the interview, it's established that you have never engaged in any method to stop drinking or using. It may be too much to try to convince you to go to a 28 day inpatient program. In my opinion, it may be wise to start with the lowest level of care, which in most cases involves weekly counseling and attendance at 12 step meetings (we’ll discuss more about meetings later) . And, depending on the drug, a detoxification process, which may require medical attention (especially alcohol and benzodiazepines) may be necessary.
If this fails, meaning the individual continues to relapse despite counseling and/or attendance at AA or NA meetings, then we may need to do something different.
The next level of care could be an Intensive Out-Patient Program. A typical program would meet 3-5 times in weekly group meetings and have one day devoted to working with family members (Multi-family group). Two benefits occur at this level. First is a lot of programming via education and group processing. Second, is people benefit from building connections from others within the group. Even if they are reluctant to attending 12 Step meetings, studies have shown that building connections have significantly increased the chances of long term recovery. Most of these programs have weekly aftercare meetings upon completion of treatment to assist maintaining recovery connections.
Most insurance companies will cover IOP.
28 Day (Residential) Program
Probably the highest level of care and of course the most expensive. Not many insurance companies are willing to pay for them because these facilities can’t guarantee success. I remember back in the 80’s when there were tons of treatment centers around the same time Nancy Reagan advocated the “Just Say NO” campaign. And of course, a lot of charlatans came on board opening their own rag-tag programs only facilitated by recovering people. I recall there were news programs with their hidden cameras exposing (rightly so) programs that were admitting people who clearly did not meet the criteria for such a high level of care. Fortunately today, most of the surviving programs have to adhere to state and federal standards. The people who work there need to have some kind of state credentials and/or certification. However, insurance companies are mostly reluctant to pay for those who really need it. Even if an insurer claims they will cover the cost of a 28 day program, the likely outcome is usually within a week THEY will determine that the individual no longer needs this level of care and will refuse to pay further treatment.
But which one to choose? The program has to be reputable. It has to have a good track record with a majority of positive reviews. So you will have to research with the intensity of buying a new home. Ask around, there may be therapists that can give you a referral(s) based on their experience with working with various facilities.
What about just doing 12 Step meetings?
I think attending 12 step meetings like Alcoholics Anonymous is a very good idea. Working with other recovering people increases the chances of staying abstinent. It also helps not feeling so alone in the process. However, it is not a guarantee. Groups like AA, NA, and CA are grassroots fellowships willing to share their own experience, strength, and hope. There are no professionals, hence everything stated at a meeting is just that individuals testimonial on how “They” got clean and sober.
For more information, please read my article “What about Attending 12 Step Programs?”
Just going to AA meetings is not a bad idea. However, I will always suggest getting an evaluation by a professional in the field of addiction and mental health in order to rule out any additional problems such as depression, anxiety, and trauma that might require additional attention in your recovery process. Ask your medical provider what they think. You should definitely consider getting a physical exam while checking into any kind of treatment. Be sure to be upfront with your doctor about having a drug or alcohol problem and honest about how much you use.
Remember, there are no quick fixes to dealing with addiction. It will take courage, willingness, guts, honesty, and having an open mind. And, you don’t have to like it!
What about attending 12 Step Programs?