Might as well face it! Understanding Addiction & Treatment

Turns out the great Rober Palmer may have been on to something. “Your mind is not your own. Your heart sweats, your body shakes…You can’t sleep, you can’t eat…there’s no doubt, you’re in deep.” That sounds exactly like an addiction. Sadly, Jimmy Eat World may have been a little closer in their description: “If only you could see, the stranger next to me, you promise, you promise, that you’re done
But I can’t tell you from the drugs. I wish that you could see, This face in front of me, you’re sorry, you swear it, you’re done
But I can’t tell you from the drugs.”

Over the past two months, there have been many pointless losses of life from fentanyl-laced heroin across the country. It seems as though the world has finally awakened to the devastation of addiction and how limited the treatment options are. Just type opioids or addiction into your preferred search engine and see how many news stories pop up. The topic is everywhere! The answers and solutions, however, are not. It is easier discussed on tv than carried out in real life. For a great and devastating example of this, I encourage you to listen to the story of Teacup from NPR.

As my first ever boss in sales used to tell me “Rachel, Let’s look at the numbers.” According to NIH 2.5 million people are thought to be addicted to opioids and 16.6 million adults ages 18 and older have been diagnosed with an Alcoholic Use Disorder. That is a lot of people. My hope is that with the increase in media and political attention to addiction, the rumors, myths and ignorance surrounding this issue fade into the humorous nonsense that we can laugh and say: “remember when we believed that?” (my former boss would have never said that). One of my favorite misconceptions is the belief that addiction can be “cured” if people just try harder or use “will power.” (I know it doesn’t compare but last week I gave up coffee for one day to see how dependent I was. It was just terrible, I’m addicted, I had headaches, bad mood, full on withdrawal. Don’t do it!) I have known brilliant addicts. I have known stupid ones too. Just recently I watched a woman in recovery relapse after over a year of sobriety. She met up with an old friend and she drank. She used drugs and made some other not to so great choices and ended up in jail. She may waste a few years sort of being sober there (maybe not). Addiction and recovery are not about being smart or stupid, moral or immoral. I’ll never forget watching the West Wing where we see hero chief of staff Leo McGarry give insight into the mind of an “addict”. Addiction cannot be boiled down into simple components. Addiction comes from the most complicated of places: our brains, our genes and the environments we grow up in and live in.

Now that I have cleared up some misconceptions and shared some knowledge of the mindset of addicts, addiction and offered an entree into the multiple factors that go into someone being addicted, let’s discuss how it can be treated. There are many theories and modalities.

-One of the most popular right now is the medical model which views addiction like any chronic illness (think diabetes).

-There are medications like Suboxone and Methadone just to name two. These medications block receptors in your brain so you can’t enjoy getting high thus over time you break the habit of using and positive aspects of dependence. Check out this cool comic from Scientific American regarding addiction and the brain for some clarity.

-Others take a support group approach which involves going to AA/NA meetings, being sponsored and sponsoring, becoming committed to the process of recovery and learning from others who have been there. They are incredibly welcoming spaces. I’ve been to a few open meetings (yes there are many different types) and have never felt more support and love from a group of total strangers in my life.

-Let’s not forget regular the old standard, psychotherapy. Getting one to one support to process and develop new skills for a person’s overall mental health needs are imperative.

What is the right way to treat addiction? All of the above. A combination of all of these treatments is the best plan for success. Addiction is a hard thing to understand and to treat. I have seen successes in many environments and treatment modalities. It all depends on each person, their individual situations and needs. However, the only way to begin the work towards getting sober is access to treatment. ACCESS TO TREATMENT. Waiting for weeks for a bed at a treatment center, waiting for an intake session, not being treated for crack use, only getting into a short-term (5-7 days) detox program without the promise of a long-term rehab program and an aftercare plan are just a few of the other seemingly endless barriers like insurance or the expense of treatment need to go. Treatment for substance use also has to be combined with treatment for mental health. They go hand in hand. When people have a mental illness and a substance abuse issue it’s called a co-occurring disorder or being dually diagnosed. The National Alliance on Mental Illness (NAMI) defines this as,“a term for when someone experiences a mental illness and a substance abuse problem simultaneously. Dual diagnosis is a very broad category. It can range from someone developing mild depression because of binge drinking to someone’s symptoms of bipolar disorder becoming more severe when that person abuses heroin during periods of mania.” NAMI goes on to note that about “a third of all alcohol abusers and more than half of all drug abusers report experiencing a mental illness.” Mental health challenges are not treated in a 30-day program. That can be the starting point but not an end. The way the insurance system currently works, a person would have to complete a short term program, return to your life and then relapse in order to get into a higher level of care. To access long-term, substantive treatment to really process your experiences, get on the right combination of meds and develop a safe and sober support system after graduating is hard to accomplish. Even then, rates of relapse are high, much like a relapse after a period of stability with a chronic illness.

There needs to be more research and better, more thorough treatment options. An article in the NYTimes reports that many private rehab programs don’t use evidence-based treatments. Staff are not trained to specifically work with substance abusers. Clearly, not training staff and using treatment models that don’t work is not the answer.

The current discourse and attention to the Comprehensive Addiction and Recovery Act 2016 have finally moved forward. This bill was discussed last week in the senate and there will now be a limited debate on it.Call you senators and get this bill passed and keep your eye on its movement this coming week.

As an aside: If you have a person with opioid addiction in your life, find a way to get yourself http://www.webmd.com/mental-health/addiction/drug-overdose-naloxone. It may save someone’s life.

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