Monday, July 25, 2011

8 Candid Thoughts About Substance Abuse Treatment From An Insider

8 Candid Thoughts About Substance Abuse Treatment:
From an Insider

1. Cliche to say, but treatment works. It saves lives and ripples to save families. You will hear all the stats about only 1 in 10 who participate in treatment will stay sober for a whole year after discharge, but there is other stats that state almost 50% of those in treatment will eventually maintain long term sobriety.

When you squeeze an Orange, you get Orange Juice, because that's whats inside. Inpatient and residential treatment squeezes folks a little better and you find out whats truly inside. Yet intensive outpatient gives the therapist and client real life scenarios to process.

2. Treatment doesn't work, for some folks. I believe that substance abuse treatment has cast too wide a net, and that there are many patients in substance abuse specific treatment, who are actually primarily personality disorder or other issues. For these folks, using drugs or drinking is just one of many symptoms.

I am not talking about the bipolar or depression diagnosed client where the two disorders feed off of each other and make both set of symptoms worse. The problems I find are primarily when dealing with specific personality disorders.  Many of the social arenas provided in treatment, including groups and 12 step support meetings, are actually just another stage for the narcissist or anti-social personality disorder member to practice their pathology.

3. There are too many recovering addicts treating other addicts. Okay, maybe I contributed to the problem, but I find that when folks become experts and well-versed at AA or NA, they tend to expect others to work a program or get sober exactly as they did. These are the folks who do way too much self-disclosure, and every moment is an aa/na meeting, and they have a slogan for every situation.
One irony I have found in two different work environments is that when staff needed another staff to confide something personal in, they tended to gravitate to the 'non-recovering' staff member.

4. AA itself is not treatment.
Let me explain. The focus of treatment needs to be on clinical issues such as negative, self-destructive thoughts, inability to manage emotions or self-soothe without substances, or social anxiety. Treatment is facing cognitive distortions, behavioral patterns, and yes finding hope admist spiritual and emotional despair. Treatment is not writing out ones first step, listing 3 examples of powerlessness, and getting a sponsor. These things are essential, I believe, but they are a supplement. Too often, the steps are force-fed and seen as the primary therapy themselves.

5. Substances are different, yet addicts are the same. Certain substances are simply more powerful. A small dot of cocaine or crystal meth, a small rock of crack, a spoon and a lighter simply have a different effect on the mind.  In this case, I do believe you have had to have used them to understand, and this is an example of the power of a clinician being in recovery. That said, once a heroin addict, alcoholic, or cocaine addict are in the middle of their cravings and in their seeking mode, the inertia to use is all the same.

6.  The 12 steps are not about staying sober. Look at the steps, and the sole reason for working them, the result, is a spiritual awakening.  And once you have a spiritual awakening, (all the while doing the clinical work) you will not need to use substances.

7.  Addicts will not follow suggestions one hundred percent, or even 90 percent, or even 75 percent, nor should they.
This drives therapists crazy when a patient consistently ignores suggestions to change (as in, if you are jumping off a plane, I suggest you use a parachute.)  Yet making choices is essential, including the wrong ones, and there is more to learn by failing than fear of failing.
100 percent of us clinicians can agree with their dentists recommendation to floss their teeth regularly, but maybe 30% do.

8.  Clinicians, MSW's, Psychiatists, and other caregivers experience incredible stress, however, it is the healthy few who use their skills to address these issues.
In writing the novel Stray, Stray on Amazon  I wanted to demonstrate the connection between the lifes in crisis of the patients, the stray animals, as well as the caregivers.  All of them struggled, yet the ones who survived (speaking of the humans) and then thrived were the ones who tried to address and change these issues.

I will add to this list as the spirit strikes me. Feel free to comment.

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