you are not alone

addiction

diagnosis

A warning

Family Recovery

Outpatient & Inpatient

Stages of treatment

detox

RTC

PHP

IOP

RSS

Relapse

“I was always the black sheep. Then I started going to meetings and found the rest of the herd.”

We are not Saints

At this moment, you are asking yourself, “So, what do I do now? Who do I call? What do I need to know?”

Know this — you are not alone. Addiction is an equal opportunity abuser and it does everything to defend itself. It attacks families at every socioeconomic level — from Park Avenue to skid row. It doesn’t matter if you are male or female, employed or unemployed, young or old, any race or religion, everyone is fair game.

In 2020, 72,000 in America overdosed on illicit substances. That’s more than the total of U.S. soldiers killed in Vietnam; more than car accident deaths at their peak; deaths due to AIDS at its zenith; and the highest ever number of gun deaths.

Currently in our nation, there are over 61 million suffering from substance use disorder (SUD) and/or a mental disorder. That’s the population of California, Oregon, Washington, Idaho, Montana and Nevada combined. 51.7 million of us suffer from mental illness — that equals 20% of all adults 18 and over in the U.S. — plus 20.4 million with SUD — 7.8% of us 12 or older — but with an overlap of 9.5 million who suffer from both.

Many of those who are dependent on drugs or alcohol are “functional” — 70% of those with an SUD are actively employed, 55% of them full-time — and the disease will worsen over time.

All this means that nearly one-third of our nation’s families are impacted by addiction and/or mental illness. It’s nearly impossible to speak with someone who’s not dealing with addiction or mental illness in their family or at least knows of a family who is.

“No single factor determines whether a person will become addicted to drugs.”

Nora D. Volkow, M.D., Director of National Institute on Drug Abuse

Addiction is a chronic brain disease causing the inability to control the impulse to use a substance or repeat a process despite devastating consequences. It is not a moral failing, a result of bad character nor lack of will — though some unenlightened people still believe that. It is a chronic disease that alters the individual’s brain structure and function that cannot be stopped by the simple, “just say no,” or “just buck-up, will ya?”

What causes addiction? Nobody knows for sure, but research points towards it being a long-term illness resulting from the complex interplay between one’s genes and environment. Scientists estimate that genes account for 40% to 60% of a person’s risk of addiction.

Contributing factors are believed to be mental disorders, physical, emotional or sexual abuse and/or trauma. Other factors include parental substance use; availability of drugs or alcohol; exposure to stress; incarceration of a family member; poverty; and age when use begins. Some people with mental disorders use drugs to lessen the psychiatric symptoms, but actually intensify them in the long run.

As with other chronic diseases like heart disease, asthma, diabetes, hypertension, there is no cure, but it is manageable. Manageable through treatment and an evolving, ongoing support system so that anyone can live a self-directed, full, active, meaningful, loving, productive life just like anyone else on this planet.

“You know you’re an alcoholic when you misplace things — like a decade.”

Paul Williams

In order to treat an SUD, it is necessary to know exactly what needs to be treated. The true diagnosis of an SUD is principally based on a clinical assessment by a licensed behavioral health professional. A tool licensed professionals often use is the 5th edition of the Diagnostic and Statistical Manual of Mental Disorder (DSM-5) — where 11 diagnostic symptoms define if there is a disorder and the severity of it.

• Using in larger amounts or for longer than intended.

• Wanting to cut down or stop using, but not managing to do it.

• Spending a lot of time to get, use or recover from use.

• Craving for the substance.

• Inability to manage commitments due to use.

• Continuing to use, even when it causes problems in relationships.

• Giving up important activities because of use.

• Continuing to use, even when it puts you in danger.

• Continuing to use, even when physical or psychological problems may be made worse by use.

• Increasing tolerance to the substance.

• Withdrawal symptoms.

Range of severity:

• Fewer than 2 symptoms = no disorder.

• 2 to 3 = mild disorder.

• 4 to 5 = moderate disorder.

• 6 or more symptoms = severe disorder.

A professional diagnosis typically comes up as one of the following:

• Substance Use Disorder — SUD.

• Mental Disorder.

• Primary SUD and Secondary Mental Disorder (Dual Diagnosis).

• Primary Mental Disorder and Secondary SUD (Dual Diagnosis).

When a crisis due to addiction or mental illness hits a family, that is the precise time when families are most vulnerable, desperate to find the right solution to their existential plight. The over $42 billion per year treatment industry is unregulated and making ruthless charlatans rich through exploitive, unethical “treatment centers” and bogus drug testing. Not to mention the defrauding of insurance companies, which only makes accessing effective treatment more expensive for the rest of us. The rehabs who promise anything just to get your business are the outliers. It is my mission to provide a “what you need to know” roadmap to navigate your way through the treatment universe to avoid the grifters and imposters who only want your hard-earned money and make an already tortuous experience even worse.

“Structured Family Recovery transforms recovery into a shared journey the family takes together with the newly recovering alcoholic or addict.”

—   Debra Jay, “It Takes a Family”

I see this all the time: a family member goes away to treatment, whether it be 30, 60, 90 days or longer and when he returns, the family expects him to be “fixed.”  Presto, no more addiction, no more problems. Trust me, it doesn’t work like that. So often have myself and treatment professionals meet patients’ family members and wham, “oh, now I see why he’s so screwed up.”  Meet the family, meet the problems.

The point is, in so many cases one’s addiction/mental disorder is a manifestation of what’s going on at home. So, it’s not just the patient who needs to do the work, the family unit has to work on itself as well. What good does it do for the patient to do all the work, but the other half of the equation does nothing? 

This is why when I send someone to treatment who is part of a family unit, I set-up that family to see a specialist who will be in communication with the patient’s therapist at the facility. That’s in addition to family therapy sessions that occur normally once per week while the family member is in formal treatment at rehab. Only when the family unit owns its role in the recovery process will the individual and the family be on a path to recovery. You can’t have one without the other.

If you are part of a family who has a member in treatment or recovery, do yourself a favor and read the book, It Takes a Family by Debra Jay. Not only does Jay explain why the family’s role is key, but she also shows step-by-step with worksheets the work that must be done and how to do it. Trust me, this book will save your family.

“Treatment is not a cure, but it enables people to counteract addiction’s disruptive effects on their brain and behavior to regain control of their lives.”

National Institute on Drug Addiction (NIDA)

There are two classes of drug, alcohol and mental disorder treatment: Outpatient and Inpatient.

Outpatient treatment provides group and individual counseling in morning or evening sessions accommodating those who maintain a regular work or academic schedule. Sessions are typically group programs at the initial level of care for those with mild-to-moderate SUDs or continuing care for those recently discharged from a residential program and live at home or in a sober living environment.

Occasionally, the same clinics will also offer the more intensive all-day treatment, PHP that takes place after residential treatment.

Inpatient can refer to care in a hospital for medically supervised substance withdrawal or care for an overdose (Detoxification). It also refers to hospitalization of an individual in an “acute” state due to a mental disorder, which also can be brought on by substance use.

It also is a moniker for Residential care — SUD (substance use disorder) treatment not in a hospital, but in a hospital-like setting that offers 24-hour support, staff and structure for intensive evidence-based clinical services and therapy.

If the resources are available — cash and/or insurance — formal treatment at a reputable treatment facility typically incorporates a combination of detox, behavioral therapies and medications, then structures an aftercare plan or RSS — Recovery Support Systems — when the individual is transitioning back into the “real world.”

However, no one treatment facility nor one single treatment is the “right one” for every individual and disorder. Just as there is no set timeline when everyone achieves long-term recovery, there is no one plan that is going to fit everyone. Treatment has to be tailored to address each person’s drug-use patterns and drug-related medical, mental and social problems.

A reputable specialty facility structures at least a one-year plan incorporating 90 days of a combination of behavioral therapies and possible medications…

…coupled with an aftercare plan incorporating RSS — Recovery Support Systems — when the individual is transitioning in the “real world.”

Documented research and treatment experts insist that the longer the treatment, the greater the odds of long-term sobriety and recovery. To lessen the chances of relapse and increase the chances of successful outcomes, experts assert that anything less than 90 days of formal treatment at a specialty facility is of limited effectiveness.

The aftercare plan — RSS — should not only be for the balance of one year, but also serve as a roadmap for a lifetime of continued recovery that must be continually assessed and modified to meet the individual’s changing needs including:

• Accompanying MAT, if necessary;

• 12-step meetings;

• Continued education, employment or community service while residing in a supervised sober living environment;

• Individual and group counseling sessions;

• Changes and adjustments adapting to the individual’s current and future lifestyle.

Statistics show that maintaining a structured aftercare program for 3 years, including living in a sober environment, dramatically increases long-term recovery outcomes. Plus, I am consistently told by those in life-long recovery that 12-step meetings — or one of the other mutual support programs — continue to be a lifetime endeavor critical to their recovery.

Detox (Detoxification): Detox is medically supervised withdrawal and stabilization in an inpatient hospital or hospital-type setting with 24-hour hospital‐type care. At best stabilization, the purpose is to make a patient medically stable and as free as possible of substances prior to long-term treatment — typically 30 days of residential treatment as the next stage.

RTC (Residential Treatment Center): typically takes place in a hospital-like setting for a 24-hour, 30-day highly structured and supervised program utilizing evidence‐based therapies, medication, clinical, and holistic services. The facility also provides living quarters for the patients, hence “residential.” Its setting can be rural or urban, on a campus, in a dormitory-like setting, cottages, residential home or apartment where all associated activities take place.

PHP (Partial Hospitalization Programming): residential treatment delivered on an outpatient basis, meaning the patient receives treatment in one location while living in a separate sober living environment. Frequently, it is referred to as “residential-lite.”

IOP (Intensive Outpatient Programming): a less intensive schedule of therapy that allows the individual to integrate further into the “real world.” Continuing to reside in sober living, the individual has a choice of morning or evening sessions at a clinic or occasionally on-site to make time for getting a job, continuing education or community service. This stage of the treatment plan is when the individual’s social network of those living in sobriety just like himself is growing. New relationships and support he never had before are now becoming integral parts of his life.

RSS (Recovery Support Services): After 90-days of formal treatment, RSS is the continuing care or aftercare balance of a 1-year and hopefully a lifetime-long treatment plan. Recovery support is exactly that — a foundation in maintaining sobriety, preventing relapse, and living a lifestyle of recovery for his or her lifetime.

“Because drug addiction is typically a chronic disorder characterized by occasional relapses, a short-term, one-time treatment is usually not sufficient. For many, treatment is a long-term process that involves multiple interventions and regular monitoring .”

Nora D. Volkow, M.D.; Director of the National Institute on Drug Abuse

Relapse is frequently part of the journey — especially for millennials — not the failure of treatment. I have witnessed parents lamenting, “Well, there goes that money down the drain. What good did that do?”

A hard and expensive lesson, but one to learn nonetheless. The chronic nature of addiction means that relapsing is not only possible, but likely since its recurrence rates are similar to other chronic diseases like diabetes, asthma, hypertension with relapse rates of 50% to 70%. More than 60% of people treated for an SUD relapse within the first year of discharge from treatment and remain at increased risk of relapse for many years.

What do you do when one relapses? Does it mean that treatment was a waste of resources? Your hard-earned money down the drain? No, not at all, far from it. Relapse does not mean failure. Treatment of chronic diseases involves changing deeply rooted behaviors.

Relapse is the time to reinstate treatment, but with adjustments or even a completely different approach.

“Treatment teaches the addict tools to help the addict get sober. However, the addict gets sober when he/she truly wants to get sober — it is completely up to the addict.”

Walt Quinn, Cumberland Heights

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