We recently asked for his insight on treating addiction. Here’s what he shared:
Can you tell us a little about your background in addiction treatment? How did you become interested in the field?
I sobered up when I was 18 just after aging out of foster care. I started in the field at age 19, when I was a nurses aide for a state-run medical detox. Since then, I have worked in nearly every level of care from private therapy to residential treatment. I have worked with difficult populations such as adolescents or late-stage relapse-prone individuals. One facility I worked for had the tag line, “For the reluctant to recover.”
What misconceptions or myths about addiction recovery would you love to clear up?
There is only one right way to recover is a consistent myth that is propagated but has made some headway in recent years. The fact is, there are a lot of ways to recover. The elements of consistency that I see tend to be that a person has support, is of service to others once they stabilize and they re-create their entire lifestyle. It isn’t enough to decide to get better.
I would also like to state that it is a myth that everyone needs to “go away” to get better. Often this is only true in the most severe cases. Most people can recovery in an outpatient or intensive outpatient setting. Going away to residential treatment is often good for a one- or two-time immersion but after that the odds of it helping are very low. Patients have already figured out what to do in “the bubble.” Their real work is on an outpatient level where their families, their employers and their lives really exist. They need to be able to come in to treatment regularly over a period of time to discuss how to actually put the many good tools they often already possess into action in their meaningful, real lives.
What are signs that an individual should seek some type of recovery program? How can individuals and/or their family and loved ones determine whether their ready to seek help? When should they make the call?
A person should seek help when their symptoms start to negatively impact their lives. This could be in myriad dimensions of their lives including physical, psychological, emotional, relational, etc. The major thrust of the point is to get help when the symptoms start to become apparent.
Family often can’t tell where a person is at as far as readiness. Their are a lot of convoluted feelings tied into addiction and family so the idea someone could have an objective view of their loved one is well meaning but misplaced. The focus should be more relational in nature. Are you being effected by this person? Have you gotten support for yourself to cope with loving an addict who may or may not be getting help?
Families are often much better served (as are those with substance use disorders) when they get help for themselves rather than focusing on helping the “patient”. In fact, the healthier the family member gets, the more quickly the person with the substance use disorder tends to ask for the help on their own accord and without resentment.
How should concerned family or loved ones start a conversation with an individual about their addiction? What are the dos and don’ts?
An initial conversation to open dialogue is good. Stay out of making it a moral issue and stay out of interpreting behavior or symptoms. Stay close to talking about how you feel about whats happening and how you are being affected. Showing empathy for the obvious struggle can also go a long way though it may seem counterintuitive.
For a loved one who feels they won’t say the right thing – what’s a universal sentiment they can offer to anyone struggling with addiction?
This question suggests a nice idea. There aren’t silver bullets in the treatment of this illness. As much as we seek black and white answers and certainty, its better to acknowledge that we may not have that available to us as the norm. I strongly suggest enlisting professional support for yourself before approaching the discussion whenever possible. It isn’t always possible, but when you can I advise it.
What can individuals and their families expect from a recovery program? How do they typically work?
Recovery programs vary quite a bit so a direct answer to this may not be a good idea.
Some generalizations I will make to identify a reasonable program are that they program has an experienced staff and has multiple disciplines represented on their core staff. Many programs list a lot of consultants on their websites to make it look like they have a large staff but their core staff is very green and the treatment day to day is done by case managers with low levels of education, experience and training.
Find out who is going to do the most work with you, your family, and your loved one. Are they licensed? At what level? How long ago did they graduate from school or are they still a student? It’s OK to have interns and and associates on staff. Many of them are very good, but be careful to not let them be the only ones at the table. One licensed therapist who serves as a clinical director may be coming in once a week to discuss cases with the case managers. That is not enough expertise to treat this illness.
What do families need to know about finding the right recovery program for their loved ones? What are signs that a particular program might not be a good fit?
Don’t get caught up in what I call “pinstripes.” Lots of programs have chefs and nice views. It’s ultimately meaningless. As long as the facility is clean, safe and large enough for the census it treats, it’s fine. Focus more on the core clinical staff and the therapies they will provide to your loved one. Ask a lot of “how” questions. A sales pitch might be, “we offer expert psychiatry weekly.” How that looks is a different psychiatrist comes by the facility for five-minute med checks once a week and does a pass down to next week’s psychiatrist. It could also mean that a psychiatrist is on site 40 hours a week and spends 30 minutes a week with your loved one and is available for extra sessions when needed (rare).
Get particulars on these types of issues. Group therapy is incredibly important in addiction counseling. Who actually runs the groups? Are they core staff or outside consultants who drop by once a week? Core staff is better for the majority of groups as it provides continuity in the care instead of repeating the same work with a slightly different angle. As you can imagine, more progress can be made. Some consultants or limited duty clinicians is good and can even be great for specialized therapies, but make sure the bulk of the work is done by a qualified core staff.
What can families do to help foster recovery for their loved ones? What shouldn’t they do?
Families need to participate in services themselves and get support and counseling for themselves and what they are going through. It feels like you don’t have time for it but the truth is you don’t have time to not do it. You double their chances of recovering if you do your own work, much of which may have little of nothing to do with them.
What are your favorite resources for individuals and their families regarding addiction treatment? (Books, websites, articles, etc.)
What do you find are the most challenging aspects of addiction recovery?
This varies by individual quite a bit. Could be emotional, behavioral, motivation. Could be another disorder they have that they would like relief from. Some people have high cravings while others are much more cognitive about relapses.
What would you tell individuals who are dealing with an addiction, or their families about feelings of isolation and shame surrounding their addiction?
There are a lot of us out there. Watching a documentary like “The Anonymous People” can be uplifting and help people to see how many of us there are and can aide in destigmatizing substance use disorders. Reading voraciously can help as well. As you open up to others you will find out you are not alone.
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