FYI In this blog, we use the term “addict” to mean any individual that consumes any substance of abuse or has a behavioral addiction. This list includes legal or illegal drugs, alcohol, food, gambling, shopping, etc.
Many “using addicts” ricochet from crisis to crisis and are reluctant to enter residential treatment. The national statistics evidence the high risk of accidents or overdose due to prescription pills, cocaine, benzodiazepines, heroin or other addictive substances. (See National Institute of Drug Addiction’s “Overdose Death Rates” at http://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
For friends, family members or loved ones, the risks associated with substance abuse intensifies the demand for interventions and treatment. Anyone who watched the reality show Intervention witnessed the arduous and harrowing task of getting an addict into treatment.
As a former CEO of two residential treatment centers and a participant in many interventions, I have been wondering what is the problem with our Interventionists or rehabs if they cannot guaranty success.
Let’s explore some of the reasons Interventions and rehabs fail from the perspective of a friend, lover or family member in a close relationship with a practicing addict. Here goes!
Our story involves Leo and Kate. Leo and Kate are young lovers, madly in love. Kate is addicted. Leo wants Kate to stop using. Our young couple decides to leave England and sail to NY where Kate has promised she will stop using. They board the Titanic Kate smuggles her drugs on board.
When the Titanic sinks, we hold our breath, praying Leo and Kate survive. Luckily, Kate makes it into a lifeboat. Leo stays on the ship. In our story, once Kate is safely in the lifeboat she remembers she left her drugs in the cabin and panics. Leo falls into the freezing water and swims for Kate’s lifeboat. Kate dives into the freezing water and swims for her drugs on the Titanic.
Why would Kate leave Leo to die in the icy water and swim back to the Titanic? Doesn’t Kate love Leo? Why would she risk her life for her drugs? Maybe Kate does not see the Titanic as a heap of metal sinking in a sea of ice but thinks she was on the “Love Boat.” For any younger person reading this blog, the Love Boat was a TV show in the 1970’s, and 1980’s featuring an elegant cruise ship that magically motivated romance among its passengers.
To understand Kate, we need to learn a little bit from scientists who study the brain’s neurotransmitters, which are the chemicals that communicate information throughout our brain and body.
Researcher Helen Fisher scanned the brains of young lovers and found that brain parts start lighting up when they see their partner. Ms. Fisher, shared her research in a TED Talk entitled “The Brain in Love”, where she answers the question, “Why do we crave love so much, even to the point that we would die for it? ”
We know from the story that Kate and Leo are madly in love. So why would Kate be more obsessed with getting her drugs then saving Leo from drowning in the freezing ocean or risk her survival to swim back to the Titanic?
Researchers studying the brain’s neurotransmitters have found that an addict’s desire for drugs, at times, will be stronger than their desire for love. Sorry Leo. Falling in love with a practicing addict is risky. Please watch Helen Fisher’s TED Talk it is great. As your watching, just substitute craving for love with an addict’s hunger for drugs.
Let’s go back to our original question. What is the problem with our Interventionists or rehabs if they cannot guaranty success.
Many addicts will be hit by an “obsession to use” anywhere in their first year or two of recovery. It is tough not to act on an obsession. In our story, Kate’s passion drove her to jump off the lifeboat and swim back to the Titanic leaving poor Leo to drown. Addicts with the obsession to use will find a way to use whether they are at a treatment center, sober living, psych hospitals, outpatient program, church, 12 Step meetings or jail.
Interventions rarely produce sustained behavioral changes. The TV show Intervention demonstrated one type of intervention designed to encourage an addict to enter a treatment center voluntarily. At times, the intervention was successful, and other times it wasn’t.
Even if the intervention was successful and the addict enters treatment, what are the success rates of the treatment center? This question “what are the success rates” sounds simple. But don’t be fooled. The word “success” means different things to different people.
An excellent exercise is to try to define success for yourself or your loved one.
Here are some ideas, hopefully, you’ll make your list from some of the ideas shared in this blog. Success is:
being abstinent from all mind or mood altering drugs
feeling good about myself
being in a healthy relationship with fill-in-the-blank (significant other, family, friends, etc.)
having a sense of purpose and meaning
having a satisfying spiritual and/or religious connection
being emotionally healthy
being physically fit
being self-supporting through my own contributions
giving back to my community
If we compare the treatment of diabetes vs. addiction, we may see the difficulty in measuring success.
If two patients diagnosed with type 2 diabetes, go into treatment. They are both prescribed the same treatment plan of insulin, exercise and a low sugar diet. Patient A follows the treatment plan, and when the treatment center follows up two years later, Patient A is diabetes is managed. Patient B eats sugar, does not exercise, take insulin regularly, and dies one month after leaving treatment. Patient A and Patient B received the same treatment plan for the same condition but had two very different outcomes because Patient B was non-compliant.
It helps to think of diabetes and addiction as chronic disorders that need managing. Having an addictive disorder is a complex condition with no easy answers. We do know that addiction will diminish a person’s impulse control. Therefore, it should be assumed that an addict will not follow her treatment plan.
If residential treatment is not going to “cure them” then is treatment effective. The short answer is yes. Just like treatment for diabetes, an addict in treatment will be given a treatment plan.
If the reader can tolerate one more analogy, let’s compare the recovery process to a runner training for a 26.2-mile marathon.
The recovery process has similarities to running a marathon. Many athletes require practice, coaching and changes in lifestyle to complete a marathon. If you do a search on the Internet, you’ll read lots of articles on marathon runners’ hitting “the wall.” This time, we’ll envision recovery to running a marathon and the obsession to use as hitting the wall.
Here’s how “the wall” is described on a blog posted on Runner’s World. “You’re in the middle of a run when things start to fall apart. Your legs feel like concrete, your breathing grows labored, your strides turn into a shuffle. Negative thoughts flood your mind, and the urge to quit becomes overwhelming.”
Here’s how the obsession feels to an addict in early recovery. It’s Friday, and I just got my paycheck. I feel like getting high, but I don’t want to lose my sobriety, and I don’t want anyone to know. I have the weekend; no one will find out. I’ll just use this once. My heart starts beating faster. It is hard to breathe. My mind is racing with fear, guilt, excitement; it’s excruciatingly surreal. I better breathe, take some deep breaths. Where can I find some? I hope they’re around. Breathe! Am I going to have a heart attack? My fingers are so tight around the steering wheel; my hands are turning white.
Reading the descriptions on the runners’ websites of hitting the wall, it seems evident that the causes are complex. Runners’ openly discuss their theories of the causes and their solutions. It appears that most running experts and hobbyists share about the wall without guilt or shame. It seems the wall is an accepted condition associated with running a marathon.
Wouldn’t it be wonderful if individuals in early recovery and the professionals could openly discuss the obsession, without guilt or shame. Runner’s vigorously search for the complex, psychological and physiological causes of hitting the wall.
Recovery from addiction is a marathon. Many of these walls (obsessions) in recovery are difficult to see, rooted in the complex, psychological and physiological characteristics of the condition. If we can’t predict or prevent an addict’s obsession how can we prevent relapse in residential treatment, sober living, outpatient, a 12 Step group, a faith-based program or a psychiatric hospital? Pharmaceutical companies still haven’t found a drug(s) that will prevent an addict in early of recovery from being compelled to use by their obsession.
Without a cure, effective addiction treatment requires applying a set of research-based best practices, which will be elaborated on in our next blog. If we think about the addict running a marathon and every time, he hits the wall the health care providers or other people that are part of the addict’s recovery, intervenes. Interventions may take place each mile i.e. 26 times before the runner finishes the race. The people and health care providers working with addicts better get used to recovery being a marathon, lots of interventions before the finish line; and sadly all too often an addict will swim back to the Titanic from the life raft.
If I had a magic wand, I’d get all my friends, relatives, and clients off the Titanic.
About the organization and the author: The 12 Angels Evergreen Fund’s mission is to provide the investment capital, consultation, and mentorship to support sustainable businesses that support recovery from addiction and other mental health disorders. We believe every person with an addiction should have a chance to enjoy healthy and productive lives.
Our goal is to help improve the lives of individuals suffering from addiction and related mental health disorders. Our primary focus is to break the cycle of economic dependency of addicts on their family, friends, and community. We believe recovery is incomplete until each member of the recovery community can have a sense of purpose, economic self-reliance, or both.
Disclaimer: The author of this blog is Alex Shohet, who is an entrepreneur in the recovery industry. Alex Shohet is not a clinician or health care professional. He doesn’t have a license or certificate in the treatment of mental health disorders or substance abuse.
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