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"Forget Disneyland, I'm going to Betty Ford's." (David Letterman's Top Ten #7. Sept. 9, 1994)
A sign of the times! A late-night television show acknowledges that a chemical dependency center is as well-known as Disneyland.
The word is out, treatment centers reestablish relationships and salvage nonproductive lives. In order to avoid future trouble with substance abuse, an individual makes the decision to build a sound and healthy "internal environment," and seeks the place to do it.
Because substance abuse is such a cruel and obstinate disease, the substance abuser needs support and help to put his disordered life back together. He may think he takes drugs because of an unhappy childhood, an unhappy marriage or pressures of his career, but he takes drugs because he can't help it.
Abstinence is the only effective means to conquer substance abuse, and a treatment center is the only effective place to get the help that is needed. Abstinence means complete freedom from all drugs.
The first order of business is to consider the best treatment for the individual. It is necessary for the person to gain a sound understanding of what has brought him to this point. He must gain insight into the complete helplessness he has been experiencing in his struggle to get control over the situation.
There has been a radical change in the treatment services available. Approximately half the chemical dependency treatment centers that existed in 1986 in Northern California have closed. This is due largely to the fact that insurance companies and employers have been less willing to provide inpatient benefits for the traditional three- to four-week hospital stay of years before (Addiction and Recovery, Nov/Dec 1993).
So treatments have been revised. In 1991, the American Society of Addiction Medicine published a guide of the first nationally recognized criteria for determining patient placements in varying levels of care. This sensible criteria is helpful to treatment centers, insurance providers and employers.
The professional training of nurses, physicians, counselors and social workers has changed vastly in regard to the knowledge of substance abuse. Prevention of the disease is emphasized, and the maintenance of good health habits is given much attention.
Treatment is designed to stop the drug abuse process and introduce the person to a drug-free lifestyle. When does treatment begin? The individual's family or employer will intervene when the addict's behavior becomes intolerable. Frequently the addict will cry for help. If you hear this plea, get the person the help he seeks.
Frequently it is a counselor or a physician who evaluates the substance abuser and suggests the type of treatment that will be beneficial. Treatment is also determined by the insurance or money that is available. The American Medical Association has a checklist for physicians to help in determining if the person is a substance abuser who needs treatment.
Some substance abusers can withdraw from drugs "cold turkey." This can be uncomfortable, and if the person consumed large amounts of drugs, it can be dangerous. But some people are able to do it, and it is a big boost to their self-image. When they accomplish this, they have second thoughts of taking the drug again. "I'm not going through that again!" When they are successful, they have true pride in themselves. A person in poor physical shape is advised not to try this method.
Alcoholics Anonymous is a self-help support group based on a 12-step program. Substance abusers help other substance abusers. The power of the group is in its spiritual philosophy and in the notion that substance abuse cannot be cured.
In 1935 two men, Bill Wilson and Dr. Robert Holbrook Smith, became aware of the fact that only an alcoholic could help an alcoholic. They lived in Akron, Ohio, and both were alcoholics. A mutual friend brought them together, and they found they had a lot in common. They both had happy marriages and the physical constitution to withstand years of chemical abuse. Each had wrecked a noteworthy career. Bill was a stockbroker and Dr. Bob was a surgeon.
They had an immediate bonding. Bill had become aware that in order not to drink, it helped to talk to another alcoholic. They both had a desperate need to share their problems but did not want to be judged or preached to. Preaching was the way the clergy or others had handled talking to them. They met as equals and talked as equals.
Neither could stop drinking by himself, but together they began to find their sobriety. They acknowledged their powerlessness over alcohol, and that was the first step to recovery. They talked about the physical aspects of alcohol on the body. They soon had a nucleus of half a dozen men meeting together and staying sober. This was the beginning of Alcoholics Anonymous. The anonymity was an important concept. They used first names only and promised that what was said in the room, stayed in the room.
It was a practical program of recovery. Whenever difficulties came up, a solution was found. Slogans and witty sayings appeared and were used. One of the original slogans came about because Bill was sometimes longwinded, and Dr. Bob would say to him, "Keep it simple."
Most men were overwhelmed at the idea of never having a drink. The idea was insurmountable. A 24-hour plan was devised. It soon developed into the "one-day-at-a-time" slogan.
Another important concept was "we admit our life is unmanageable." This rips away the curtain of denial. To be able to acknowledge this was the beginning of awareness.
This organization grew and is acknowledged to be the single factor in the recovery of millions of alcoholics. To become a member, one has to have only the desire to stop drinking. There are no fees. Members are encouraged to attend several meetings a week or as many as needed to remain sober. Meetings are held in every community and at varied times.
Bill said, "A drunk must be led, not pushed." The Twelve-Step Traditions is the heart of the program. Though it is spiritually oriented, it is not based on any specific religious discipline. "God or Higher Power" is whatever it means to the person. It is different for each one, and it doesn't matter because it is someone or something outside of the person.
Bob: I drank like a fish. There was much pressure at work and a great deal of tenseness at home. After my second divorce, things weren't going so great. I decided to see what this Alcoholics Anonymous was about. At first I thought, this is not a group I'd care to hang out with. I liked the idea of one day at a time, because that is the way I had to do it. I realized my drinking was getting in the way of my life, and I knew I couldn't stop alone. So I stuck it out. When it came time to take a "personal inventory," I was amazed to think that all my problems weren't caused by "someone else." It was an eye-opener for me. I have been a member of AA for almost 10 years. I have been sober for 10 years, and I know I have to attend meetings the rest of my life.
Alcoholics Anonymous says, "If you don't want to slip, stay out of slippery places." Choose your environment carefully. Choose your friends carefully. Choose a new lifestyle.
Alcoholics Anonymous talked about stress relievers before it became a popular pastime. "Don't ever get too hungry, too lonely or too tired." The ideas, traditions and inspirations came about by trial and error. A life of serenity includes good friends, fun, laughter, forgiveness and interaction.
Once a person stands and expresses his fears aloud, they disappear. Individuals are encouraged to select a sponsor. The sponsor is someone who has been abstinent for several years and someone to work with on personal and emotional problems.
No matter what kind of treatment a person is exposed to, he is encouraged to attend Alcoholics Anonymous or Narcotics Anonymous meetings to keep motivated and drug-free.
Narcotics Anonymous was founded in 1953 in Southern California. It is a program adapted from Alcoholics Anonymous. It does not identify any one chemical substance but dwells on the disease of addiction.
As addicts, members of Narcotics Anonymous acknowledge that the use of mind-altering substances has caused a problem in their lives. They follow the same principles of Alcoholics Anonymous and work through the 12-step program.
"Easy does it" is one of their slogans. They didn't become addicted in one day, and so the cure is slow.
Bernice: As a California gal, I did all the normal things. I went to the beach, I played volleyball and was a cheerleader during football season. Alcohol was my first drug. Some of the guys had it at the beach. Then it started, marijuana, cocaine and heroin. I became so hooked, my parents didn't know what to do with me. I went to live with a guy who was a pothead. I thought we were cool and that getting high was the ultimate. To make a long story short, one morning I found myself lying on the beach, face down in the sand. Some people took me to the hospital, and I was lucky enough to get into a rehabilitation program. The fellowship of Narcotics Anonymous has kept me clean. I am no longer alone. I am with people who understand how I feel and can help me over the rough times.
Everything that happens in Narcotics Anonymous is geared toward carrying the message of recovery to the addict who still suffers.
Al-Anon, another self-help group, was formed to help the families of alcoholics. The need was recognized when Lois, Bill Wilson's wife, became angry because he was away from home so much. She had no way to cope with his changed behavior since he'd begun treatment with Alcoholics Anonymous. She'd stood behind him as a co-dependent when he'd been drinking, and now she was upset when he was sober.
So Al-Anon Family Group was developed for families who realized they needed to be unified and to share experiences. The 12-step program of Alcoholics Anonymous was adapted to meet the needs of husbands, wives, relatives, friends and others close to the alcoholic.
One important objective of Al-Anon is to help family and friends free themselves from the obsession of another person. They are encouraged to focus only on themselves. Give up control. Hands off. Al-Anon members do not offer advice, but by sharing and listening to each other, they learn there are other choices. In helping others, they help themselves and are better able to make decisions.
In 1957, a high school boy in California felt the need to talk with someone else with whom he could identify. Alateen was created out of that need.
An inpatient program is a program based at a hospital. Patients are under around-the-clock care. It is not necessary or right for all individuals.
The patient is given a complete physical on admission to the hospital. If the patient is in a crisis situation, stabilization is the first order of business. Detoxification is the next step. This may be done at the hospital or a detoxification center.
Detoxification is the process of clearing the body of drugs or poisons. It is the process of withdrawal. People who have indulged in substance abuse for a long period of time may have to be medically monitored. The process takes three to seven days, depending on the patient. The patient may experience tremors, rapid heart rate or high blood pressure. Hallucinations or even seizures can occur during this time.
The physician may order Librium, Valium or some other central nervous depressant to help the patient through this period. Careful attention has to be paid so that the person does not get dependent on tranquilizers. If he is dehydrated, he is encouraged to drink plenty of fluids or intravenous fluid will have to be given. Once the person is detoxified and vital signs are stable, he can be admitted to the rehabilitation portion of the treatment.
The inpatient treatment program takes care of any medical problems the person has. For instance, is he a diabetic? Diabetes must be monitored and corrective measures taken to keep it stable.
The treatment program is multidisciplinary and has a team that includes the attending psychiatrist, physician, psychologists, social workers, registered nurses, counselors and occupational therapists.
A comprehensive treatment module integrates psychiatric and medical services efficiently to address the combined specialty needs of the person. If the person has the dual diagnosis of psychoses and substance abuse, a format is provided that includes group and individual therapy. Family involvement is encouraged and recognized as a vital component to the success of treatment. Skilled professionals follow an individually developed treatment plan that focuses on stabilizing the addictive behavior and the psychiatric disorder.
A person with dual diagnosis will have a program that focuses on four essential elements of change:
There will be therapeutic group counseling and education that addresses such specific needs as:
An inpatient program is especially helpful for the senior citizen with a substance abuse problem. Because of physical decline, memory loss and social isolation, the senior person experiences severe emotional distress or behavioral difficulties.
Treatment in the hospital usually lasts 30 days. Then a continuing program should follow for an unspecified amount of time.
Confidentiality concerns many people, although some are less secretive today because of celebrities "coming out." But there are still individuals who do not want their employers, family or friends to know that they have been in a treatment program.
The Betty Ford Center in Rancho Mirage, California, has a Professional in Residence Inpatient Program. Its purpose is to expand the awareness and understanding of addiction treatment so that professionals in the health and human services fields will be sensitized to the process of recovery from alcoholism and drug addiction.
This is a three- and a half-day program, which begins Tuesday afternoon and ends Friday afternoon. Participants attend groups and lectures covering the 12 steps of Alcoholics Anonymous. There is an overview of the entire treatment process for the patient.
Components of a typical patient day are: meditation, lectures, group therapy, peer group session and exercise. The idea is to give the professional the insight of the process of recovery as a substance abuser experiences it. He will have an understanding of how the interaction with fellow patients and the staff supports the recovery process. He can experience firsthand the interdisciplinary treatment approach at the Betty Ford Center.
The Betty Ford Center also has a treatment program designed especially for the needs of women. This is a program based on the Twelve Steps of Alcoholics Anonymous and consists of individual and group therapy, educational presentations, physical exercise, activities which address stress and leisure, peer interaction and support groups. The Women's Program addresses all the problems that are special to women. Research demonstrates that women have a higher recovery rate than men.
Outpatient treatment is conducted in outpatient clinics where the patient comes every day, Monday through Friday, and where workshops in raising self-esteem, parenting and assertiveness training are offered. There is chemical dependency education, step study, recovery planning, relapse prevention and issues pertinent to specific groups. There is also group therapy.
Some communities offer local experts to talk about nutrition, relationships, communications, domestic abuse and boundaries. These nonresidential services are presented in local "serenity" houses where child care is provided, the number one obstacle for women in receiving daytime recovery services.
In some ways outpatient care for the substance abuser is more effective than inpatient. The person's life is not as disturbed. He is learning new techniques in his own living environment.
Outpatient therapy has to be chosen with great thought for the individual's needs. If therapy focuses on a specific drug, for instance, treatment for cocaine or heroin, outpatient therapy would be a better choice for the person. Statistics show that a person has a more complete recovery in a program that is tailored to his specific habits.
One of the main goals in drug treatment is for a person to learn what triggers using the drug. He has to learn behaviors that will control that urge. For example, when he thinks he is going to seek "a fix":
Many kinds of stimuli will initiate the urge to take a drug. It is the individual's task is to be aware of this and learn to live in this world drug-free.
A good outpatient drug treatment program will do frequent drug testing, usually a urinalysis, sometimes twice a week. This eliminates any guessing about whether the patient is telling the truth. The testing acts as a control and requires the patient to acknowledge the consequences of his actions. Recently a highly publicized call girl flunked the drug test four times. This means that if she was in a treatment program, it wasn't working. It also told authorities she was not sincere in her desire to abstain, and that she was not abstaining. The authorities knew they had to deal with her another way. They put her in jail, which is no solution either. But it did stop her token participation in a treatment program.
All drug treatment programs insist on abstinence from all mood-altering agents. Then an assessment of the patient's general well-being is done. How is his physical condition? What is his mental condition? How does he interact with other people? A picture of the person as a whole will identify any areas that need more inspection.
A physical evaluation will determine if there is some other problem that needs to be addressed. Laboratory tests are vital to this examination. A positive outcome of these tests allows those in charge of the treatment program to concentrate on the therapy, and not be detectives.
Remember Andy? He was the young man whose family intervened and he went into a treatment center. He spent 90 days there. When he came out of treatment, he returned to his parents' home. They had moved him, bag and baggage, from his apartment. He had a slight resentment against his folks, though he acknowledged the move was necessary. He expressed his resentment to them, and they acknowledged his feelings.
He soon found employment in work with computers, something he loved. After a time, he was able to move into his own place and start anew: a new job, new apartment, new friends and new environment. This really simplified Andy's decisions. He continued his treatment by attending Narcotics Anonymous meetings. He has forgiven his family for interfering in his life, and he has been drug-free for 15 years.
The recovering addict who returns to the "same-ol'-same-ol"' has a harder row to hoe. But it can have a positive outcome also.
Teri: When I was drinking, I always had someone else to blame for my life not going right. If only...was my cry. Now that I am in recovery, I find that the hardest thing to accept is my part in my failure. I am going through that phase now, and I'll be glad when I finally accept all the responsibility. I'm not there yet.
It is not easy to say, "Yes, I was to blame." But it is a critical part of the recovery program.
The substance abuser comes through the transition period and early recovery with many changes. The thinking is clearer. Behaviors and attitudes are also in the process of constant change. It is a time of spiritual awakening. Problem-solving and decision-making skills are improving.
The decision on how to get through life has been made by the substance abuser. It is without the need to use drugs. It is a step in recovery toward maturity and growth. The addict's thinking was so "muddled and fogged over" that it was difficult to accept new-found insights.
Maturity implies fall growth and development, a state of completion. It is the "state of being ripe." There are various theories as to what maturity is. The one I like is "the ability to maintain a balance between what is expected and what actually happens." In other words, don't overreact when things don't go your way. To strive toward maturity is to grow. Mature individuals are self-contained. They have an aura of inner peace.
Life is an adventure and we're all in it together. The substance abuser isolates himself when he uses drugs or associates only with others in similar circumstances. Now it is time for the recovering person to make new friends and widen his circle. Friendship is an important ingredient in an individual's life.
Everyone is unique and different in his own way. A person can learn from anybody. It is exciting to get a different perspective, exchange ideas or just have a witty exchange with someone. And once a person finds inner peace, people will flock toward him.
Some newly sober people have an experience in which they act as they did when drunk, even though they are sober. This is probably the result of not learning new ways of coping. The old behavior takes over. They are irritable, argumentative or can even be tearful. Sometimes the person is more difficult to live with than when he was drinking.
Being a dry drunk is no excuse for inexcusable behavior. Sometimes the person just has a bad temper and being sober makes him more so. Old habits are hard to break. One characteristic of this behavior is a grandiose manner. The individual may promise things he cannot deliver. Sometimes anger and resentment will emerge and he'll strike out at the nearest person. This takes extra understanding on the part of all who come in contact with this behavior. One way to make things easier is to interject humor into the situation. Humor can ease most circumstances.
Laughter has a way of diminishing pain and making anyone feel better. No one can explain how it works, but it does. Humor helps us keep things in perspective. It's important in relieving stress and tension and in the prevention of overreacting. Endorphins are released and that explains the "good feeling." When a person laughs, the heart rate is increased, and respirations are amplified with an increase of oxygen exchange. The arms, legs and stomach get a good workout. The muscles of the face and the diaphragm also are exercised. The circulatory and endocrine systems are healthfully stimulated.
Who decides whether you will be happy or sad? You do! It was Abraham Lincoln who said that people were just about as happy as they made up their minds to be. Happiness can get to be a habit. What a wonderful way to live.
The recovering addict acquires new habits and attitudes and gathers around him a healthy support system. When he is stabilized in his new lifestyle, he is able to delve into family-of-origin issues. Family of origin are the parents or whoever raised the addict. Childhood is where a person learns by example beliefs, conduct and rules. If he is reared in a dysfunctional family, many of his beliefs and behaviors are destructive. This time of his life has to be explored, and the maladaptive habits corrected.
Recovery is an ongoing process. The challenge of each day has to be met and accepted.
Recovery begins the second the substance abuser admits his life is out of control and drug abuse is the reason.
Reentry or the transition period is the most vulnerable time for the substance abuser.
Purpose of the transition period of recovery
The Process of Recovery
The family can help a recovering addict by educating themselves about addiction, treatment programs and the recovery period. The family supports the addict by joining a support group and working their own program.
Factors that define wellness and maturity are