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From Treatment to Sustained Recovery

Thu, 14 Jan 2010 20:34:13 -0700

by William L. White, M.A.
Professional treatment of alcohol and drug problems can start someone on the road to recovery, but a few weeks of treatment should not be mistaken for long-term recovery.
If you have severe alcohol and other drug problems, you should know that successful recovery from these problems involves significant changes over time in: 
• personal identity and beliefs
• family and social relationships
• daily lifestyle

It is about where you live, how you work and play, who is included and excluded from your life, and how you cope with the stresses of daily life. Recovery is more than just not drinking or using drugs; it is about putting together a new and meaningful life in which alcohol and drugs no longer have a place. Recovery from addiction is not like getting over an infection for which we can rest and take medication for a week or two and then get back to our otherwise unchanged lives. Those who view treatment for addiction in this way make up the group for whom treatment does not work. Recovery from addiction is closer to how someone successfully manages diabetes or heart disease - conditions that require sustained decisions and actions for life. 
The Good News
• The positive effects of addiction treatment are substantial, as measured by sustained sobriety (about one-third of those treated) and decreases in substance use and substance-related problems.
• Active participation in treatment aftercare meetings and recovery support groups such as Alcoholics Anonymous can significantly improve your chance of permanent recovery, improve your quality of life and prolong your life expectancy.
• Combining professional treatment and attending recovery support meetings improve your chances of recovery better than either activity alone.
• Lifetime recovery rates of people with a substance use disorder approach or exceed 50%. There are millions of individuals and their families in long-term recovery from the effects of severe substance use problems.
• There are multiple pathways and styles (secular, spiritual, religious) of long-term addiction recovery
• Recovering people can go on to lead lives of significant achievement and community service

FIVE SOBERING FACTS ABOUT WHAT HAPPENS AFTER ADDICTION TREATMENT  1. Most people completing addiction treatment are fragilely balanced between sustained recovery and resumption of alcohol and drug use: more than half will consume alcohol or other drugs in the year following discharge from treatment.
2. The window of greatest vulnerability for relapse after treatment is the first 30-90 days following discharge.
3. Between 25-35% of people who complete addiction treatment will be readmitted to treatment within one year, and 50% will be readmitted within five years.
4. Recovery is not fully stabilized (point at which future risk of future lifetime relapse drops below 15%) until four to five years of sustained recovery.
5. Sustained addiction can be lethal: relapses following addiction treatment produce high death rates from accidental poisoning/overdose, liver disease, cancer, cardiovascular disease, AIDS, suicide and homicide.

Traditional“Aftercare”versus Assertive Approaches to Continuing Care (AACC):

Sun, 10 Jan 2010 09:42:42 -0700

Revamping the process of linking clients to communities of recovery is part of the larger revamping of the traditional idea of “aftercare.” In the traditional view, acute treatment initiates and stabilizes recovery and provides aftercare in the form of step-down treatment (outpatient sessions following discharge from residential). Participation in professionally directed “aftercare groups” and participation in A.A. or other recovery support groups would serve to maintain recovery. In this model, aftercare arrangements rely primarily upon verbal encouragement for such participation to each client by his or her counselor and are only available to those clients who have completed recommended levels of care.

In the new recovery management model, all care is part of a process of assertive
continuing care. In contrast to traditional aftercare models, assertive approaches
to continuing care:
■ encompass all admitted clients/families, not just those who successfully
“graduate,” including those who terminated treatment against staff advice or
were administratively (“therapeutically”) discharged,
■ place primary responsibility for post-treatment contact in AACC with the
treatment institution, not the client,
■ involve both scheduled and unscheduled contact (e.g., “I’ve been thinking
about you today and thought I would call to say hi and see how things were
going.”),
■ capitalize on temporal windows of vulnerability (saturation of check-ups and
support in the first 90 days following treatment) and increase monitoring and
support during periods of identified vulnerability,
■ individualize (increases and decreases) the duration and intensity of checkups
and support based on each client’s degree of problem severity, the
depth of his or her recovery capital and the ongoing stability or instability of
his or her recovery program,
■ utilize assertive (see discussion below) linkage rather than passive referral to
communities of recovery,6
■ incorporate multiple media for sustained recovery support, e.g., face-to-face
contact, telephone support and mailed and e-mailed communications,
■ place emphasis on those combinations and sequences of services/experiences
that can facilitate the movement from recovery initiation to stable
recovery maintenance, 
6 Referral is not linkage; it is affirmation of the need for linkage and the hope that linkage will happen. Linkage is a process that assures that the connection between an individual and indigenous recovery support systems really happens. 
■ emphasize support contacts with clients in their natural environments,
■ may be delivered either by counselors, recovery coaches or trained volunteer
recovery support specialists, and
■ emphasize continuity of contact and service (rapport building and rapport
maintenance) in a primary recovery support relationship over time (Dr. Mark
Godley, Director of Research, Chestnut Health Systems, personal communication,
February, 2006).

U.S. addiction at pandemic levels

Tue, 15 Dec 2009 22:33:33 -0700

BALTIMORE, Sep 15, 2009 (UPI via COMTEX) -- Untreated alcohol and drug addiction in the United States remains at pandemic levels, with little change from year to year, an expert says.

Victor Capoccia, director of the Closing the Addiction Treatment Gap initiative -- a nationwide effort to expand addiction treatment -- says 23 million Americans are addicted to alcohol and drugs, but only one in 10 are treated.

Capoccia says the annual National Survey on Drug Use and Health Data released by the Substance Abuse and Mental Health Services Administration shows in 2008, 23.1 million persons ages 12 or older needed treatment for an illicit drug or alcohol use problem -- consistent with numbers reported in previous years.

The most common reason cited by those who wanted treatment but did not receive any was the inability to pay for it.

"The nation is focused on how best to reform our healthcare system. Access to effective addiction treatment will save billions of dollars over a decade's time compared with the costs and health complications that come with not treating people at all," Capoccia said in a statement.

"Ignoring any disease -- be it addiction, diabetes or hypertension -- is bad medicine and should not be an option in today's healthcare system. Addiction treatment should be fully covered by all insurance plans."

URL: www.upi.com Copyright 2009 by United Press International

Does Relapse Mean Treatment Failure?

Mon, 14 Dec 2009 10:00:57 -0700

This article challenges three mistaken beliefs that often prevent treatment professionals from dealing effectively with relapse prone clients. These beliefs are: (1) Relapse is self-inflicted; (2) Relapse is an indication of treatment failure; and (3) Once relapse occurs the patient will never recover

Read this great article by Terence T. Gorski
http://www.tgorski.com/gorski_articles/does_relapse__mean_treatment_failure_010524.htm

Relapse Attitudes

Sun, 13 Dec 2009 22:12:15 -0700

SOBRIETY IS BORING I’LL NEVER DRINK/USE AGAIN I CAN DO IT MYSELF I’M NOT AS BAD AS ….. I OWE THIS ONE TO ME MY PROBLEMS CAN’T BE SOLVED I WISH I WAS HAPPY I DON’T CARE IF NOBODY ELSE CARES, WHY SHOULD I? THINGS HAVE CHANGED I CAN SUBSTITUTE THEY DON’T KNOW WHAT THEY ARE TALKING ABOUT THERE’S GOT TO BE A BETTER WAY I CAN’T CHANGE THE WAY I THINK IF I MOVE, EVERYTHING WILL CHANGE I LIKE MY OLD FRIENDS I CAN DO THINGS DIFFERENTLY NOBODY NEEDS TO KNOW HOW I FEEL I’M DEPRESSED I SEE THINGS MY WAY ONLY I FEEL HOPELESS I CAN HANDLE IT IF I HIDE BEHIND EVERYONE ELSE’S PROBLEMS, I WON’T  HAVE TO FACE MY OWN I CAN’T DO IT WHY TRY
THE EVENT: A RETURN TO THE USE OF ALCOHOL AND/OR DRUGS.

The Ten Most Common Relapse Dangers

Sat, 12 Dec 2009 07:56:31 -0700

1. Being in the presence of drugs or alcohol, drug or alcohol users, or places where you used or bought chemicals.  2. Feelings we perceive as negative, particularly anger; also sadness, loneliness, guilt, fear, and anxiety.  3. Positive feelings that make you want to celebrate.  4. Boredom.  5. Getting high on any drug.  6. Physical pain.  7. Listening to war stories and just dwelling on getting high.  8. Suddenly having a lot of cash.  9. Using prescription drugs that can get you high even if you use them properly.  10. Believing that you no longer have to worry (complacent). That is, that you are no longer stimulated to crave drugs/alcohol by any of the above situations, or by anything else – and therefore maybe it’s safe for you to use occasionally.

Relapse Signs and Symptoms

Fri, 11 Dec 2009 21:45:58 -0700

Experiencing Post Acute Withdrawal: I start having problems with one or more of the following; thinking difficulties, emotional overreaction problems, sleep disturbances, memory difficulties, becoming accident prone, and/or starting to experience a serious sensitivity to stress.
Return To Denial: I stop telling others what I’m thinking/feeling and start trying to convince myself or others that everything is all right, when in fact it is not.
Avoidance And Defensive Behavior: I start avoiding people who will give me honest feedback and/or I start becoming irritable and angry with them.
Starting To Crisis Build: I start to notice that ordinary everyday problems become overwhelming and no matter how hard I try, I can’t solve my problems.
Feeling Immobilized (Stuck): I start believing that there is nowhere to turn and no way to solve my problems. I feel trapped and start to use magical thinking.
Becoming Depressed: I start feeling down-in-the dumps and have very low energy. I may even become so depressed that I start thinking of suicide.
Compulsive And/Or Impulsive Behaviors (Loss Of Control): I start using one or more of the following- food, sex, caffeine, nicotine, work, gambling, etc. often in an out of control fashion. And/or I may react without thinking of the consequences of my behavior on myself and others.
Urges And Cravings (Thinking About Drinking/Using): I begin to think that alcohol/drug use is the only way to feel better. I start thinking about justifications to drink/use and convince myself that using is the logical thing to do.
Chemical Loss Of Control (Drinking/Using): I find myself drinking/using again to solve my problems. I start to believe that “it’s all over ‘till I hit bottom, so I may as well enjoy this relapse while it’s good.” My problems continue to get worse.
Adapted from Terence T. Gorski's Warning Sign Identification Process

More Shall Be Revealed

Tue, 8 Dec 2009 11:44:30 -0700

The first time I heard this statement I had no idea what it meant. I came to believe that it means I have no idea what’s around the corner and the thought that I might have ultimate control over the outcome causes me great anxiety. I have found that if I let go of the results and just do the footwork, everything is.