By Anthony Anders, ADC, LCDC-III – Chemical Dependency Counselor
I took a call from a young man this morning asking to get into treatment for his addiction. After asking the usual questions and giving the usual answers, he asked, “How long will I be in treatment?” Having never met him, and not yet having done a proper intake, I could not even begin to give a proper answer. Even with that information, I cannot give a proper answer most of the time. At least, not at this point in the game.
I am not a fan of giving a definitive length of time that someone will be in treatment. Even in my own journey, I learned that if you tell me a time frame (e.g. “28 days”), that is the number that will stick in my mind. At twenty-nine days, I will most likely consider myself done, completed, accomplished. Treatment does not work that way. The time frame can become a distraction. One may focus on “crossing the finish line” as opposed to gleaning as much information and insight as possible while connected with the necessary resources.
As I pondered the answer to the question the young man posed, I came up with four responses to how long a person may need to be in treatment or recovery. They are rather nebulous to some degree, but all can be considered relevant to every individual.
My first answer would be “right now.” Initially, it is about being present and reconnecting with what someone needs right now. If you are at the stage of change that prompts you to call and inquire about treatment, strike while the proverbial iron is hot. Much distress in addiction comes through negative projection of what may come, what may get in our way, what may harm us, and through that lens, many come up with unfounded conclusions as to why now is not a good time to change. Many who have lost the battle to addiction have fallen while thinking, “tomorrow may be my day.” Recovery begins now. The only time in reality is now, Change occurs in the now. And then it is our job to get to the next right now. The concept of changing forever is tough. But to consider changing for just right now, is often a digestible amount.
After engaging into treatment, when asked “how long will I need to be in treatment,” I say, “I don’t know.” Upon becoming stable, we must allow for chemical changes to occur within ourselves to allow for the other necessary changes to commence. These can involve physical, mental, emotional, legal, occupational, educational, social, spiritual, environmental, experiential, etc. This phase I call “cleaning out our closet.” We reorganize, declutter, inventory, and choose what needs to stay and what needs to go from our life. Since everyone’s backstory is different, the time it takes to gain traction in a new direction and sweep up some of the collateral damage from a lifestyle of addiction can take a minute. Bottoms are relative. How far it takes to bounce or climb up from yours is yet to be determined. As we say, “recovery is not a sprint, it is a marathon.”
About the only definite I can commit to in any form of recovery is that a year is a good place to start. Whether it is recovering from addiction, a health issue, divorce, or other traumatic event, a year is a solid timeline to plan on. The reason is that within a year, you will encounter every holiday, season, anniversary, and occurrence that may come across your radar that can pose a challenge. The anniversary of the death of a loved one; perhaps a bleak grey winter like we have here in Ohio. Your first football season without drinking or using your drug of choice. Triggers present in a variety of ways so a year gives you a broad enough set of encounters that will show you where you are. The storms show us where our leaks are. The second year, we can reflect. What did we do correctly? Where do we need to patch the leaks?
The final answer is “forever.” Yes, we can say that we are in recovery forever. But recovery is also a philosophy. Will you be on a medication forever? Will you go to meetings forever? Will you be tethered to professionals forever? I don’t know. What I do know is that recovery is a philosophy. It is a dynamic, ongoing, evolving assessment of one’s wellness and needs and concern with dealing with the onslaught of stimuli that can nudge us in a positive or negative direction. We develop filters for our thoughts. We learn to realize that substances only blur the situation and not remove it. You will be in recovery forever. But from that, I mean in a broader context that the situation that brought you to recovery should serve you by raising your awareness of your need for certain protections. Being “sober” is not abstinence from drugs or alcohol. It is clarity of thought, concern for our wellness, concern for those we encounter, awareness of what does not serve us or cause us harm, and a genuine quest for a growing sense of authenticity. It is not the sum of the results in your urine screen.
So, recovery is now, it’s unknown, it’s next year, and it’s forever. Don’t get hung up on the time but what you can become as a result of what you have gone through. Use the tools and the people at your disposal and prepare for a change that can be extraordinary and take you to new levels. But as the young man that called this morning did, and if you do nothing more, pick up the phone. Begin your own comeback story.
Written by: Anthony Anders, ADC, LCDC-III Chemical Dependency Counselor
In short, it’s not easy, but it’s not impossible. Addiction is a family disease where the loved ones are often caught directly in its blast radius. Addiction rarely just happens overnight, but it will insidiously infiltrate a family over time to where it gets all within its grasp in some way. It is not just the addict who can use help in making some changes.
Loving someone in addiction (as well as in recovery) is often off-balance due to the circumstances of recent behaviors. Many find that loving someone in, or attempting, recovery is counterintuitive to “normal” relationships. Many skills do need to be learned to get on the road to wellness. We often do not see the problems that have, over time, become just a typical day in traversing chaos and disruption.
Here are a few tips in dealing with loving someone who is in our lives dealing with the problems associated with addiction and trying to gain traction in recovery:
Written by: Anthony Anders, ADC, LCDC-III Chemical Dependency Counselor
“All you have to do is quit using drugs and your life will automatically be better.” Sorry, but no, it is not that easy. True, a major life barrier to wellness will be removed, but that is where the work begins. Drug use is often symptomatic of a deeper underlying issue. In my years as a counselor I have yet to hear anyone say, “Ever since I was a young child, I wanted to find something that would destroy my life and hurt everyone close to me.” But it happens.
As a counselor, I was trained and understood that my job was solely to deal with talking about cravings, medication compliance protocols, and if a relapse had occurred (in a nutshell). What I have come to realize is that there is a myriad of elements permeating one’s life that brought a person to a life of addiction, and until they are managed or eradicated, or new coping mechanisms to these elements are established, a return to chemical incarceration is probable if not imminent.
I work with people in seven broad wellness sectors that help people uncover issues and make plans for the recovery journey ahead. I truly believe “the storms show us where our leaks are” but we must have ways and cohorts who can help us patch these leaks. These sectors help people divide and conquer as well as see the separate influences on our overall wellness that was once so compromised. This way too, after abstaining from drugs, we are able to see a dynamic way to observe certain influences that need our continual attention and restoration.
Physical Wellness: This is where the drug abstinence starts. We need to address the deleterious conditions we are subjecting our body to for overall wellness to have fertile ground to grow. Along with that, we must also explore physical conditions that may have occurred as a result of neglect (e.g. diet/nutrition, dental) as well as medical conditions posing greater threat (e.g. Hep-C, HIV). Physical wellness can include, diet, nutrition, medication, supplementation, exercise, and a variety of avenues to help people on the journey back to health.
Mental/Emotional Wellness: Drug often diffuse mental health issues and make it challenging to discern an underlying issue that has lurked for some time or one that may have been exacerbated by an ongoing substance use issue. This sector may need added layers of supports and therapies and can often be crucial to assist someone in galvanizing a recovery plan that will remain effective.
Social Wellness: New people and new places. Is the person isolating or among powerful influences? Are these influences positive or negative? This sector also explores the health of the family unit overall and interactions of the patient in recovery. It can be hard to get or feel well when the social environment is polluted and not suitable for the needs of a person trying to get their footing in recovery or treatment.
Spiritual Wellness: This element can trip people up. Religion and its practices are a difficult topic for some, but to me, when embarking on recovery, spirituality is about reconnection. It is about exploring one’s beliefs and philosophies. It is about finding peace and a place. Where you sit on what day of the week to do this, what book(s) you read, and things that inspire you are part of your own personal journey. The key is to seek truth and awe and is a long-term, and very personal relationship.
Environmental Wellness: The actual locality of where a person tries to recover is paramount to their recovery. To try to grow and thrive in the same polluted environment can be a lofty goal at best. This can require simple tidying, remodeling of one’s living space to a total relocation if necessary. But triggers can lurk in very clandestine ways, so giving a face lift and strong consideration to how and where one lives and/or spends a lot of time (work, school, home, etc.) can greatly impact outcomes.
Occupational/Educational/Contributional Wellness: Having purpose or a raison d’etre helps in our recovery navigation. Yes, having a job/career is essential for certain resources, but this does not mean that the unemployed or unemployable are without promise or merit. If not a job, I ask is there a way to contribute or volunteer? Can a person grow in the contribution in their own home as they move toward their redemption? Are there skills the person has always wanted to learn. Perhaps not one of the initial factors we explore, but in ongoing recovery this is important and many find that their pursuits turn to more altruistic of motives as well.
Experiential Wellness: I always have said that recovery gives us “a chance to do everything all over again for the very first time.” We can see the world through a new set of eyes. But new experiences, travel, relationships, tasks, and hobbies to name a few, can spark new connections not only in our brain but in ourselves as a whole. I tell people, “When you are green you grow, when you are ripe you rot” and to get out there and experience a new world in recovery. Addiction and drug use robs people of anything that impedes the continual and voracious feeding it requires snuffing out the luxury of new experiences. Recovery bestows that right back to us and it is up to each person to reach for it.
Giving up drugs is the excavation, but what we build as a new life in recovery is where the work begins. I try to show people how even though one sector may be thriving, this may free up attention and energies to address others. Recovery is ongoing. It is dynamic. And recovery is a philosophy of authenticity, growth, exploration, and expansion. When a person in recovery gives up what used to be the world, a suitable replacement must be waiting in the wing. I feel by exploring the sectors of ongoing wellness is definitely a good place to start.
* If you or a loved one is interested in recovery, make sure you inquire about counseling and the peripheral supports offered to help the individual and their family get the help they need!
Written by: Anthony Anders, ADC, LCDC-III - Chemical Dependency Counselor
The short answer is “no.” It is giving medicine to drug addicts. I wish I could stop here, but since this assumption is rather rampant and withholding this information or access to these medications is costing people their lives and increasing family suffering, I felt compelled to elaborate.
Buprenorphine (e.g. Suboxone, Zubsolv, Bunavail, etc.) are very effective tools in helping someone deal with opioid addiction and dependency. It can be a controversial therapy to use a medication that contains some of the components of the crisis it addresses. For the sake of staying on track, you can research the DATA Act of 2000 and the resulting literature for more on how approving this therapy surfaced to mainstream.
Here is the deal; opiates are a viable treatment for certain types of pain in certain types of individuals. I am not a doctor and will leave more in-depth arguments for their use to the trained physicians, but they are indeed useful in some situations. However, if not properly obtained, prescribed, managed, and secured, bad things can happen. Very bad. (The same with other medications and substances.)
Buprenorphine acts upon the receptors affected by opiates by reducing the incessant internal screaming and agonizing gnawing that an addict feels as a call to feed an ever-growing insatiable hunger. (Writing that last sentence has now prompted me to write an essay about what withdrawal feels like – but that will take a minute to attempt to create.) Back to the topic at hand. Buprenorphine helps reduce the withdrawal symptoms the addict feels that allows for a reprieve from the physiological and psychological/emotional distress that prompts the observable behaviors noted in the diagnosis. In short, the medicine allows for people to begin working on their “come-back.” The medication is not the salvation – the un-impaired efforts and repairing cognition of the addict in recovery over time is where the results lie.
That being said, this is why accountability, counseling, measurable strategies, multi-modal approaches to care, individualized plans, and a journey free of stigma and misinformation are paramount to a person’s success. Without these, results are pale at best.
I liken giving a patient Buprenorphine without counseling and the above supports similar to giving a person suffering from diabetes insulin without ongoing medical monitoring, dietary coaching, speaking to them about changing their diet and thoughts about food, how to cope when dining socially, how to deal with cravings, and adding other supports to leverage their successes over time. It is criminal and a shame in both cases.
You see, we often blame a medication for the poor observed results of some, or we are not holding people and facilities accountable for offering the whole package that is so desperately needed to see progress.
Buprenorphine, like other certain medication are indeed a “crutch.” But, if you broke your foot, you would need crutches for the early convalescence needed to heal or to embark on a new phase of recovering. Then you may go to a single crutch, a boot, then physical therapy, walking, and then eventually you run again. If you remain on the crutch after the foot heals or too long in a certain phase, you impede progress, impose fear, and the “foot” atrophies worse than before the break. Same principle applies to buprenorphine therapy. This is again why objective measurable therapies from layers of trained people are needed. Buprenorphine, again, is only a tool. A necessary tool for some in dealing with the opioid crisis.
As treatment providers, we need as many options as we can get at our disposal since this disease is so multi-faceted and complicated. It helps us by having medications, facilities, 12-step support groups, and other therapies and organizations that we can choose from as there is no one-size-fits-all program. If one thing falls short, we have options. We need to engage people in an ongoing continuum of care that is flexible to meet the needs of every individual we see. Buprenorphine is the not the problem people think, yet, not addressing certain harmful behaviors listed above and needs not being met by qualified professionals are where people’s concerns should lie.
Help us put stigma and misinformation to rest as we work on helping other’s achieve their ultimate comeback.
Your shares, likes, and comments are appreciated!
Written by: Anthony Anders, ADC, LCDC-III - Chemical Dependency Counselor
I hate hearing people exclaim that “addicts are where they are due to their choices. Or, “It’s not a disease, it’s a moral failing.” I have as much trouble with hearing that now as much as I did when I sat at the edge of my own bed in treatment dealing with my own situation. Being told I had a disease did not sit well. I thought, “A disease is like cancer, or diabetes, addiction is something else.” “Addiction is bad people doing bad things.” It is not a bad person who needs to get “good, “ it is a “sick” person who needs to get healthy.
As I moved forward in working on myself, as well as getting my degrees in Mental Health, Addiction, and Psychology with a concentration in addiction, I became aware of the importance of dissecting some of these terms in helping both the addict and those on the periphery in coping with the complicated subject of addiction. I came to realize that people will often gaze upon addiction and alcoholism through the lens of their own personal experiences. For example, if someone were raised by an abusive alcoholic, then all alcoholics will seem like abusive a-holes. If one had a heroin addict in their life who was stealing to support their habit, then all opiate addicts are thieves. I realized I had some work to do.
I first started by looking at the definition of “disease.” Merriam-Webster’s Dictionary offered this:
“A condition of the living animal or plant body or of one of its parts that impairs normal functioning and is typically manifested by distinguishing signs and symptoms.” (Merriam-Webster Dictionary Online)
This put my mind at ease as I have come to realize the term “disease” itself is broad enough to encompass the broad array of that which it defines. Addiction does involve impaired functioning and does have its signs and symptoms. So, my recommendation is for people to not get so hung up on the diatribe of whether or not it is a “disease” (it is) and move on to either help someone else who suffers or to galvanize their own coping whether in dealing with it personally or socially.
People compare addiction claims to cancer or diabetes thinking that [addicts] unfairly juxtapose themselves to these groups of individuals, but let’s look a bit deeper. Certain behaviors can create disease. Take cancer for example. There are internal or genetic causes that may prompt the onset of these diseases. True. But there are other portals for disease to occur.
In the case of lung cancer, it can happen in a variety of ways, but let’s look at smoking for the sake of argument. Smoking is not the disease but the potential cause. Smoking introduces toxins that impair healthy cellular function which causes the fertile ground for cancer to develop (very short description to make a point). Smoking (the behavior) triggers pathological organ changes that result in the disease state of cancer.
Also, since people like to compare, if you are a smoker, put down your cigarettes right now. Just stop. Been there. It’s kind of hard isn’t it? Chemical dependency is chemical dependency. The level of withdrawal and other insidious behaviors are only indicative of the ingested drug, but if you want to quit and can’t, it is still addiction.
Similarly, since many bring up diabetes in their argument, poor diet and sedentary lifestyles (behaviors) can prompt the conditions that allow diabetes to develop (the disease). I use these examples to show how it is hard to sterilize this down into simple definitions, and yet one that will sit well with all people. Let’s just say, or be open to digesting that using drugs or alcohol (to the point of chemical dependency) is a behavior that creates changes in the body that becomes a disease. The word “disease” is not an excuse, just a definition that many do not quite understand. (Plus, diseases can go into remission, but that is another conversation.)
As I did use the word “behavior,” I must pause for a moment to show the dichotomy between the words “choices” and “behaviors.” In my years as a chemical dependency counselor, I have yet to find anyone who has sat on my couch saying that, “Ever since I was a young child, I wanted to find something that would harm my health, take my money, cost me jobs, ruin relationships, put me in jail, and possibly kill me.” If you are to ask most any young child, they are probably aware (in today’s age) that drugs are bad.
I firmly do not believe that people “choose” their current lot. Choices are often decisions we make with many facets that can determine how we come to conclusions. Our age, environment, health, upbringing, culture, etc. are just a few of the many influences. When one may, for the first time, “choose” to take a puff, a sip, a pill, or whatever, the choice at the time is influenced by many factors that may make this snapshot decision in time seem like a good idea (even if devastatingly bad in the future). “I just broke up with my girlfriend, so yes, I will take a drink”, “My foot is broken, and the doctor gave me these pills as medicine,” “I want them to think I am cool at this party so I will take a hit off the joint.” I use this example in both embarking into, and recovering from addiction, “If you are on a rowboat in a lake, a one inch nudge of your rudder can take you to a while different part of the lake over time.”
I think we have all made decisions at one point that may have gone south, cost us a job, a marriage, health and friends, even our freedom. At the time of the decision, whether it be for self-soothing, retaliation, immediate gratification, or immature ignorance, it “nudged our rudder.” The thing with drugs is we have then introduced something that can chemically alter our brain likened to giving the keys to your car to a hijacker that promises to get you home safe (Rarely is “home safe” what you get.)
Another comparison - if our regular computer gets a virus, the virus corrupts the operating system - bad data comes out, a system crash occurs, or it is rendered inoperable. Our brains are, in essence, a chemical computer. If we download a virus (drugs/alcohol), we spew bad thoughts and behavior, we crash or can be rendered inoperable with our operating system corrupted. We then, as do our home computers, need an “antivirus” (detox, medication, etc.) and then to put up a “firewall” (counseling, rehab, support groups, etc.) so it does not happen again or at least reduces risk. The same brain that tries to abstain from using is the same one screaming, “Feed me!” Brain chemistry trumps will power, morality, character, and sadly even love every time until the chemicals are eradicated and failsafes introduced.
So, yes we observe people using. We see a behavior. A chemically-driven, very complicated, convoluted, behavior that results from perhaps a combination of genetics, environment, exposure, trauma, and bio-pharmacology that can prompt a decision to use something that, over time, results in addiction/dependency to a substance that impairs the brain to a diseased state that distorts reality and succumbs the individual to a rapacious internal drive to feed on that which can eventually kill the host. (Whew!)
I emphatically do not believe active addiction is a “choice.” It is something that occurs from a variety of impacting forces that can cause people to make decisions to engage in behaviors that over time trigger dependency to where escalated and repeated use creates a diseased state in our brains that allow the brain to take over in a behavior that can cause self-destruction. (Whew, again!)
If nothing more, let’s bypass arguing over disease vs. non-disease (it is). Let’s separate observable “behaviors” from “choices” (they are different) and at least agree that there is a problem out there. Let’s agree to protect ourselves and those we love with good information and be proactive in protecting those we care about and our communities. Be open to being open. And if we can prevent a disease in some way, let’s do so by making the choice to engage in good behaviors by seeking help from those who can.