John was addicted to Norco (a pain pill that contains hydrocodone the same opiate pain killer found in Vicodin), taking up to 30 daily. He started drinking heavily to cope with the feelings he would get when he could not get enough Norco. Things finally collapsed when the police stopped him while driving intoxicated. He was sent to a hospital for three days to “detox” off his pills and alcohol and then referred to “rehab” for a 2 week stay. While there he participated in groups, ate well, and bided his time until he could leave California sober living. He had to admit that he was an addict. He continued to have withdrawal symptoms throughout his stay.
He scored drugs on the way home from the rehab center and was careful to go to all the meetings and group sessions that were required by the courts. When a urine test shoed him to still be using, he was sent through detox and rehab again, with similar results, although this time he really tried to stay clean and was successful for 6 months before relapsing.
This story describes the lives of many addicted persons in our society. They are not “Bowery Bums.” They are middle and upper class folks, who suffer from a deadly condition that is resistant to treatment. In fact, about 15% of the population suffers from some type of substance dependency or abuse (not counting smoking).
The typical detox/rehab system that John experienced has a success rate of less than 15%. Yet the response to failure is to put people through the same process again and again. Repeating something over and over, and expecting a different outcome has been described as a form of insanity.
What’s wrong with the Detox/Rehab Cycle?
The current predominant system of treatment stresses the social aspects of this all-encompassing problem. The usual treatment is to “go to “rehab”. While this is differs from place to place and program to program, what usually happens is that after medical “detox”, the affected person is sent to a residential program of varying length and luxury or is sent home to a relatively brief outpatient program. After this, the person is released to their previous life and lifestyle to be supported by local 12 step programs, like Alcoholics or Narcotics Anonymous (AA and NA).
This assumes that once an addicted person gets through the first few weeks off their drug they eventually return to normal. This is a fallacy. The withdrawal symptoms, such as depression, anxiety, fatigue, and muscle aches, and can go on and on, sometimes indefinitely. (This is a HUGE problem with methamphetamine use). This condition is called the Post Acute Withdrawal Syndrome (PAW). In addition, there are psychologic triggers for cravings that can themselves cause the return of these physical symptoms. Eventually, almost all of these people succumb and restart using. Here’s why..
1. It fails to recognize and treat the brain disease that causes drug cravings using amazing new medical advances, including the Prometa protocol and buprenorphine (Suboxone)
2. Most detox-rehab programs don’t diagnose and treat underlying psychiatric conditions such as depression, anxiety, and even bipolar disorder. The usual medications used to treat these problems may not help addicts and may actually make the problem much worse.
3. It fails to analyze each person’s individual situation and to work with him or her to realize the extent of his or her problem. Addiction counselors should use tools like the Readiness to Change Quadrant Evaluation and then follow up with advanced counseling techniques such as motivational interviewing.
4. Most detox-rehab programs do not effectively evaluate and treat the nutritional aspects of substance abuse using a variety of supplements that vary from person to person.
5. The current detox-rehab cycle does not include treating alcohol and drug addictions on an ongoing and personal basis for at least a year using the Recovery Maintenance Model.
6. Current detox-rehab programs allow addicted persons to return back to their homes and lifestyles after the acute treatment is completed without modifying their environment.
7. The treatment is for “Substance Abuse” and everyone gets basically the same treatment regimen. The person must admit that they are an addict and submit to the program’s mandates, even if they do not buy into the process. Many folks do what John in the story did. He “shined it on” until he could get out. Others check out early and return to using very quickly.
Abstinence based programs that keep patients in residence for a specific period and then have them go back to their prior lifestyles are doomed to fail.