like a diabetic would like to avoid the need for dietary restriction and insulin, this is no longer a viable option.
Some studies show that “just stopping” actually works for some people. There is a small subset of people who do just stop on their own. It’s called “spontaneous remission.” In most cases, however, it takes a “wake-up call”; often some sort of “spiritual event” to get them to stop using drugs. And by spiritual, I don’t necessarily mean a religious experience.
It could be that a person suddenly wakes up from an overdose or a car accident resulting from being impaired, with paramedics standing over him, while he’s on the gurney, and he’s close to death. Or she wakes up in the emergency room. Or his wife leaves, or she gets fired from her job, or something similarly traumatic. Something has thoroughly shaken them up. And that something is frequently enough to motivate people to rethink the course of their lives and look at their use of alcohol and other drugs more openly than perhaps they have ever been able to before.
Once people stop using, the challenge is to stay stopped, and for most that involves engaging in the process of recovery. Many people need a support or mutual-aid program to accomplish this. The most popular support groups for addiction are found in the various twelve-step programs. Twelve-step programs—Narcotics Anonymous (NA), Alcoholics Anonymous (AA), and others—are the longest-standing mutual-aid/support resources for people struggling with addiction, and represent a spiritual (as opposed to religious) approach that has helped millions of people achieve and maintain recovery.
However a spiritual approach to recovery doesn’t resonate for some people. Some people prefer Secular Organization for Sobriety (SOS), other people go to Self-Management and Recovery Training (SMART), while others go to LifeRing or Rational Recovery. Some women derive benefit from another group called Women for Sobriety (WFS). A number of support groups are available that help many people.
An important point to remember, if you yourself are in recovery, is that your role as a counselor is to help your client recover from addiction. Occasionally, counselors in their own recovery experience some confusion between their role as professionals and their personal recovery. There is the potential for these roles to bleed into each other, but it is critical to maintain the boundaries between them. Counseling is always about the client and his or her individual needs. Remember that everyone is different. Perhaps for you, abstinence-based treatment and twelve-step-oriented recovery has been a great fit, but for your client it may be different.
You have to work with your client as an individual. Certain clients may be better off with Suboxone or methadone maintenance, or maybe they are extremely uncomfortable with the central role of a Higher Power in twelve-step programs, and an SOS support group would be a better fit for them. There are a lot of treatment programs that are twelve-step-oriented, but you can’t tell clients that “it’s either twelve-step participation or nothing,” because it’s not the only answer—and if you think it is, you’re in the wrong profession.
You’re going to read a lot more about this later in the book but for now, keep in mind that if you are going to be an effective counselor or therapist in this field, you need to be aware of all treatment and recovery-support options: those that are twelve-step-oriented as well other support groups, in addition to all the new medications for addiction that are coming out every day.
Twelve-step programs began with Alcoholics Anonymous in 1935 and expanded with Narcotics Anonymous in 1953. Since then there has been a proliferation of other twelve-step programs that relate to various manifestations of addiction and to other areas, including but certainly not limited to Cocaine Anonymous, Crystal Meth Anonymous, Nicotine Anonymous, Gamblers Anonymous, Neurotics Anonymous, etc. There are also multiple subgroups within some twelve-step programs. For example, in AA there is a group for lawyers, called the Other Bar; a group for airline pilots called Birds of a Feather; one for physicians called Caduceus; and one for police officers called Peace Officers Fellowship.
There are many different potential routes to abstinence. As I noted previously, there are some people who can stop by themselves without treatment and without ever going to a support program. Some people need treatment and participation in a support program. Others go to treatment but never participate in a support program, while others never go to treatment but participate in a support program long-term, and others may participate in a support program for a period of time, get the hang of it, not go back, and never use again. Some who leave support programs will return from time to time when they feel they again need the support/mutual aid, or after they relapse back into active addiction.
Some people go to AA or NA for the rest of their lives. Others go for years before deciding that they have their addiction under control so they stop, and many end up using again. It’s like chemotherapy for cancer. AA/NA is like their medication, their chemotherapy. If they don’t go, they often relapse, maybe not right away, but later if not sooner.
Even when addicts achieve stable abstinence and have time in recovery, they remain at risk. Research has shown that significant changes in brain functioning can persist long after drug use stops. In other words, the brain is not the same as it was, which is why addicts can go through a detox program, and then go on to complete treatment, remain abstinent as years go by, and then decide they can drink again. Within a very short period of time, they end up right back where they were when they stopped. This is evidence of disease progression. The brain is the same addictive brain—once “pickled” it is always “pickled,” and that pump is permanently primed. The first subsequent use of alcohol or other drugs can trigger a rapid return to active addiction.
The progressive loss of control that occurs in addiction is a very real, palpable phenomenon that does not differentiate based on financial status, job, race, religion, or gender. You can have a captain of industry, like someone who runs a Fortune 500 company, who went to Yale or Harvard, or is a senator, or a professional athlete who is brought to his or her knees by addiction. These are people who have been in control of everything around them for most of their lives. They may have millions of dollars and live in luxury homes in the most desirable, upscale communities, but then somebody introduces them to an addictive substance such as prescription opioids, cocaine, or crystal meth, or they get increasingly caught up in using whatever it is they can’t control. The more willpower they try to use, the harder they work to control it, the more they end up losing control.
They can’t control it because attempts to control behavior use the thinking part of the brain, the prefrontal cortex, as addicts try to think their way out of addiction. But thinking one’s way out of addiction is not possible because drugs of abuse target the midbrain (the so-called reptilian brain, below the cortex, which operates at a level beneath conscious thought). As a result, a different approach is required.
Sometimes patients will arrive and explain that they have their own ideas of what will work for them, and if it (whatever configuration of appropriate treatment, mutual aid/support group involvement or medication they may have in mind) does work for them, that’s fine. The problem I have is when patients come in and say, “I don’t want to go to AA/NA. I don’t want to go to the rehab program. I don’t have to see a therapist. Just detox me and let me go.” I say, “That probably isn’t going to work. You’re probably going to be right back here again in a month or two.” And their response is “Oh, no, I’m going to be fine.” And then they’re back again two or three months later, and this will go on and on.
Then there are the patients who are taking medications and they stop taking them because they think that the medication that they’re taking to help with their addiction is having an adverse side effect. One thing you learn in medicine, and it’s not just with addiction medications, it’s with any medication, is that with some people the medication is going to work effectively while others are going to get hives, a rash, or vomit. In short, they can’t tolerate the medication. Whether it’s an addiction-related medication, a blood pressure pill, or a diabetic medication, there is a lot of trial and error involved
