Treating Addiction: What works?

I have what some may think is a unique perspective when it comes to knowing what works when treating addiction.  I figure my addiction started when I was 12 years old and I discovered that food comforted me emotionally.  At 15 I found alcohol and that was the beginning of a 15 year run of alcohol and drug addiction for me.  At age 30 I found recovery.  I didn’t just happen upon it.  My family organized it for me.  My mother called an interventionist and got the ball rolling.  This is how it happens for most addicts; someone who cares about her “gets the ball rolling”.

I know addiction from the inside out.  I have been an addict in recovery since 1994 and I have been treating other addicts professionally since 1995.  I have studied and acquired degrees, certifications, and credentials  in counseling, gambling addiction, sex addition, intervention, and chemical dependency.  I have worked in detox units, residential treatment programs, outpatient treatment facilities, and in private practice.  I have worked with addicts who are indigent and homeless and wealthy, successful, and high profile.

Addiction runs a predictable course, no matter who you are.  Addiction is chronic, progressive and fatal.  I have kept a list over the years that I affectionately call “Dead Addicts”.  That’s it, “Dead Addicts”.  That is how we addicts end up if we don’t get in to recovery, it is that simple.  On my Dead Addicts List I currently have 21 names of addicts I have know who have died in their disease.  This list motivates me.  It motivates me to stay clean and sober personally; and it motivates me to never stop trying to help other addicts recover.  Every time an addict dies I say the same thing, “That was not necessary!”.

It is not necessary because we know how to treat addiction.  And it works!.  

The initial change necessary to heal addiction is best facilitated in an inpatient or residential program because outpatient treatment requires a high degree of internal motivation on the part of the addict.  He must be willing to change everything he thinks and everything he does.  Everything.  Not some things, not most things, everything.  And this kind of change does not occur overnight.  It takes time and internal motivation, and an inpatient or residential program can provide the 24 hour support necessary to prevent relapse during this time.  We want to prevent relapse because a relapse can be the demise of the addict; he may die on this run or the next.  Or the relapse will instill an even greater sense of hopelessness and he may never again summon the motivation to get clean – and ultimately he will die in his addiction.  This is why an intervention from family and friends is most always necessary to help someone get into treatment.  An addict is always motivated by some external consequence to get help – the wife is leaving, he is going to get fired or already has, he his homeless, the judge court ordered treatment, he is going to jail for his 2nd DUI, his liver is failing, his family has facilitated an intervention and will no longer enable his addiction, etc –  the internal motivation for recovery doesn’t come until the addict has had some time in sobriety and recovery to get a clear perspective on things and find some hope.

Here is the recipe for recovery:

90 in 90.  Go to at least 90 AA or NA or whatever “A” speaks to your problem meetings in 90 days.  That means at least one meeting per day for at least 90 days.  While you are there, buy an AA Big Book or NA Basic text and read it.  Find a sponsor and start working the 12 Steps.  This isn’t rocket science, you could almost teach a monkey to do it.  So there are no excuses, just do it.  I’ve never met anyone too stupid to recover, I have met a lot of people too smart to recover.  These “smart” folks think they don’t really need to do “all that”.  They can “get it” with less effort.  Several of these “smart” people are on my Dead Addicts list.  If you have an issue with 12 step recovery, I encourage you to just put it aside and go to meetings.  12 step recovery just works, the science says it is because of the belonging, acceptance, and community that this method offers.

Change your playmates, playgrounds, & playthings. This means don’t hang out with the people you used to drink or use with, don’t go to the places you used to drink or use, and get rid of the paraphernalia and other items that represent your alcohol or drug use.  So, dispose of those Jagermeister T shirts, you don’t need that Budweiser neon sign anymore, give away the vintage wine collection, your shot glass collection goes too.  No exceptions.  That is the first half of it.  Remember that change means you let go of something old and replace it with something new.  You have to find new playmates, playgrounds, and playthings.  It is important to recognize that in between letting go of the old, which needs to happen immediately, and forming new relationships and habits there is a lag period.  You will feel lonely and empty during this lag period.  Expect it and prepare for it.  If you are in treatment and /or going to at least one 12 Step meeting per day that will help a lot with the lonliness.

Detox the first 3 to 5 days.  You have to detox in a safe manner.  Alcohol and benzodiazepine drugs require a medically supervised detox.   Acute withdrawal from these substances can be fatal if not treated professionally.  But everything else can safely be detoxed without 24 hour medical supervision.  Even opiates.

Next, secure a safe & sober living environment.  A residential treatment program, your home or the home of a relative can work if it is truly a sober environment consisting of people who support you in doing everything you need to do to recover.  If you do not have this type of built in support there are sober living environments available.

Find a sober support group you can spend at least 6 hours with daily, anything less will not suffice.  If you are living in a sober living home or treatment center this is already taken care of.  If you are living in your own home or the home of a relative it means you will need to spend at least 6 hours every day at 12 Step meetings and with other recovering addicts.  This may sound like a lot to manage.  But once you start going to meetings you will understand that the one hour meeting most often continues at a coffee shop afterward.  Or you spend an hour talking with your sponsor before or after the meeting.  Or you hang around the Alano Club (Alano Clubs are dedicated 12 Step meeting places that are open all day and accessible between meetings) and meet with other recovering addicts who help you learn how to stay clean and sober.

You must maintain your recovery for the rest of your life.  Recovery will forever be priority number one. This is not difficult once you have developed a foundation for living a clean and sober way of life.  If you work a diligent and complete recovery program your first year, you will develop a strong foundation that will carry you the rest of your life.  If during the first year you establish friendships and relationships with sober people, you secure a job that supports recovery, or you start school that will set you up in a career that promotes recovery, and you live in a safe and sober environment these things will lay a foundation upon which you can build a healthy, happy, clean & sober life.  I was recently sitting around my dining room table with 10 other recovering addict friends enjoying a New Years Eve meal.  We spontaneously polled this group of addicts who have been clean and sober for 4 to 32 years.  Every one of us began our recovery by attending 90 meetings in 90 days.  We all changed our playmates, playgrounds, and playthings.  This is not a coincidence.  It isn’t exactly a clinical study either.  But it is certainly noteworthy!

Let me say a thing or two about 12 Step Programs.  12 Step Programs work.  Anyone who tells you otherwise has not worked a program diligently and completely.  AA (Alcoholics Anonymous) was the founding 12 step program.  It began in the 1930’s and has been successfully helping alcoholics get sober and stay sober ever since. In the 1950’s NA (Narcotics Anonymous) began to help drug addicts get clean and stay clean.  Then in the 70’s CA (Cocaine Anonymous) came along.  Through the years all kinds of addiction has been treated with a variance of AA’s program.  The 12 steps treat addiction of any kind.  Gamblers, sex addicts, cigarette smokers, food addicts, and the list goes on – have all found freedom and recovery with the 12 steps.  The 12 step program is the only method that has consistently over time achieved positive results with treating addiction.  If something else worked better, the treatment industry would be pushing that.  But nothing else has ever worked as well, consistently over time, as the 12 Steps.  If you’ve tried AA before and “it didn’t work” – I suggest to you that it probably wasn’t AA that wasn’t working.  It may have been you who wasn’t working the program diligently and completely.  So give it another try.  Approach it this time as if your life depends on it, because it does.

As I mentioned in the first paragraph, it is typically a family member who “gets the ball rolling”.  Every recovering addict I have known got clean and sober because it was someone else’s idea.  The nature of the brain disease of addiction precludes the addict from being able to help himself.  An intervention from outside the addict must occur if an addict is ever going to recover.

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