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Monday, September 9, 2013

Isolation and Trust: Are Recovering Addicts In a Closed Society?

"It is a truism that substance abusers are a heterogeneous group, and this is certainly true about their ability to relapse, as a significant minority appear to succeed with any treatment effort."

 (Frank M. Tims, Ph.D. and Carl G. Leukefeld, D.S.W. "Relapse and Recovery in Drug Abuse."
Division of Clinical Research. National Institute on Drug Abuse.
 NIDA Research Monograph 72 1986)

High relapse rates among substance abusers remain old news. Relapse (defined as resumption of substance abuse following a period of abstinence) is the rule and not the exception in substance abusers entering or completing treatment. Numerous studies have documented that high relapse
 rates prevail across classes of substances.

For example,  a 1998 study by the Substance Abuse and Mental Health Service Administration (SAMHSA) found that common relapse rates were incredibly high, though they varied significantly by the chemical of choice. The worst results were in those chemically dependent on heroin, with relapse rates of 87 percent after drug treatment. Crack experiences the second highest relapse rate with nearly 84 percent of crack users returning to use, as compared to just over half of cocaine users (55 percent). For all narcotics taken together, including legal pain pills that are abused, the relapse rate within five years is 69 percent.

Questioning Trust of Addicts Seeking Recovery

As in any cooperative alliance, the members of the recovery community feel an intimate link of confederacy. They have a very strong comradeship as they share personal understandings and experiences of what it means to be an addict. This strong connection is beneficial and has certainly saved countless lives. Yet, I contend many addicts trust only those who have also suffered through addiction, and, within those limits, there exists a significant problem.

This attitude that persists throughout recovery isolates those recovering. It serves to deny them more access to help and more widespread distribution of essential research that allows the public to understand addiction, both the nature of the condition and its treatment.

I have been close to many addicts as a part of a citizenry attempting to comprehend the nature of a health epidemic, and I have sensed that many of those in recovery view me as "an outsider looking in." I see many struggle and rely upon each other to prevent relapse. In my experience, I question how much faith they put in the general community that inevitably must embrace their successful return to society.

There exists a distinct gap of trust between recovering addicts and the majority of the public. How much of this may be due to the recovery community viewing itself as a "closed group"?

A old research study conducted in Boston at East Boston methadone maintenance treatment program in the 1970s concluded that with any substance or process addiction, the drug or behavior in itself is not addictive, but rather the result of a meaningful relationship between a person with the addiction and the object(s) of his or her addiction.

One important message that may be drawn from this early study is that understanding drugs and behaviors may not equip a person with significant practical insights into addiction. Instead, it requires exposure to the drug(s) -- "the object(s) of the addiction."  A mantra surfaces: "Only an addict can truly understand how to help an addict on his personal road to recovery."

All addicts know experience intimacy with substances, a relationship many of them believe can only be understood by being addicted. I believe this attitude is simply not true.

To illustrate my point, let me contrast this view with the fact that now most medical professionals believe that addiction is a progressive disease and psychiatric disorder. Addiction, as defined by the American Society of Addiction Medicine, is "a primary, chronic disease of brain reward, motivation, memory and related circuitry characterized by the inability to control behavior." It creates a dysfunctional emotional response, and it affects the users ability to abstain from the substance or behavior consistently.

(Stuart Gitlow. "Addiction Society of Addiction Medicine."
Addiction Society of Addiction Medicine. 2013"

Researchers argue that the addiction process is like the disease model, with a target organ, a defect, and symptoms of the disease. In other accounts, addiction is a disorder of genes, reward, memory, stress, and choice.

(Berridge, K. C., & Robinson, T. E."What is the role of dopamine in reward: Hedonic impact, reward learning, or incentive salience?" Brain Research Reviews, 28(3), 309-369.1998)

If the recovery community does distrust "outsiders" and rely too much upon those in their realm of experience -- recovering addicts -- to guide them to successful treatment, how can these sick people build significant confidence in medical doctors and nurses when they know most of the doctors and nurses have never experienced addiction firsthand? 

Do many struggling from dependency and addiction see these health professionals as "nerdy aliens" without practical solutions? I think so. But, of course, those with other life-threatening diseases comprehend that a medical doctor does not have to suffer from the malady to treat patients and save lives. In my opinion, addicts should not view medical professionals as temporary providers, but rather as long-term healers.

Many counseling professionals are also certified to help those in the difficult process of recovery: alcohol and drug counselors, chemical dependency counselors, substance abuse counselors, and other related addiction professionals. Due to the numbers of those seeking treatment, the demand for  services is staggering and continues to grow. 

Addiction psychology mostly comprises the clinical psychology and abnormal psychology disciplines and fosters the application of information obtained from research in an effort to appropriately diagnose, evaluate, treat, and support clients dealing with addiction. Throughout the treatment process addiction health professionals encourage behaviors that build wellness and emotional resilience. 

I see many ex-addicts hired as counselors and advisers to those in recovery. A significant number of these counselors have been addicted and know the disease intimately, yet that experience is certainly not imperative to having the appropriate credentials to treat addiction. In fact, I believe many so-called "recovery counselors" put too much credence in sharing experience and too little in appropriate recovery education and research. Suffice it to say that treating recovering addicts is difficult, demanding, and stressful

Comradeship and parallel experience is highly valued in these positions. Yet, many of those with past dependencies are still struggling to return to normal. True, most can handle the basic challenges of accepting a workload and adapting to the changes of earning a living, but I wonder how the stressors and emotional demands of their daily encounters play into their lives in the long run.

Every year, SAMHSA publishes data on the statistics of drug rehab programs from facilities that are licensed or certified by the state substance abuse agency.  According to the report for 2005, the number of patients that dropped out of all types of treatment without completing them was 
24 %.  

Another 24% of patients had their treatment terminated or failed to finish because of incarceration or other reasons.  In 2005, it is reported that 44% of patients completed treatment, although it is hard to say whether or not the treatment was successful in the long run.  It is common for addicts to revert back to their old lifestyle if their treatment was not effective.  Some states have begun mandating better recording practices by rehab facilities in order to more successfully treat substance abuse.  

 (Benedict Carey. "Drug Rehabilitation or Revolving Door?" December 22 2008)

The Future?

In 2012, an estimated 23.9 million Americans aged 12 or older were current (past month) illicit drug users, meaning they had used an illicit drug during the month prior to the survey interview. This estimate represents 9.2 percent of the population aged 12 or older. Illicit drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers, stimulants, and sedatives) used nonmedically.

The rate of current illicit drug use among persons aged 12 or older increased from 8.1 percent in 2008 to 9.2 percent in 2012. The rate in 2012 was similar to the rates in 2009 to 2011 (ranging from 8.7 to 8.9 percent), but it was higher than the rates in the years from 2002 to 2008 (ranging from 7.9 to 8.3 percent)

Treatment? Estimates described in this section refer to treatment received for illicit drug or alcohol use, or for medical problems associated with the use of illicit drugs or alcohol. This includes treatment received in the past year at any location, such as a hospital (inpatient), rehabilitation facility (outpatient or inpatient), mental health center, emergency room, private doctor's office, prison or jail, or a self-help group, such as Alcoholics Anonymous or Narcotics Anonymous. Persons could report receiving treatment at more than one location

"In 2012, 4.0 million persons aged 12 or older (1.5 percent of the population) received treatment for a problem related to the use of alcohol or illicit drugs. Of these, 1.2 million received treatment for the use of both alcohol and illicit drugs, 1.0 million received treatment for the use of illicit drugs but not alcohol, and 1.4 million received treatment for the use of alcohol but not illicit drugs. (Note that estimates by substance do not sum to the total number of persons receiving treatment because the total includes persons who reported receiving treatment but did not report for which substance the treatment was received.)"

 ("The 2012 National Survey on Drug Use and Health." 
U.S. Department of Health and Human Services. 2012)

The demand for recovery and the need for improvement in recovery rates is evident. As the health community struggles with these challenges, I ask a simple question: "What can we do to decrease the gap of understanding between those addicted and those who want to help stop the national epidemic of drug abuse?" To me, each army on the right and left of this crevasse seem to distrust solutions.

Without casting the blame for uncooperative interaction entirely upon either group, I still feel obligated to beg those suffering from the disease of addiction to allow others to discuss, to digest, and to understand addiction. It is not an easy task to comprehend how healthy individuals can choose dependency and eventual addiction. This meeting of the minds to save a nation will require complete cooperation.

Drugs, themselves, can contribute to feelings of isolation and rejection. Yet rigorous therapy involves behavioral modification. Without a doubt, the eventual agent of change is the client. The client must take responsibility for working a program of recovery and changing his behaviors.

No matter the protected, isolated environment of rehab and recovery, in the real world, healing souls must eventually deal with people of all kinds and natures. This is the new experience any ex-addict must face and learn to accept. Separate communities of dependents and non-dependents thwart constructive answers to beating addiction.

I don't have to have been addicted to heroin, prescription drugs, or other substances to love and help a person suffering from a disease of addiction that threatens to take his life. Neither do I have to have experienced a hardship or a tragedy to feel apathy for someone struggling with mental problems and ever-increasing dependency on chemicals. If you demand my "badge" of experience before I offer assistance, I guarantee you, you will labor long before finding what you seek. 

"Face your deficiencies and acknowledge them; but do not let them master you. Let them teach you patience, sweetness, insight." 

 --Helen Keller

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