Addiction Recovery Support on the Web

As an Addiction Medicine physician I am pleased that we now have at our disposal several medications effective against the deadly disease of Addiction. That being said, there is much more to Recovery than taking a pill. It is easy for both patients and physicians to become complacent and lazy, not realizing that Recovery is being taken for granted and hangs by the thin thread of the next prescription.

The evidence that medication assisted treatment is far more successful in opioid addiction than group or individualized talk therapy alone is powerful and unequivocal. However, the flip side is true as well. An individual who only takes medication for his/her addiction without the addition of CBT or other psychologically based therapeutic modality will likely relapse and will have a very hard time discontinuing the medications we prescribe as a bridge to sobriety.

One can argue over the value of one type of therapy over another, but the fact is that such therapy – whichever modality you choose - is an important part of Recovery.

An often overlooked component of Recovery is the role of Community. Community is whatever you define it to be. What is clear, however, is that if your community is predominantly comprised of those who abuse drugs or engage in other dangerous behaviors you will have a hard time maintaining sobriety. Yet, giving up “community” is not a good option either as loneliness and isolation are side roads leading right back onto the highway of drug addiction. What one must do instead is to replace your old community with a new one that will support a sober lifestyle.

One can find community in a number of ways – outpatient treatment programs, AA, and NA are just a few options. These communities are location-specific and require an individual to attend an activity in person. This works well for those comfortable in new social situations but what about the approximately 40% of addicts who have some degree of social phobia. The stress of being thrown into that environment may simply be too much, especially early in Recovery when they need as much support as possible.

For these people, the best answer to the question of how to build a personal Community early in Recovery may be those that are found online. With these online communities, the addict can choose his/her level of engagement. He/she can tailor his/her involvement to

what makes him/her comfortable. Hopefully, over time these online social interactions will increase the addict’s comfort level with specific individuals with whom he/she has interacted online. Eventually in -person meetings with such supportive individuals may be possible allowing the addict to engage in sober social activities that would previously have caused significant anxiety.

Online Communities

There are several communities on Facebook that impress me. Here are a few.

I Hate Heroin – run by a mom who knows the struggles of addiction first hand

Heroin Addiction Support  – what I like about this page is that he moderator understands the role of medicine in the treatment of Addiction.

Let me know if you find these links to be helpful. And of course feel free to contact me if I can help lead you or someone else back to a path of sobriety and happiness.

 

Have any Questions or Comments?

Visit Detox at Home NY on Facebook!

 

‘Addiction Treatment Brokers’ – From the Desk of David Seitz MD, Diplomate of the the American Board of Addiction Medicine

The following is a rather long article because I didn’t want to try and oversimplify the problem of addiction treatment brokers. This isn’t a subject that can be discussed in a paragraph or explored in a 2 minute sound bite. This issue is complex and I want to avoid the “throw the baby out with the bath water” approach that many, including Google have proposed and implemented because that approach, as expedient as it may seem, may lead to an even more tragic outcome for those in need of addiction treatment.

As an addiction treatment professional it is gratifying to see that the disease of addiction is finally receiving the attention it deserves – from the media, from the public and most importantly, from politicians who are empowered to fund treatment and prevention programs. Most of these programs are of high quality, staffed by competent and compassionate counselors and medical personnel who work in this field not for financial remuneration but because they want to make a difference. In fact, as a primary care physician who chose the sub-specialty of Addiction Medicine as opposed to other more lucrative choices, I knew I was trading better pay for the privilege of helping those in need put their lives back together.

For several years I have worked with addicted patients and have advocated for the field of Addiction Medicine, largely through my work with ASAM (the American Society of Addiction Medicine) and NYSAM (the New York Society of Addiction Medicine). I can’t tell you how many of my letters and phone calls to politicians and policy makers went unanswered from 2000 through 2010 – as I tried to sound the warning about the opioid epidemic as loudly as possible. Then I watched helplessly as well-meaning politicians with little understanding of addiction hurriedly passed laws and enforced regulations that although well-meaning, drove patients from prescription opioids to heroin increasing rather than decreasing the rate of overdose. These consequences may have been a surprise to lawmakers but they certainly were not a surprise to my Addiction Medicine colleagues and I.

Now I fear that a new development and the proposed response to it may once again hurt more people than it helps. Since the field of Addiction Medicine is finally getting the respect and funding it deserves, we have run into a new problem: the emergence of opportunists who see a way to make money by marketing themselves as a gateway to treatment. What I am referencing here are treatment “brokers” and the way they have used Google search and Adwords to create a business model that I believe is immoral and unfair. By dominating Google search (through a combination of web design savvy and their willingness to pay enormous sums for addiction-related keyword bids), they insert themselves as middlemen between addicts and treatment centers, making it difficult to find actual treatment centers or addiction medicine professionals without going through them first. Moreover, their presence drives up the price of advertising through Google Adwords to the point where actual addiction specialists and treatment programs can no longer afford to advertise treatment services as such programs usually operate with small budgets with little or no profit margin.

In other words, when it comes to advertising for addiction treatment the playing field is most certainly not level. Treatment brokers have little or no overhead as they don’t actually provide treatment. They don’t need a building or counseling staff. They simply build a flashy website and hire an operator who answers the phone and refers patients to the treatment programs that can afford to pay huge sums to brokers for such referrals. Those treatment programs are not recommended by the broker because they are good and most appropriate for a given patient, but because such treatment programs pay dearly for such referrals. Of course, a program that must spend large sums for such referrals cannot also afford to hire the best professionals to provide evidence-based addiction treatment so it faces a choice: either it can raise the cost of treatment to the point where most people can’t afford it (it is not unheard of for a month-long treatment to exceed $30,000) or hire cheaper staff who are less competent and qualified.

Although I imagine that Google was unaware of this practice until recently, their bid-based advertising model has made them complicit in this scam. After the following New York Times article exposed this business practice and Google’s active although unwitting complicity – https://www.nytimes.com/2017/09/14/business/google-addiction-treatment-ads.html – Google bowed to pressure and reacted by pulling virtually all addiction treatment ads for their site. However, this un-nuanced, all be it well-meaning knee-jerk response – could actually have more tragic repercussions for addicts than making no changes at all as it “erases” legitimate treatment programs as well as these brokers. In other words, as Google, for all practical purposes, has a monopoly on search, removing all ads for treatment professionals and programs will likely result in the addict or his/her family believing that no quality addiction treatment is available locally, when, in fact, that is not actually the case.

What Google is attempting to do here is to wash its hands of the problem so it can focus on less controversial industries. I understand the company’s reasoning but In my view, that approach is not acceptable. The bidding war for keywords (which is a direct result of the Google Adwords model) created this problem. As a socially responsible company (which, I believe, it tries to be) Google itself must directly address this issue. By taking a small percentage of the legitimate profits Google can generate from the advertising of qualified treatment professionals and treatment programs, Google can help to “police” itself and the addiction treatment industry, providing links to legitimate treatment providers while excluding the treatment brokers that have tarnished its reputation.

The issue at hand is how to most efficiently and fairly vet treatment providers so the legitimate ones are given a Google “good housekeeping” seal of approval, allowing them to advertise and publicize their services through the search engine. I realize there are no easy solutions here – but if treatment professionals and the advertising professionals at Google are given the chance to work together, I am sure we could create an effective and equitable system where providers are vetted before their ads go “live”.

In terms of physicians, this vetting process is relatively easy because much of the work has already been done. First, physicians are required to file a lot of paperwork to maintain licensure to practice medicine. In addition, in my view, anyone who calls himself/herself an addiction specialist should be Board Certified by the American Board of Addiction Medicine or the American Society of Addiction Psychiatry, two credible organizations that require physicians to stay current in this rapidly developing field.   As medication assisted treatment for opiate dependence is now the “standard of care”, any addiction specialist should also have the SAMSHA waiver to provide buprenorphine. Lastly, a treatment facility wishing to advertise on Google should employ an Addiction Medicine physician as its medical director and Medication Assisted Treatment should be an option for patients who request it.

On the counseling side, treatment programs should be required to hire qualified counselors who are licensed by the state in which they practice. In New York, for example, counselors may have a social work license, a psychology license or be Certified Alcohol and Substance Abuse Counselors. Of course, every state has different licensing requirements so criteria will have to be tweaked depending on program and provider location.

My point here is that this is not rocket science. With a well-thought strategy, Google can help the addiction treatment industry to police itself, removing the few bad actors who do not adhere to high treatment standards. This is not to say that we need Google to be “Big Brother”. There are certainly different legitimate evidence-based approaches to care and there is no need for every provider to practice addiction treatment in exactly the same manner. From diversity comes innovation and I understand that. However, as in other fields of medicine, I think we can agree on some broad guidelines. Medication Assisted Treatment is good. Putting leaches on someone to cure his/her addiction is not. Agreed?

In my view, we all need to step out of our bubbles for a minute. Treatment providers and technology giants like Google must work together to guide those suffering from the deadly disease of addiction to safe and reputable care. Opportunists hijacked technology to create the problem. Trusted treatment providers and software engineers working together can solve it.

Older Adults Doing The Most Research On Addiction

At least that’s a true statement when it comes to our website and our Facebook page. The biggest demographic to engage with us is women – ages 45-54 followed by women ages 65 and up. It is not what I expected and I’m curious about what this means.

Are our viewers looking for treatment for themselves or their loved ones? Are they simply interested in the epidemic facing America and trying to learn more about it?  If anyone is interested in starting a dialogue with us about this please contact us here or call (877) 636-3996

Assuming that many people are looking for treatment for a loved one – a son, daughter, grandson or granddaughter – I thought it might be useful to suggest a few positive approaches that can be used to help them access treatment.
There is no question that even broaching the topic of addiction with a loved one can be tricky. Such a conversation can often disintegrate into arguments, allegations and perceived judgments with a negative rather than positive outcome.

Although interventions can sometimes work, unless they are facilitated by a professional and attended by several members of family whom the addict respects, often the outcome is not what one would hope.

In contrast, the methodolgy I utilize requires patience and stresses love, guidance and respect, creating a rapport that will open the door to a frank discussion of addiction in the future. Here is the step by step approach that has worked very well for my patients and their families

1) Open the door – to a conversation about addiction by bringing up the topic in a very general way – referring to something addiction-related that has no direct relevance to your relative’s life. For example, if your relative is suffering from opioid addiction you could note all of the celebrities who have died from overdoses in the past year or two.

2) Do Not Judge Others – During the “open the door” conversation refrain from passing judgment on those who are suffering or have suffered with the disease. Show empathy for those individuals, no matter how nasty or egotistical they may be. It is important that your family member knows that you can provide a sympathetic ear when the time is right.

3) Express Your Love – Express in a general way that you would love your relative no matter what – that your love is unconditional. Most addicts make the assumption that their relatives would just abandon them if they knew the truth. This is not accurate in most cases, so it is important that you state this fact here.

4) Express Your Availability – We live in a busy world and we all have lots of responsibilities. Communicate that you are available – that even though you may be busy your relative must know that there is nothing more important to you than family. You can make a joke about being older and wiser – or whatever is necessary to make the addict feel comfortable in bringing his/her problem to you.

That’s it for Round 1. The goal here is to open the door and to keep it open. The hope is that at some time in the next few weeks after that conversation the addict will have the courage to approach you about his/her problem. If, after a month that hasn’t happened, repeat steps 1-4. It may take several repetitions of these steps, but eventually, you will be able to have the next conversation – when you discuss your relative’s personal addiction and make suggestions on how it can be addressed.  We will explore that in another blog

Why Medication Assisted Recovery Works

How many of you remember the term homeostasis from high school? Although a very simplified model of the human body, most body systems are set up to maintain chemical concentrations and other parameters at constant levels, regardless of what is happening outside the body. The body acts a shock absorber or buffer, resisting quick change that would “shock” the system and likely kill the person. The body adapts – not fully – but enough to maintain life.

How does this apply to drug use? Various drugs of abuse have something in common. They lead to the release of large quantities of dopamine – the “feel-good” chemical. Certain activities, such as sex, also do this and having such a system in place is adaptive for the species as it leads to procreation. However, opiates hijack this system, creating a rush of dopamine, not because one ise engaging in behavior to naturally release dopamine, but because the opiate does it autonomously. Thus, a brain swimming in dopamine becomes the “new normal” and activities that were once pleasurable – like sex – pale in comparison to the “high” experienced when you take the drug.

Over time, the body adapts further and one needs more and more drug to feel good – and eventually simply to avoid getting sick – and addiction is the result.

So what happens when you take the drug away? In the short term, there is withdrawal. That is certainly unpleasant but can be avoided with a careful detoxification process. However, even when detox is complete many patients don’t feel entirely normal. They often can’t enjoy life and slip into depression – which often leads them right back into the cycle of drug abuse.

The reason this occurs can be understood through the concept of homeostasis. Drug use causes brain changes at the receptor level. Just as it took months or years for the receptors to adjust to the high level of exogenous opiates, it takes months or years for the receptors to re-adjust to sobriety. During that time, a patient often feels depressed, cannot find joy in life and is often unmotivated to pursue his/her interests and to take back family and work responsibilities.

Recent studies have demonstrated that the brain will eventually return to a relatively normal state but that may take 3-7 years depending upon a number of factors. That is a long time to feel depressed and frankly, without the help of medication, most patients cannot maintain sobriety for long enough to allow the brain to heal.

What is the solution? Luckily, scientists have developed medications that can mimic the effects of opiates on dopamine receptors. Moreover, these drugs are not addicting and do not cause physical dependence or withdrawal. One such example is Wellbutrin – an antidepressant that works as a dopamine reuptake inhibitor, effectively increasing the effect of dopamine in regions of the brain affected by addiction.

So often I hear from a patient “But doctor – I know it’s all in my head” as a way of dismissing the very real symptoms he/she is experiencing. My response – I agree. “Yes, it is all in your head”, I say but not in the way you are thinking. After a short lesson in neurobiology the patient realizes that he is not “crazy” or “wrong” about the way he/she is feeling. These symptoms are completely legitimate and expected. Moreover, they can be treated with a judicious combination of medications that will provide the bridge to sobriety that many patients need to be successful.

Medication Assisted Recovery

So doctors are often accused – and rightly so – for speaking Medicaleeze – in the same way a lawyer might use Legaleeze. The term “Medication Assisted Recovery” is something addiction specialists throw around a lot, but what does it mean? In a nutshell, it means the use of medication to assist an individual in his/her recovery, both to improve the chances of staying abstinent, but also to improve mood and allow him/her to enjoy life once again. In my view, an addict who stops using but is still miserable is not an example of successful treatment. My goal is to give someone back his/her life, so he/she can feel once again and be happy, while addressing his/her addiction.

Although many treatment programs and government agencies have spent years trying to develop a “formula” for treating various addictions, we at DetoxatHomeNY know better than that. To be successful treatment must be completely individualized. If a patient has chronic back pain one cannot simply take away his/her pain medication and expect things to go well. In the same way, if a patient has an underlying psychiatric disorder (and studies have shown that somewhere between 25% and 50% of addicts have concurrent psychiatric conditions) it needs to be treated at the same time we are addressing an addiction or the patient will likely relapse.

In the end, being a good Addiction Medicine physician involves a lot of listening and constant adjustment in medications and medication dosages to make the patient comfortable. Recovery is a lifestyle and medicines can provide a bridge to abstinence that will support sobriety and lead a patient back to a life of fulfillment and enjoyment. In my next segment I will discuss the neurochemical basis and rationale for medication assisted recovery.

Marijuana Studies

When I am at a gathering and it is known that I am an addiction specialist, dinner-party conversation always seems to veer towards my views on marijuana use, particularly in teens. It is clear that people feel strongly about the subject. However, often the evidence for what they are saying is poor or nonexistent.

To begin, we need to separate the legalization question from the medical question of whether the benefits of its use outweighs the risks. As far as legalization is concerned you may be surprised to know that I favor making marijuana legal for a number of reasons. First, I do not believe in a nanny state. Second, I believe the law should be consistent. If the government is to dictate our behavior, than all dangerous behaviors and substances should be made illegal. Alcohol would have to come off the shelves along with cigarettes, sodas and candy. Moreover, as the era of prohibition proved quite clearly, making a substance illegal may affect total consumption of a product, but does not affect the rate of addiction to that product. This makes sense, of course, because addiction, by definition, involves the loss of the effect of the negative consequences (such as getting arrested) of a given behavior upon the use of the drug.

That being said, there is a body of emerging scientific evidence implicating marijuana in negative behaviors and health outcomes.
Here is some data that I find pretty interesting.Early marijuana use (before the age of 21) appears to be more dangerous than use after that time. This makes sense given the fact that the prefrontal cortex is still developing in one’s late teens and early twenties.
For more information look here: https://www.sciencedaily.com/releases/2017/03/170328105901.htm

What is also becoming clear is the adverse effect of marijuana on school performance. This has been seen anecdotally for years but it is good to see some objective data on student grade point averages to support the claim.
For more information look here: https://www.sciencedaily.com/releases/2017/03/170308144728.htm

Then there is the issue of whether marijuana may actually cause or be associated with physical problems such as osteoporosis. This is of particular concern in heavy users.

For more information look here: https://www.sciencedaily.com/releases/2016/10/161012132657.htm

And now there is evidence from rat studies indicating that marijuana use can affect not only cognition, but the willingness to tackle cognitively difficult tasks.
For more information look here: https://www.sciencedaily.com/releases/2016/08/160824144033.htm

To be clear, I don’t think it very productive to debate whether marijuana is good or bad. There are studies showing its benefits and we hear about them every day. However, now it is becoming clear through objective studies that there are some very real risks here as well.

The Adolescent – The Development Of A Healthy Ego – The Subtext Of My Kindergarten Experience

This blog post may seem a bit out of place for an addiction specialist. However, I think it important to understand that the cause of addiction is multifactorial. Some causes are innate – alcoholism, for example has a strong genetic component but many other modulating factors are learned.

Think of a rat in a cage. When exposed to a noxious stimuli the rat will try and escape. People behave similarly. So if a student is unhappy in school, he/she will either not go to school at all or will try and escape through substances that will change the way he/she feels while in school.

As a parent of a child in NYC I have seen how our school system, with all its good intentions, makes students feel inadequate. This subject is rather taboo – and not discussed often. Even when it is, the focus is on the elite high schools and their entrance requirements. However, let’s wind back the clock to elementary school – even kindergarten – and you can see how the seeds of self-doubt are sown in a student’s mind.

Let’s start with reading. Many kindergarten teachers subscribe to the use of “sight words” as a basis of a literacy curriculum. Briefly, rather than sounding out words like most of us were taught to do, kids today are taught to recognize words as single entities in order to enhance the early reading experience. I have no issue with the change in method. I will leave that debate to learning specialists. However, what is apparent is that this seemingly innocuous approach to an important skill – reading – comes with “baggage” that is problematic.

Let me explain. These sight word lists are distributed to parents and we are expected to work with our children to memorize the lists prior to the child being “tested” by the teacher. Depending on the aggressiveness of the parent and/or child, one child may be on List 1 while another is on List 8. Anyone who believes the kids don’t know exactly where they stand in this regard is lying to themselves. My daughter knows exactly who is doing which list. Moreover, it breaks my heart to hear her say – at the age of 5 – that she is not as smart as some other kid in the class because she can’t memorize things as fast. To make matters worse, when you complete a list you get a “sight word crown”. Really, I’m not kidding. You get a crown that commemorates this achievement and says to everyone else who has not yet achieved it that they are somehow inadequate.

This methodology has another significant problem. Children are not learning to read because it is intrinsically enjoyable or because it provides information that is of interest to the child. They are learning to read because it results in an external reward – a sight word crown – and defines their self-worth not intrinsically, but in reference to where he/she stands in the pecking order relative to the other children.

Fast forward a number of years and multiply this experience but 100 and the result is predictable. In my view, what needs to be done to prevent drug abuse (and other unhealthy ways to escape) is to completely revamp the educational system through the creation of an ego supporting curriculum. What an adolescent needs to know is that one has to look internally – and not to external forces – to find happiness. It may seem cliché’ and “new age” but adolescents need to find value in themselves and what they do – not what they put in their mouths or veins.

 

We Are Making A Difference

 

It seems that every day we hear about someone who was a victim of a drug-related death. Sometimes even those of us who work in chemical dependency treatment throw up our hands and question the efficacy of treatment. However, some recent evidence shows that our interventions are working, particularly with adolescents.

I have excerpted some information from the Monitoring The Future survey of drug use that I find encouraging.

 

  • The percentage of students reporting past-year use of illicit drugs other than marijuana continued to decline in 2014. It is at the lowest level in the history of the survey. 5.4% of 8th graders, 9.8 percent of 10th graders and 14.3% of 12th graders report such use now as compared with 12.6% of 8th graders, 18.4% of 10th graders and 21.6% of 12th graders 15 years ago.

 

  • Marijuana use declined among 8th and 10th graders and remained unchanged among 12th graders as compared with statistics from 5 years ago despite changes in marijuana drug laws and its increased availability

 

  • Alcohol use is also down. Daily alcohol use among 12th graders significantly decreased to 1.3% while binge drinking declined among 8th graders to 3.4%.

 

  • Daily cigarette use by adolescents declined sharply – from 10.4% of 8th graders in 1996 to only .9% at the current time.

 

Now I am not saying that we don’t have a lot more work to do. The point, however, is that our efforts at educating young people about drug use are working.

Although I am skeptical about the whole “gateway drug” idea because I believe it oversimplifies a very complex problem, these statistics indicate that in all likelihood drug use in college and beyond will decrease if we maintain our emphasis on prevention during adolescence and early treatment.

The Opioid Epidemic – How Did We Get Here?

I always find it interesting how bewildered most people are – including physicians and healthcare administrators – when asked about the opioid epidemic. Most point to societal factors and unstable family structure as primary causes and there is ample evidence to support this view. However, a significant factor – and one that is not often discussed – is the role of physicians, their administrators and medical practice guidelines prevalent in the 1990’s.

 

I am not going to try and simplify things. Honestly, there are many causes of the opioid epidemic. However, one often overlooked fact is that changes in the practice of medicine that took place in the 1990’s – changes that really were well-meaning – actually contributed to opioid addiction. Moreover, these changes were tied to reimbursement – particularly for hospitals – so physicians and hospitals had to “play the game” or risk losing funding and employment.

 

Back in the 1980’s when I was training to become a doctor, we probably under-treated pain. Pain medicine was used to “take the edge off” but neither patient nor doctor expected the medication to remove pain entirely. As training physicians in an urban setting, we were aware of the risks of addiction and definitely subscribed to the “less is more” philosophy of pain management.

 

Things changed a lot during the 1990’s. Probably the most significant change was the adoption of a well-meaning but soon to be abused phrase – put forward by the American Pain Society in 1996 – PAIN IS THE 5th VITAL SIGN. In other words, in addition to Pulse, Blood Pressure, Temperature and Respiratory Rate every patient had to be assessed for pain. In theory, this wasn’t a bad idea as it prevented under-treatment of pain. However, as is often the case, the pendulum swings too far in the opposing direction. All of a sudden, this slogan became more of a mantra.

 

This mantra echoed in the halls of Congress and soon a patient’s perception of pain management became tied to Medicare and Medicaid reimbursement. Hospitals were told that to receive maximum payment for their services, patients had to complete surveys indicating whether their pain was managed appropriately in the hospital. Poor scores on this metric would lead to poor reimbursement rates. This would “trickle down” to lower salaries, less resources, etc.

 

What happened as a result? Hospital administrators pushed physicians (particularly those working the Emergency Department) to prescribe more pain medication. As one hospital administrator (who will go unnamed) once said to me “Over-treat don’t Under-treat Pain. A patient who is overmedicated and/or asleep doesn’t complain.”

 
Sadly, as physicians, we didn’t stand up to this clearly misguided rhetoric. Medical training is similar to military training in many respects. You don’t question your superiors, especially hospital CEO’s. You just do as you are told. And so we did. ER docs started prescribing Percocet like water, Dilaudid became the new Tylenol, etc. Patients completed their surveys and went home with prescriptions for Percocet and other opioids. The resourceful ones even “threatened” ER docs and staff with a poor review if they didn’t get the prescriptions they wanted.

 

… And so a new generation of addict was born. This was not the heroin addict of the 1960’s – injecting bags of dope in bad neighborhoods. This was blue collar and white collar men and women with large mortgages and little savings running on the hamster wheel of economic prosperity who were simply overwhelmed. They wanted a magic pill to make their problems go away – at least for awhile. And they got it – in the form of semi-synthetic opioids.

 

The question is not how we got here. It is how do we get away from here.

Addiction Is A Family Problem

Most of my other blogs focus on the addict. In this one, I want to focus on the addict’s family because it is often a family member who contacts me first about treatment. What becomes clear in just about every conversation is that the addict has altered the family’s dynamics over a period of months or years, creating a state of disequilibrium that has all family members on edge.

The presence of addiction in a loved one, in particular one’s child, inspires a myriad of feelings that leave family members disturbed, if not downright depressed. In the many family sessions I have done (where I meet with the family with and without the addicted individual), family members describe intense feelings of guilt. Would the addict not be an addict if we didn’t move when he/she was a teen? Why didn’t we see the warning signs early? How did I allow myself to be so manipulated? Why did I enable my son’s/daughter’s addiction for so long?

To make matters worse the addict, although impaired, is often very perceptive when it comes to his/her ability to cause emotional pain in others to get what he/she wants (money, a place to stay, etc.). He/she may say horrible and hurtful things to those he loves, trying to “unload” his personal pain on others around him. On an intellectual level we know that it is the drugs that are talking – that our addicted son or daughter doesn’t really mean what he/she is saying. Nevertheless, it hurts – especially when we want so much to help our loved one.

My Approach To Addiction In A Young Adult

In addiction treatment, we have spent far too much time looking for a silver bullet – that curative medication or approach that will simply make the problem disappear. We want something simple, something that is standardized and guarantees results. Of course, there is no magic tool, just a number of approaches that, along with hard work on the part of the patient and family, can free the addicted individual from the chains of addiction.

Given all the frustration and intra-family turmoil caused by the addicted individual and our wish for a simple solution it is easy to understand the attraction of the “tough love” approach. If the addict is manipulating the family and causing emotional pain to family members, simply cut him or her off. Kick him/her onto the streets. The theory is that he/she will hit “rock bottom” and then reassess his/her life, leading him/her back to family and a productive existence.

From the standpoint of logic this makes sense. If a family is enabling the addict then go to the opposite extreme – “tough love”. However, in my experience this is a very dangerous approach. Anecdotally it may have saved a few lives (I’m sure we have all seen some variation on this approach on television at some point), but it has also ended the lives of many addicts leaving family members with guilt and shame.

What is wrong with an approach that seems so “logical”? The answer is simple. The addicted brain does not follow the rules of logic. Without slipping into the complex world of neurobiology (you can look at some of my other published articles and blogs for that), we can make the general statement that drugs of abuse “highjack” normal brain function. Control is transferred from the pre-frontal cortex (the center of logical thinking) to the ‘nucleus accumbens’ (a center of emotion).

Once this hijack of the brain takes place, the well-intentioned “tough love” approach does more harm than good. A logical brain faced with a decision weighs the options appropriately. If I steal this, I end up in jail. Therefore I won’t steal it. This kind of logic is the basis of law enforcement. The addict’s brain doesn’t work like that. It is completely preoccupied procuring the drug at all costs. If that means hurting others, participating in illegal activities and putting oneself in dangerous circumstances, the addicted brain will still move ahead. If an addict is offered a choice between maintaining his/her housing and family ties but without the drug, and being homeless on the street with an ability to buy the drug (often as a result of illegal and immoral activities), he/she often makes the seemingly illogical decision to maintain the addiction.

So what works? A measured and structured approach, individualized for every patient with numerous supports from several disciplines including general medicine, psychiatry, psychology, social work and recovery coaching. It is not a miracle and it doesn’t lend itself to catchy sound bites or engrossing videos. It is hard work. In summary, the team leader (who could be from any of the above disciplines) puts together a team that will best suit the patient’s needs. A physician handles detoxification and ongoing psychiatric treatment, a psychologist does therapy (generally cognitive-behavioral or psychoanalytic) and a social worker or recovery coach provides sobriety strategies and sobriety-focused teaching and counseling. At ‘Detox at Home NY’ we work together as a team not only to maintain sobriety, but to address psychiatric and social concerns as well as family dynamics. Everyone’s path to recovery is a little different. However, the key to success is maintaining honesty and open communication between all family members, repairing the rift that addiction has caused.