Broken or restored? Drug and alcohol dependency

Broken or restored? Drug and alcohol dependency

Alcohol and Drug Addiction

The bowl above has been repaired using a Japanese technique involving metallic lacquer. Do we now think of it as damaged and faulty, or as beautifully restored and just as functional as before?

Working in substance use units down on the Sussex coast left me with a general impression that clients were choosing to self-medicate, finding distraction or oblivion regarding past or present pressures. Some did not even like the taste of what they chose to drink but were consuming precisely measured volumes to achieve and maintain a state where they were able to cope. My impression was of people suffering in their own private hells, finding fixes to help them get by.

Working in substance use units down on the Sussex coast left me with a general impression that clients were choosing to self-medicate, finding distraction or oblivion regarding past or present pressures. Some did not even like the taste of what they chose to drink but were consuming precisely measured volumes to achieve and maintain a state where they were able to cope. My impression was of people suffering in their own private hells, finding fixes to help them get by.

Although perhaps tempting to stick metaphorical labels on clients’ foreheads labelling them all as dysfunctional addicts in need of professional help and a standard path of treatment, working as equals together seeking to find the cause(s) of their dependency was usually productive. Separating the person, their substance use and the cause of this dependency allowed us both to identify and focus on the underlying issue(s). A simplistic formula would be ‘Person + cause = behaviour’; remove the cause and the behaviour goes away, leaving just the core person. Therapy can aim to be a helpful period of change, rather than a life-long restriction or obligation.

A couple of clients were angry about previous experiences elsewhere, feeling that they were required to think of themselves as permanently broken to the point of having to abdicate their autonomy and submit to a ‘higher authority’ – once an alcoholic, always an alcoholic, no longer responsible enough to even go into a café if alcohol was sold there. This felt uncomfortable for me as well, we can all use a helping hand at times but hopefully to move us on in our lives rather than hold us back at a fixed level of development.

Replacing one dependency with another, less damaging one for a brief time can be a good halfway stage for substance users to break a habit. Apart from the benefits from cutting back on their drug(s) of choice, it can provide an opportunity to address the original cause(s) of use and tackle these rather than the symptom. Giving a man a fish whilst he learns to fish for himself feels better than telling him he cannot be trusted with a fishing rod again and must constantly remind himself of this.

Indeed, clients play a significant role in effective therapy. Miller, Duncan and Hubbard (Escape from Babel, 1997) explore the shared areas where different therapeutic disciplines prove to be effective, and how results are achieved. Interestingly, they suggest that the single most effective factor in therapy outcome is the client (roughly 40%), with other factors being the quality of the relationship between therapist and client (30%) and the placebo factor (15%). Only the remaining 15% can generally be attributed to the method used by the therapist, and colleagues have agreed that, after a couple of years it can be hard to tell the difference as we often seem to be working in the same ways regardless of our original training.

The importance of clients being involved in the process is highlighted by Carl Rogers, one of the founding humanistic psychologists. Focusing the attention on the client in a person-centred way, Rogers view was that the therapist helped and supported the client explore and resolve personal issues whilst avoiding leading or directing them in any way. He considered the client to be an expert on themselves and their needs, with the therapist only able to glimpse parts of their internal world from the outside, never able to enter or understand it fully. Rather than joining the many voices telling the client what to do, or to pull themselves together, we instead give them a ‘damn good listening to’ – the chance to explore anxieties, acknowledge past or current hurts or losses and just simply to have their voice heard for a change.

After intensive extra training in drug and alcohol awareness, our group was somewhat shell shocked by the end, but the lead tutor advised us not to worry or panic. If ever stuck and not sure what to do, we should just follow Rogers’ three core conditions for therapists. This has proved to be excellent advice, often there is no need to go beyond these simple but effective requirements. Interestingly, they also figure strongly not only in the effective strategies mentioned in Escape from Babel (see above), but also in the new guide written by Christians and other theists for pastoral support and chaplaincy workers but intended for use with all patients (Psycho-spiritual Care in Health Care Practice, Guy Harrison).

These core conditions simply require us to always extend empathy, congruence and unconditional positive regard. Being honest, open and respectful to clients, their views and their anxieties and concerns can come as a novel experience at a time when social media and the pressures of modern life have altered the way many of us communicate. Change and progress come from the client as they realise and accept not only their current position, but also the challenges they face and the options and resources available. Giving people the time and space to hear themselves think, the understanding that they are valued and respected can help them realise and accept their potential to change, adapt and grow based on inner strengths and abilities perhaps previously discounted.

Sometimes clients want to tell their experiences, to pass on bad memories in a ‘problem shared, problem halved’ way. Often, they need someone to recognise and confirm their progress and achievements, to acknowledge and validate small successes as they build up over time to form a larger pattern. Rather than playing a game of snakes and ladders where there are no ladders and many snakes that all lead right back to the start, a lapse (common in recovery) can be put into context rather than seen as a requirement to start all over again. If getting lost driving in a distant town, would you go all the way back home and begin again, or instead go back to the last place you recognised and start again from there?

We can help those who are struggling with a dependency to take pride in how far they have come, to recognise and celebrate that. A single lapse after three months can be taken as resetting the counter to 000, or else as 1/91, the next day can be counted as either 001 or as 1/92. The latter recognises that as humans we are not perfect and will probably have the odd set back or glitch in our lives. Our path probably won’t be smooth, and we’ll pick up honest wear and tear along the way as we knock about and are knocked about by life. We can choose to think of ourselves as damaged and broken and ‘stuck’, or else recognise and celebrate our achievements and potential, and keep moving forwards.

Paul Hurst

Nick Conn / 14th March 2018/ Posted in: Latest News

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    Detoxification (detox) is the medical intervention required for someone who is physically dependent to drugs or alcohol. If required, medical detoxification would be the first step taken in residential rehab. Detox is used to prevent uncomfortable and dangerous (even fatal) withdrawals symptoms resulting in suddenly becoming abstinent from alcohol/certain drugs.

    The goal of a medical detox is to aid in the physical healing required following long term addiction and rid the body of all together of substance whilst providing a cushion for unpleasant symptoms of withdrawals. Detox is not considered the whole treatment for drug/alcohol addiction and it is always recommended that a comprehensive rehabilitation program is used along side to help maintain long term abstinence.

    Medication is often required for alcohol detox. If you are dependent on alcohol and experiencing withdrawal symptoms it is vitally important to seek medical advice prior to stopping. There is a long list of medications used when treating alcohol addiction and the exact medication given to an individual will depend on their needs/medical history. Some of these include;

    • Chlordiazepoxide (Librium)
    • Lorazepam (Ativan)
    • Diazapam (vailium)

    Librium and Valium are the most commonly used detox medication in the UK. All medication used to help with alcohol detox have been proven to help reduce the effects of withdrawal symptoms.

    There are also a number of drugs recombined by the NHS to help treat alcohol misuse. Some of these include:

    • Naltrexone
    • Disulfiram (Antabuse)
    • Nalmefene
    • Acamprosate (campral)

    Medication is always required for heroin detox. For someone suffering from heroin addiction, the thought of detoxification (detox) can be exceptionally daunting. Withdrawal symptoms from opiates, such as heroin, can be severe and include pain, vomiting, nausea and shaking.

    There are different ways that heroin detox can be carried out, most usually either ‘maintenance therapy’ or ‘full medical detox’.

    Attempting to switch from heroin to a heroin substitute, usually on a controlled prescription, is known as Maintenance therapy. Subsites used are most often methadone or buprenorphine.

    A full medical detox from heroin will always be carried out in a residential rehab setting and will allow the individual to switch form heroin to a substitute and slowly withdraw completing treatment free of all substances. Someone using a heroin substitute can choose to have a full medical detox at any time, however detoxing substances such a methadone can often add to the length of detox required. Drugs most commonly used to fully detox from heroin are, Subutex, Suboxone and Methadone. Much like alcohol, the exact drugs used will be dependent on the individuals needs/medical history.

    Once detoxed from heroin the risk of overdose is much higher following relapse due to tolerance following withdrawal.

    The length of treatment in a residential rehab depends on a number of elements. Some substances require longer periods of detox than others.

    Private paying patients will also often choose a length of stay that suites their therapeutic and financial needs. As a rule, a full treatment program in a rehab is considered to be 28 days (often referred to as a month), however, treatment is offered in several different ways and lengths starting at 7 days.

    Treating alcohol addiction will always require a minimum of 7-10 days, this would be considered the detoxification (detox) faze. The length required for treating drug addiction can vary drastically depending on the substance being used. Detox for Heroin addiction is generally around 14 days minimum, with more time required if substances such a methadone are being used. Treating prescription drug addiction can often take the longest. The time required for treating gambling addiction, eating disorders and sex addiction will be based on the individuals needs.

    Rehab programs can be as long as an individual requires but primary treatment is normally caped at 12 weeks, with the offering for further secondary and tertiary treatment thereafter.

    *based on average rehab stays, everyone will vary dependant on needs and medical requirement/history.

    There is no need for your employer to know that you are seeking help for trauma and addiction unless you choose to involve them with the process. All employers should have a policy that explains what you do if you cannot come to work due to illness – illness to include treating alcohol addiction/treating drug addiction.

    If your work absence extends over 7 days your employer is likely to require an official statement of fitness to work which would be obtained from your GP. This would need to supply evidence of your illness as well as any adjustments required for returning to work, fazed return or reduced hours, but does not need to specify in detail the reason why you have been absent.

    If you are absent from work for 7 days of less, for example entering rehab for a detoxification (detox) on a Saturday for 7-10 days taking a full week away from work, you can self-certify your illness by letting your employer work you will not be attending work for that period of time. Exactly how an individual would do this would be dependent on a specific companies’ policies on taking sick leave.

    Any time longer than 7 days it is likely an employer will require a note from the individuals GP certifying their sickness and a fit note on return. Most companies have a clearly outlined policy on sickness and receiving sick pay so the exact requirement can vary. A rehab will always be willing to advise on time off work.

    How much does rehab cost is a very frequently asked question. The cost of treatment can range from £1,000 per week upwards depending on the place, with luxury rehab being the most expensive.

    There are free options available on the NHS but the waitlist of those looking for free treatment is longer than that for privately paying patients. Some private health insurance policies will cover treatment in some rehabs around the country.

    Choosing the right rehab centre will often be based on priced but it is important to follow guidance on the most suitable treatment centre for an individual’s needs which our expert team of advisers are on hand to offer.

    There are certainly pro’s for both treatment near by and traveling for treatment with one of the most asked question being should I get rehab near me? There are rehabs all over the UK and around the world that all offer expert programs, let’s look at how to choose a rehab.

    Local treatment

    Being close to home gives certainly has benefits. Visitors are normally permitted in rehab following the first 7 days stay, therefore if an individual is in treatment for a length of time longer than that being local will make it easier for loved ones to visit.

    Most rehab centres will also provide a full aftercare plan for someone following treatment, this will include ongoing aftercare in the specific treatment centre. Living close by can make it easy to take full advantage of ongoing aftercare. There can also often be the option for ongoing care with an individual therapist, again being close by will allow that treatment to be carried out face to face.

    Some individuals wish to be local but are willing to look broader, for instance the greater city of residence (London, Manchester, Liverpool, etc)

    Treatment Away

    Getting treatment away from home can be very appealing to some. Being out of the local area makes it a lot harder to just walk out of treatment as resources locally are unknown. Some also take comfort in knowing that they are not near home and focus more on treatment.

    As the price for treatment can vary so much from one residential treatment centre to another, private paying patients often would rather travel to keep the cost down. Those using private health insurance may also have to travel to find a treatment centre covered in their policy.

    When opting for treatment away from home this can be anywhere in the UK and also abroad. Aftercare can still be carried out and very successful using tools such as The Online Rehab.

    There is no right or wrong when choosing where to go to residential rehab, but our expert advisors are always on hand to help provide information on all possible options.

    Whilst millions of people in the UK have taken recreational drugs (amphetamine, cannabis, cocaine, crack, crystal meth, GHB, heron, ketamine, methadone, and prescription drugs) and drank alcohol not all become ‘addicted’. Most recent reports show that 279,793 individuals were in contact with drug and alcohol misuse services in the last year with over half of that being from opiate addiction and a quarter for alcohol.

    There are several risk factors invoiced in addiction and those using drugs and alcohol socially, simply take the risk. These risks are as follows;

    Tolerance – basically, if a substance is used repeatedly an individual’s tolerance to it will build. This will result in more of the same substance being required to get the same effect. In the long run this can easily lead to addiction and physical dependencies.

    Environmental risks – these can include influences such a peer pressure and stress as well as physical or mental abuse of an individual (particularly as a child). Overall, those who live with frequent pressures and stress are more likely to reach for a substance to cope and are therefore at higher risk of becoming addicted.

    Drug type – it is very well known that certain drugs are simply more addictive than others. Using substances such as heroin increases the risk of becoming addicted for need to ‘chase’ a high as well as physical dependency.

    Drug administration – how a drug is administered can affect its addictive qualities. A drug injected rather than smoked or snorted will release a quicker and more intense high thus making it psychologically (and in many cases physically) more addictive.

    Biological factors – it is now widely reported that being an addict is not only psychological but also biological. This includes your genetic makeup, mental health, sex and age. It is also reported to be 8 times more likely for the child of an addict to become an addict themselves.

    Its believed that addiction is approximately half genetics and therefore some are 50% more likely to become addicted than others.

    How do you help a loved one trapped in addiction?

    The first step is to help and encourage the individual to become willing to accept help. They do not need to be shouting this off the rooftops, but they do need to be willing to go into treatment. There are ways to help someone become willing to get treatment for alcohol or treatment for drugs.

    Set boundaries – set boundaries and stick to them. Once you have laid them out follow through with whatever consequences you have set however hard it is.

    Stop finances – if you are financially supporting someone stopping these finances can be the quickest way for the addict needing to ask for help. With no money to acquire a substance an addict’s options become very limited.

    Intervention – getting together with other family members/friends/colleagues and staging an intervention is often very successful in the fist stage of acceptance and gaining an admission to residential rehab.

    You can’t make them quit, this can lead to dangerous withdrawal. Boundaries are very important in helping someone become willing to get help. Unfortunately you cannot do someone’s recovery for them and without self-motivation it is very hard to make it work.

    The next step is to call our highly trained advisers 0203 955 7700.

    There is a huge range of rehab options available and where to start can be completely over whelming so let us help.