There are several components of substance abuse treatment but for the sake of simplicity the focus of this article will be on three: intervention, treatment, and aftercare. Each of these categories have a number of elements, all of which are important to an individual’s chances of staying sober. An intervention requires the counselor to both recognize the critical issues creating the problem and the ability to communicate a viable course of action. Treatment involves individual, group, and family counseling. Aftercare is most important because this is the time when all other aspects come together to establish a sober way of life.
What Happens in Treatment?
In an outpatient program like Insight the time a person spends in treatment is usually about 12 weeks. This sounds like a considerable amount of time, but in reality there is a lot of information to pack in a short period. Most people don’t come into treatment with a tremendous amount of self-awareness and breaking through denial is an arduous process. Ultimately, the point of treatment is to establish a strong foundation for long term recovery. It is dangerous to expect a person with a drug/alcohol problem to be focused on issues outside of learning how to stay sober on a daily basis. A young person who is dependent on drugs and alcohol needs months of repetition to learn new and better coping mechanisms. This doesn’t mean life has to come to a complete halt but it does mean that expectations should be shifted. By the time someone is discharged from treatment there will be a clear plan of action on how to move forward in sobriety and in other areas of life.
What Happens in Aftercare?
Aftercare is where the rubber meets the road for a person in early sobriety. Through the course of treatment the recovering drug abuser has recognized the nature of his/her problem, become aware of the primary triggers that lead to using, and identified the relationships that have been harmed as the result of continuous drug and alcohol abuse. It takes time to develop a serious drug and alcohol problem and the destruction can be far-reaching. It takes much longer to clean up the mess and move forward. Most people in early recovery need several months (sometimes years) to change what has become a default mode of coping. In aftercare the newly sober individual has a specific plan of action and a lot of emotional support. In Insight the after-care and follow-up part of the program takes place over a two year period. Remember treatment usually lasts around 12 weeks. A person in aftercare continues individual counseling, support group meetings, and social functions while reintegrating into main stream life. The key is that this reintegration is as a sober person. This transition takes time.
Substance abuse recovery for young people is not the same as it is for adults. A common misconception is that a program designed for adults can be delivered to young people in an effective manner. There are numerous problems with this belief. People will often assume that a young person has the same sense of urgency as someone who has been drinking or using for several years. This rarely happens. There are several reasons why this is the case.The combination of years of abuse, brain development, and life experience create a much different perspective for adults than for adolescents.
The Adolescent Brain
One significant factor in the difference between adults and young people in recovery is brain development. When a young person starts using drugs or drinking alcohol he or she is at a point in life when the brain is going through significant changes. In his book Sacred Connections, Dr. Steven Jaffe gives a great explanation of how the brain is affected in recovery. Dr. Jaffe explains: “The nucleus accumbens is the pleasure and reward system; it is responsible for drug seeking behaviors. The prefrontal cortex helps to regulate impulses and make informed and smart decisions. Unfortunately, this area of the brain does not fully develop until a person’s mid-twenties.” (Jaffe, 72) This clarifies why an adolescent struggles to make better decisions in recovery, even after abstinence. The drug abuser’s brain has been compromised and it takes time to create better decision making skills.
Healing Takes Time
Recovery doesn’t happen quickly. It is a process. In an enthusiastic sobriety program the combination of fun and engaging activities with strong counseling is key. Twelve step recovery involves physical, emotional, and spiritual healing. This has to be attractive to an adolescent so he or she can maintain motivation. Fear will not inspire long term change in a young person. He or she needs a loving, safe, and fun environment along with supportive relationships. As the addict forms a strong foundation in recovery, he or she will practice better ways of thinking as his or brain develops. All adolescents experience periods of emotional instability. This is exacerbated when a young person is using drugs and drinking. It takes an extended period of sobriety for emotional and mental health to internalize.
Twelve step recovery can be very challenging for young people because so much of it is based on concepts that are usually associated with an adult perspective. A realization of powerlessness, any admission of wrong doing, reliance on a Higher Power, and a willingness to face people who have been hurt is difficult. This is particularly a challenge for adolescents and young adults. Adults in recovery have a difficult time taking responsibility for their actions, much less a young person. In the mind of a young drug and/or alcohol abuser there is nothing wrong with what he/she is doing. In his or her mind if everyone would just back off, there wouldn’t be a problem. This has always been a challenge for young people who need help but is especially difficult today.
Drug and alcohol treatment is not immune to the current climate of identity separation. If you look around, there are 12-Step meetings available to almost every imaginable classification of people. Many of these group distinctions are unnecessary and can water down the message of recovery. It is generally dangerous for a person with drug and alcohol problems to be “terminally unique.” However, young people are at a different stage of development. Not only are they working through a dangerous drug and alcohol problem they are experiencing normal brain development along with hormonal changes. This can be a lot to deal with. These factors don’t excuse poor behavior but must be understood when treating young people. An 18 year old with an opiate or marijuana addiction is not going to experience early recovery the same way a 45 year old alcoholic does. (Yes, I am aware that I wrote marijuana addiction)
Sobriety: The Great Equalizer
Any recovering addict or alcoholic learns the importance of “living life of life’s terms.” The sober man or woman recognizes the value in being a productive member of society. The same is true for a young person. Although some of the definitions may differ, a person in recovery needs to mend broken relationships, become responsible, and learn to adapt to changing circumstances. These characteristics are essential to long term recovery. The twelve steps provide a simple framework to achieve these goals. Change may not happen immediately but with patience and perseverance these turnarounds can be permanent.
Another year is coming to an end. For many people 2017 was an emotional rollercoaster. If you happened to enter into a recovery program this year you certainly know what I mean. Drug and alcohol abuse tears families apart with unrelenting voracity. The healing process can be unpredictable and painful. However, as sobriety takes hold emotions start to calm and a new perspective takes shape. Finally, those who have experienced tremendous fear, anger, and anxiety can begin to be grateful for a new lease on life.
means that those who are affected by addictions of any kind tend to have a pessimistic and hopeless outlook. A change in thinking can begin to melt away the negativity that keeps people stuck in destructive patterns. When someone is a ble to take a step back and be grateful for a new opportunity to change,hope is reinforced. A family in crisis desperately needs to see the possibility for life to improve. There are simple ways to begin to shift into an attitude of gratitude.
A Simple Exercise
One way to begin to shift into gratitude is to start focusing on it. For example, take five minutes every day to write five aspects of life for which to be grateful. This gratitude list can be something to look forward to each day that can have a significant impact on someone’s way of thinking. The person focused on gratitude will seek more situations to build the list. It certainly accomplishes more to think about what is good rather than to obsess over all that is wrong. Granted, we need to be aware of problems in order to find solutions. Denial is never healthy. But think about how much easier it is to remember what is wrong. Coming up with a list of items that elicit a feeling of gratitude may require some effort but it is certainly worth it.
On behalf of the entire staff at Insight I would like to wish you and your family a blessed 2018! Merry Christmas and have a wonderful New Year.
When an addict or alcoholic enters recovery it may take a few days, or in some cases weeks, for the dust to settle. Once the initial crisis that leads an individual into treatment subsides, the challenge really begins. For the person in recovery, there can be a feeling of hopelessness due to becoming aware of the damage that has been created. For a family member or loved one, it is normal at this stage for anger to come to the surface. This is the point at which recovery tools become a high priority. Without a new manner of coping, an addict may resort to using drugs and/or alcohol again. A loved one is likely to try and control the behavior of the person in need of help. This stage of recovery is scary but with some awareness deep levels of sabotage can be averted.
Ride the Pink Cloud
When a person enters treatment everyone involved breathes a sigh of relief. Even when someone starts their sobriety reluctantly, physical abstinence usually allows for a degree of relief. Early recovery is usually the first time in a long time that a loved one, especially a parent, has had any sense of solace. This period of time is sometimes described as “the pink cloud.” This break from the insanity of addiction should be welcomed. This is also a good time to start implementing aspects of the 12 steps. Once the pink cloud subsides, it is vital to have a safety net of support. This is created by forming relationships with other people on a similar journey and by developing a basic connection with a Higher Power.
It Is a Rollercoaster
There are definitely lots of ups and downs in early sobriety. It is never a smooth ride. There is a lot to learn and many issues of which to become aware. It is not abnormal to feel a bit overwhelmed. Don’t take temporary for permanent. As scary as the journey up the hill can be, it is exhilarating to rush down hill and discover what is around the corner. If everyone involved stays engaged in a personal program there is endless joy that awaits. There will be ups and downs but the adventure will always be rewarding.
The cultural environment today is not exactly conducive to sobriety. It is extremely difficult for young people struggling with drug and alcohol problems to stay focused on recovery. Even though there is a heightened awareness with addiction issues among adults, teenagers have a hard time relating to the danger associated with drug abuse. What is confusing is that some drugs are seen as bad while others are viewed as innocuous. To an adolescent there is no such thing as an innocent drug. While society is hyper focused on opiate abuse, as it should be, marijuana and alcohol have flown under the radar. Not only is it irresponsible to convey the message that marijuana and alcohol abuse are “normal rites of passage” it is dangerous.
Adults vs. Adolescents
Marijuana advocacy has become increasingly popular. Much has been written about the pros and cons of marijuana legalization. In the context of adolescence there is nothing positive about pro-marijuana messaging. Teenagers smoke marijuana for one reason and one reason alone: TO GET HIGH. A young person isn’t smoking pot to “relax” or for pain relief. Similar to how marketing has normalized alcohol abuse, we are now at the point that marijuana use has become so socially accepted that many parents are shrugging it off as “something teenagers do”. Not all teenagers who experiment with alcohol will become alcoholics and not all teenage marijuana users will wind up drug addicts. The question to parents becomes: are you willing to take that risk with your son or daughter?
Where Does It Lead?
The fact is that the majority of adolescent heroin addicts began using marijuana long before opiates came into the picture. According to the National Institute on Drug Abuse: “Some research suggests that marijuana use is likely to precede use of other licit and illicit substances and the development of addiction to other substances.” (NIDA: Is Marijuana a Gateway Drug?) In the Insight Program the vast majority of opiate addicts admitted to using marijuana as their first drug of abuse. Many adults rationalize their child’s use of marijuana by stating that they themselves “smoked weed” in high school or college. What they fail to realize is that the pot smoked today is vastly different from what they smoked and the normalization of marijuana consumption has enabled potential addicts much more freedom to use.
What To Do
The first suggestion for any parent who is concerned with a child’s marijuana use is to have the young person evaluated by a professional. This is not an over-reaction and sends a clear message that drug abuse isn’t accepted behavior. Like any other child rearing issue change has to begin at home. Social acceptance doesn’t equal “healthy, normal, and good.” Parents succumb to peer pressure as much as teenagers. No parent should feel that just because social acceptance of marijuana has changed that they need to change their opinion. In reality there may not be a more dangerous drug for a teenager to experiment with than marijuana. Not necessarily because of the immediate danger but due to the treacherous road that lies ahead.
It is not uncommon to hear stories about “at risk youth.” The term is often used but at times misunderstood. There are so many circumstances that put young people in potentially dangerous situations that in some ways young people are “at risk” all the time. Normally, parents compare what teenagers experience today through the lens of their own life but today’s world is a very different place. Every generation has its version of “these young people just don’t get it” but in reality things have changed significantly in the past three decades.
Information Changes Everything
Access to information has radically changed the way young people react to life. In most cases this is a good thing but there are exceptions. For teenagers prone to drug and alcohol abuse or other forms of self-destructive acting out this can be devastating. People that get high are in constant search of justification. Now it is possible to build an army of support for any behavior without any pushback. This is extremely dangerous for young people who are suffering because if they successfully find others to validate dangerous forms of acting out, they are less likely to find help when it is really needed. A drug or alcohol abuser is an expert at showing the world what he or she wants others to see. The isolation and internal torture a young person lives with is difficult to recognize. Receiving validation from “friends” online only perpetuates the problem. This was not the case in the eighties and nineties.
Same Mindset, Different Circumstances
Teenagers are still teenagers. Anyone can understand that simple fact. Many parents of teenagers today had their own bouts with drug and alcohol abuse in high school or college. However, it is dangerous and naive to think this provides the knowledge needed to help a struggling young person. The drugs of today are different. They are far more powerful and much more available. The social acceptance for drug abuse is rampant. These facts don’t make the situation hopeless. No one needs to accept a loved one abusing drugs or alcohol or convince themselves their child is “going through a phase.” If you are concerned about someone you love, ask for help. If this is an overreaction, so be it. With a problem this serious an exaggerated reaction is better than waiting until it is too late.
When there is an addict or alcoholic in the home all sense of peace is lost. Drugs, alcohol, and the emotional turmoil that comes with substance abuse take center stage. Family members either act as if nothing is happening or fly into irrational rages while desperately searching for something to control. By the time the drug abuser is discovered, in some ways it is already too late. Without intervention the problem will probably get worse. It is rare that an addict or alcoholic wakes up one day and suddenly decides to mend his ways. He may make promises along these lines but that is usually to avoid potential consequences, not because of a sudden change in heart. Loved ones are left confused and scared, having little awareness of where to turn. Parents of addicts need tools after their son or daughter enters recovery. Abstinence does not solve all the problems created by drug abuse. With the right help parents are able to become a part of the solution while healing emotionally.
By the time a young person enters treatment his or her parents have tried everything they can think of to stop the problem. It is not unusual for a family to start the recovery process armed with behavioral contracts so complicated that the most educated lawyer would have a difficult time interpreting its details. The failed attempts of behavioral control accomplish nothing more than contempt and alienation. It makes the parent crazy and has zero effect on a young drug abuser. Parents can make their lives much more manageable by taking the time to re-evaluate whatever rules are in place and let go of those that do not support recovery for the family. InBeyond the Yellow Brick Road, Bob Meehan illustrates this idea with the analogy of Six Shots In Your Gun.
Triage Ain’t Forever
A family affected by drug abuse is lost, scared, and desperate. There are a number of issues that need to be addressed. This takes time. Early on, sobriety is priority number one. Healing from the emotional pain and resentment comes next. At some point a “life direction” takes center stage. There has to be a process; no family is healed in 30, 45, 60, or 90 days. Everyone involved needs patience and understanding. Those who are willing to step back and take a longer view are usually rewarded with lasting recovery. People who struggle to let go of the idea that everything must be fixed and back on track within a set time frame will probably stay stuck. There has to be a plan of action. However, if the plan doesn’t involve poise and flexibility it will probably fail. Remember, it took time for the problem to worsen and it will take even more time for it to be repaired.
In order to stay sober, an addict must identify the ways drugs and alcohol make his or her life unmanageable. Without this admission, progression into the following steps is impossible.The acceptance that drugs and alcohol either created or magnified problems provides the proper foundation for moving forward in the program. For parents there is a similar need to determine how the pattern of addiction has created unmanageability in their lives. An addict creates much destruction in his wake and family members are inevitably affected. With the identification of these issues comes the opportunity to truly change. The beauty of twelve step recovery is that it provides people with coping tools to let go of negative patterns and replace them with more effective ways to cope. The primary theme that runs through the twelve steps is the recognition of the need for a relationship with a Higher Power.
There Is A God and It Ain’t Me!
Most people with drug and alcohol issues suffer from insecurity and low self-worth. This negative self perception is often compensated for by an overblown ego. It can be difficult for an addict or alcoholic to admit there may be any kind of power greater than him or herself, much less a benevolent being who genuinely cares for his or her condition. When this person has either moved away from any religious or spiritual background, or has no familiarity with spirituality at all, believing there is ” a Higher Power, expressed through love that can help restore us to sanity” is a bit of a stretch. Because this concept can be so complicated, finding a simple way to deflate the ego while finding hope is vital. This usually begins with some form of connection with the love and compassion of family and friends.
Life Beyond Addiction
Twelve step recovery is spiritually based. In early recovery everyone affected by addiction, both the abuser and loved ones, are encouraged to develop some sort of understanding of a Higher Power. This isn’t meant to answer deep theological or philosophical questions. The point is for those harmed by this terrible disease to realize they are not alone and that there is a solution. There are many in recovery who choose to deepen their spiritual life in many different ways. This should be encouraged. Some decide that what they identify with in early recovery is enough. Either way, if the person working a program is able to find a way to recover, they are a success. Don’t be afraid of the spiritual part of the program, in fact keep it very simple. Any good spiritual tradition is built on a foundation of Love. That is exactly what to look for because where there is love, there is hope.
In 12 step recovery from drug and alcohol abuse the first step involves a willingness to admit powerlessness and unmanageability. The addict or alcoholic must understand that when abusing drugs and alcohol he loses control of the ability to make sound decisions and move in a positive direction in life. He must also accept that the major problems he is experiencing come as the result of getting high and drinking. No matter how much counseling or therapy an addict or alcoholic receives, he will not change until his drug or alcohol abuse is addressed and he is abstinent. Most parents or spouses of addicts and alcoholics understand this. What can be confusing is when someone says, “Now you need to work a program too!” Why would a parent or spouse need 12 step recovery?
What? I’m Not The One With The Problem
As soon as the chemical abusing a**hole gets sober the family becomes eternally blissful and all problems just melt away. Oh, if it could be that simple. Unfortunately, as anyone who loves an addict or alcoholic knows, this is literally never the case. Undoubtedly, sobriety provides the first opportunity to repair the family. But just as the addict’s recovery really starts post abstinence, the family’s issues come into the spotlight as well. When approached with the idea of working a 12 step recovery program most parents respond with a version of “I’m not the one with the problem.” Upon further investigation a loved one of an addict will inevitably come to the conclusion that fear, anger, and guilt have created a fair amount of insanity. With this awareness comes the opportunity to create real healing for wounds caused by years of living in distress.
Families enter 12 step recovery beaten, battered, and scarred. It is difficult to find hope that life will really ever get better. As soon as a parent or loved one of an addict is able to surrender to the idea that continuing along the path they have been on will only result in more pain, recovery begins. From this point the family member of the addict is able to change course and focus on her own happiness and peace of mind. Through the discovery of a Higher Power and an honest and thorough look at patterns that have caused disruption, transformation begins. The process isn’t complicated. It simply requires the courage to ask for help.