When I started my practice Integrated Treatment Solutions in 2009, I did so out of professional conviction. My experience working in a variety of healthcare and drug and alcohol treatment settings led me to rethink my approach as a behavioral health professional. I could no longer only treat symptoms at the expense of being complete and addressing underlying issues. I realized that I was at a critical choice point and that working within a traditional clinical framework was preventing many clients from getting help – That was not going to work for me. I wanted to collaborate with clients in the exploration of their problems and see what made sense for them in their respective recoveries.
These are some things about addiction and recovery that I have learned along the way and implement in my daily practice as an addictions specialist and behavior therapist…
Understanding addiction and moving into recovery is a process, not an event. Addiction recovery takes willingness, honesty, openness and time. Recovery is not linear. In fact, it can vary person to person.
The decision about one’s relationship with substances is personal. Individuals use substances and engage in addictive behaviors for different reasons – Essentially, all behavior is purposeful. As human beings, we are always trying to accomplish something. Each person has his or her perspective and goals concerning their use, lifestyle and level of wellness desired.
As a co-occurring disorders specialist (previously referred to as dual diagnosis – addiction and mental health together) I counsel and treat clients presenting “clinical complexity.” Many have been trying to gain clarity about their conditions and make progress for many years having been through many courses of treatment but continue to struggle with relapse or are “white knuckling” it through tough symptoms. Despite previous attempts at recovery and disappointments incurred along the way, they have stepped up again! I applaud their courage and determination.
I also believe that there is hope. Even after several attempts have been made.
It has become apparent to me that there are no failed clients only failed treatment. While addiction, depression, bipolar disorder, etc. tend to be fairly standard in their presentations, each person affected is different within the issue at hand. Each brings unique strengths, vulnerabilities and life experiences which need to be taken into account when planning treatment.
Treatment must be tailored to the individual – always.
People want to get well – not only sober. To feel at home in their bodies and positive about themselves, others and their relationships – To be able to trust themselves – their thinking, abilities and choices.
Many clients who approach treatment with me had been sober before – for long periods of time and yet continued to be in physical and or emotional pain. Many have made attempts at sobriety in traditional drug and alcohol rehabs and attended daily Alcohol Anonymous (AA) or Narcotics Anonymous (NA) meetings – Worked with a sponsor through the 12 Steps of AA or NA.
Symptoms from chronic pain, mood disorder, trauma, attention deficit (ADD) or chronic physical conditions/ diseases involving the autoimmune system, or unresolved post-surgical complications can surface when the person stops using substances – “breakthrough” symptoms can result in powerful triggers fueling drinking and drug use again. Inflexible personality traits or personality disorders can also serve as barriers to effective therapy and treatment. Trying to manage what is not known or understood is confusing and painful for people.
Unfortunately, situations presenting this level of complexity are not uncommon. There are often multiple problems occurring at the same time, playing off one another. The idea that addiction is a singular issue is often a false construct – An incomplete, inaccurate or an ill-founded psychological concept.
Addiction often travels with other issues – It is critical that all of the problem issues are identified, understood and addressed in order to move towards stabilization and recovery. Expecting a person to reduce their drinking or substance use or to completely abstain (depending on risk) is not realistic without a comprehensive and holistic approach offering precise diagnosis and a personalized plan.
No problem is about “one thing and one thing only.”
Clients need and have the right to know exactly what the issues are and to be educated about them. Identification of the issues and a conversation about them needs to happen even if it means talking about conditions like borderline personality disorder (BPD), narcissistic personality disorder, Asperger’s or anything that is tough to accept.
If difficult issues are NOT talked about, they will sabotage treatment and leave clients confused and defeated yet again, resulting in an increased sense of hopelessness and helplessness. When people are not informed they are deprived of the opportunity to move through their own process of “self-diagnosis”, which means “Do I agree with this?” and “What does this mean to me?”
Knowledge is power.
Engagement and commit to change can only happen when clients are clear about what they are dealing with and have a sense of what to expect moving forward.
Effective treatment starts with a thorough bio- psychosocial assessment to obtain information about the major physical (bio), psychological, and social issues. A holistic approach posits that separate issues are often related. – No stone is left unturned in the interest of getting the “bigger picture” of what is going on.
Assumptions are dangerous. Illnesses presented as being “treated” such as autoimmune disease, diabetes, depression or conditions that tend to be minimized like, Lyme disease, premenstrual dysphoric disorder (PMDD), or sleep problems can fuel addiction and its ‘problem behavior. Medical treatments often need to be reevaluated to determine if they continue to be effective.
People are not always consistent with or misuse medications. Many do not have a trusted primary care physician. There are oversights and misunderstandings that can happen which have the impact on any health problem.
So, the solution to the problem is only as good as it’s’ conceptualization. To be inaccurate or incomplete is time, energy and resource draining.
An integrative approach to addictions treatment and its’ co-occurring disorders is collaborative, thorough, health and well- being oriented – Not just about “one thing” or symptom oriented.