The Conundrum Surrounding Drug Rehab & The Cycle Of Relapses
The sad reality is that the drug treatment, and rehab is an industry in itself, which by design perpetuates the cycle of repeated treatments, followed by relapses, and then more treatment.
Recently I watched a documentary on the situation in British Columbia. The government does not provide that many treatment beds, mostly because the problem is so huge, the cost would be excessive, and partly because no one wants to take responsibility for the problem.
The government does provide some beds, but apparently a third of them do not provide any treatment options. The low barrier housing options allows the addicts to continue using drugs, with the provision of shelter, and other supports.
Many arguments for involuntary treatment are bandied back and forth. There are those who are adamantly against forcing treatment, and those who are just as unyielding on the issue of mandatory treatment.
Given the fact the number of government subsidized beds is so sparse, considering the scope of the problem, it has given rise to a range of private treatment centres, counsellors, and options for those seeking treatment, if they have sufficient financial backing. The payment for treatment usually comes from the family members of the addict.
However what many people may not know, is that the treatment centres are not regulated in BC. How many times do you read about former addicts going from addiction, to immediately becoming counsellors? They believe their experience qualifies them.
Clearly there can be benefits to peer counselling, and support groups. But we must keep in mind that former addicts have many years ahead of them to resolve their addiction, and reduce the chance of relapse. Unless they have many years of sobriety, they should probably stay away from other addicts, even though they might have intentions to help them.
Regarding some of the treatment centres, you hear of neighbours reporting that they thought the treatment centre was a crack house. All kinds of people are allowed to come and go without any kind of monitoring. The advertising for many of these places makes them sound like a five star resort. But when people get into the program, they find out it is a different story.
The cost of some of the programs is staggering, often tens of thousands of dollars. The background and credentials of the owner/operator is often fabricated. Some of the treatments are taken to the extreme, from sweat lodges, to Kundalini yoga, restrictive diets, excessive exercise, unsupervised fasting, etc.
When a family seeks out a treatment facility, they are often at their wits end, and in fear for the life of their loved one. They are in a vulnerable position when it comes to paying upwards of $60,000.00 for a ninety day program. Because the facilities are unlicensed, and unregulated, they have to take the advertising, and claims at face value.
This is where for profit drug treatment can fail people. There is no real incentive to see people get well for the long term. In fact the cycle of addiction often includes multiple relapses. These relapses are framed as “part of the journey” and are to be expected.
The success rate is going to be much higher if the addict is motivated to get well. Involuntary treatment does work for some people. If you listen to jailhouse interviews, or to those who spent time in jail as a result of an addiction, they will often say that being incarcerated is what got them on the road to recovery, because they had no other choice. It also gave time to reflect on what got them there, and what they needed to do to change direction.
In my opinion, individual care plans might help. The benefits of creating tailored care plans based on the addicts current situation, goals, general health, childhood trauma, and drugs of choice, could help to keep them on track.
A huge part of the problem is poly-pharmaceuticals, combining prescription drugs with street drugs. Also the inclusion of so many benzodiazepines in the mix is a recipe for disaster. Benzodiazepines, antipsychotics, and antidepressants can be more lethal than opiates.
When people become long term addicted to benzodiazepines, getting off them is a nightmare. With opiates there is a period of withdrawal, and sickness for several days. But once stabilized, they can move forward.
Benzodiazepines require a very careful, long term tapering of the drug to be able to manage the withdrawal. In one case, a man was able to help his wife by micro-dosing, with minute incremental reductions. She was doing quite well, but then her psychiatrist advised a more rapid reduction. She had extreme withdrawal, and quickly relapsed.
Antipsychotics interfere with dopamine, serotonin, histamine, and epinephrine. Benzodiazepines also interfere with dopamine, and various other neurotransmitters. If these drugs are combined with opiates, the person’s dopamine levels become an absolute mess, requiring long term treatment.
Three month treatment plans might get a highly motivated person past a crisis, but what needs to be addressed is that it takes years, not months to fully recover.
Primarily there has to be a change in neurochemistry, as well as gut health. This is in addition to supports for emotional, psychological and spiritual recovery.
Another long term effect of drug use, is EPS symptoms, or extrapyramidal side effects. These symptoms can vary widely in severity, from stiffness, to Parkinson like tremors, involuntary movements, restlessness and agitation etc. Antipsychotic drugs are the worst culprits, but many other drugs can cause these distressing symptoms as well.
In so many cases, people move away from street drugs, only to become dependant on potent prescription drugs that cause just as much harm. Short term gain for long term debilitation. The exchange is not recovery. It is misery, and an ongoing cycle.
The reason a well structured care plan might help, is to avoid some of the pitfalls, as well as being shunted from one psychiatrist’s opinions, and drug choices, to another. Anyone who goes to a psychiatrist can be certain they will be prescribed drugs. This is not going help balance the system to a state of wellness.
After the initial detox, the addict needs to set out long term goals, short term goals, and daily goals. The objective is to restore natural dopamine through diet, exercise, and goal setting. It also means changing old habits, and patterns, and staying away from areas where drugs are being used. It requires learning to set boundaries, as well as to avoid being manipulated, and/or manipulating others.
Manipulation is based on the need for control, and is a deceptive tactic. But underlying the need to control others, is an unstable locus of self-control. Self-control allows us to stick to a plan, and detach from the people or things that are prone to derailing us. We cannot thrive if we are people pleasers. If we are being manipulated, it does not come from a place of love or support.
Part of self care, is to learn to be your own butler, or caregiver. It may sound selfish, but it is important to learn how to take care of your own needs. After that, you are much better equipped to help with, serve, or take care of others. Without the ability to self care, we are at the mercy of anyone who tries to influence or control us. We lack boundaries, and end up responding in a knee-jerk fashion. This kind of response often leads to resentment.
By being your own butler, it means you are thinking ahead. You are planning meals, exercise, finances, making to do lists every day, and staying organized and focused. That way you are not an easy target for those who want to sway you, or exploit you, or simply get you to join them.
Breaking out of a cycle of victimization is not easy. We have to learn to take responsibility for the many mistakes we make. We also have to forgive the things others have done to us, while setting boundaries to prevent it from recurring.
We have to change. Change only comes about by changing daily habits, by exchanging resentment for gratitude, by changing our plans, and by finding ways to restore dopamine.
Dopamine is responsible for reward and pleasure, and therefore is a major contributor to mood. It is also responsible for cognition, memory, attention and focus, which is why it is so important to start creating a written plan, along with daily to do lists.
Dopamine also plays a crucial role in multiple other bodily functions related to sleep, blood vessels, heart rate, movement, posture, and kidney function. If a hospitalized person is on a dopamine drip, they are probably in ICU.
The ways in which drugs interfere with dopamine receptors in the brain, is vast and complex. Once a person is addicted to any substance, they face a long road to recovery.
But the good news is that unlike spinal cord injuries, or brain injuries, the recovery from addiction is possible. The younger, and healthier a person is, the more quickly their system can heal and recover.
The problem for many people, is that they expect to feel better within a matter of weeks. Or they switch from one dependancy to another, by going from street drugs to prescription psychotropics.
Switching addictions puts people on the path to relapse, one way or another. There has to be a plan to prepare for the bad days, to avoid the impulse to use again. No one is in a good mood all of the time. Learning healthy ways to cope with bad moods, is an integral part of self regulation.
Setbacks are not just a part of the addicts life, but rather, they are part of life. It can be anything from a broken down car, to finding out a spouse is having an affair. Losses can occur from extreme weather conditions, losing a loved one, to losing a job, or getting a knee injury, just when you make a coveted team.
Life has many obstacles, struggles and difficulties for all of us. For those with stable childhoods, they could still be affected by accidents, illnesses, sibling relationships, parental conflicts etc. A child’s disposition can affect the way they view the world. We simply don’t know to what extent a person is impacted by the events of their childhood.
Certain things like sleep training, perfectionism, high expectations, inflexibility, too much, or too little attention – can all have an adverse effect on how a child views the world. These things can have an impact on whether or not they develop security, confidence and trust.
If a parent favours one child over another, it can have an adverse effect on both the favoured, and the rejected child. It takes us a long time to be resilient as far as the opinions, or judgements toward us.
If children are constantly hovered over, without the freedom to play, or have some unstructured time to reach developmental milestones at their own pace, they might become anxious, depressed, or rebellious. They might find it difficult to take initiative.
Some kids are naturally coordinated. Others are clumsy. Some are academically inclined. Others are not, and may excel at sports instead. For the most part, children do not want to be shaped according to their parents values or expectations. They struggle for autonomy. Even the “perfect child” who seems to excel at everything, will not necessarily feel secure or confident.
In every family, among the siblings, most of us have observed that each child is a unique individual. Even though they grew up together, they may be very different from one another.
For those who came from a traumatic, chaotic, violent, and/or addictive childhood background, they have lifelong hurdles to overcome. The brain, the adrenal system, the dopamine, fear, anxiety, and coping mechanisms all become hardwired into the system. It affects self esteem, trust, security, learning, the way the future is viewed, and basically everything. It robs the child of a childhood, as they are faced with adult responsibilities, caregiving, and the struggle for survival at an early age.
The suggestion of learning to be your own butler, or caregiver, seems glib, but yet it does make sense. The guy who suggested this idea, is a successful executive who travels a fair bit. He said he likes to have his Keurig coffee set up the night before. He gets his clothes out, and plans what to wear. He goes to bed at night thinking about what he needs to do, to make his life easier, puts things in place, and wakes up planning his day for smooth sailing.
Yes, flexibility is a key character trait in well adjusted individuals, so we have to take all planning as an outline that might need to be changed or adjusted. If we become too rigid, we risk becoming insecure, like a toddler who needs a pacifier, blanket, stuffed animal, and story in order to be able to go to sleep.
For Christians, there are bible verses instructing us to give up self. Paradoxically the notion of self care might not align with abandoning self to follow Christ. However, Christ is within us, therefore we are to take care of ourselves physically, emotionally, and most of all, spiritually.
If we abandon self care, we will allow the forces of the world to take over our lives. Self care does not mean total selfishness. It is like when you sit on an airplane and the flight attendant goes through the safety instructions. They tell you to put the oxygen mask on yourself first, then assist the person beside you. The reason for this is because you cannot help anyone, if you cannot breathe.
People are often praised for being selfless. In order to serve others without being a manipulated people pleaser, we have to take care of ourselves. We have to be sober, vigilant, discerning, and capable of setting boundaries. We have to know our own limits, and seek God’s will for our life, as opposed to being men pleasers.
For those coming out of drug addiction, they also need to take care of the former child within, to help restructure life, and bring in some of the things they did not receive to help stabilize them as children. Childhood trauma is a root cause of addictive behaviours.
If we are honest with ourselves, we can recognize the manifestations of some form of addictive behaviours in our own lives. Addiction has many long and winding tentacles. It is not limited to drugs, alcohol, food and gambling. It is any behaviour that we repeat for short term escape, or gratification – in spite of the fact it is robbing us of something important.
What about guilt? Guilt robs us of the ability to forgive ourselves. Once we recognize the need to repent, we do not need to carry a burden of guilt. We are all flawed, and we all fall short of the glory of God. We are forgiven by the grace of God.
It means we can let go of past mistakes, hurt, shame, and guilt – to allow each day to be a clean slate. Our prior tribulation can end up benefitting us, if we have trust and faith in God.
Romans 5:3-5
3 And not only so, but we glory in tribulations also: knowing that tribulation worketh patience;