Addiction and Alcoholism Treatment
Addiction and alcoholism treatment can be difficult to access, so this paper has been written to provide information for addicts, alcoholics, and their families, on treatment and recovery. It is meant to help with making decisions and choices as regards, making a treatment plan, where to get treatment, and for how long. Although I discuss Hope Rehab Center Thailand’s program, the clinical information is objective and of great value.
Common Symptoms of Active and Non-Active Addiction:
Addiction and Alcoholism Treatment by Simon Mott
Studies show: Why the ideal length of treatment is 90 days
Reports and Outcome Studies on the effectiveness of residential addiction and alcoholism treatment indicate that rehab is more effective than outpatient methods and that a client’s length of stay in treatment is a critical factor, this is according to the National Institute on Drug Abuse (NIDA).
Duration of stay in addiction and alcoholism treatment: Residential programs can last between 28 days up to 6 months. However, clinical wisdom suggests the time required for behaviour change to be internalised for all age groups is approximately 3 months. Those clients with deep and complicated issues are unrealistic in expecting to achieve this within 28 days. Even though 28 days is the most commonly offered program for addiction and alcoholism globally, this is often due to insurance company pay structures and annual leave allowances.
The Warehouse Effect: This is one of the most successful elements of a long-term addiction and alcoholism treatment program. This refers to the idea that it takes around 90 days for a person to “break a habit” and in general the idea works. By “warehousing” addicts in safe places, such as Hope Rehab Center Thailand, who provide therapies and education on addiction disorder. This is why Alcoholics Anonymous has the historic slogan “90 meetings in 90 days”: The neurological damage produced by consistent abuse manifests as the brain’s inability to regulate the production of serotonin and dopamine neurotransmitters; both of which are associated with the pleasure center and reward circuitry in the brain. According to NIDA research, those who complete 90 consecutive days of residential treatment are 35% more likely to maintain five years of unbroken recovery than people who do not.
90 Days: An extended course of addiction and alcoholism treatment can last up to 6 months and involves various stages, primary, secondary and third stage. Of course, 28 days clean is a positive start, away from the common stressors, (people, places and things) and being around recovering people and a clean environment provides the opportunity to consider extending treatment further. At Hope Rehab Center Thailand you can access the 90-day package that gives a client the best chance for long-term results.
What are Addiction and Alcoholism?
The American Society of Addiction Medicine (ASAM) just released this new definition of addiction after a four-year process involving more than 80 experts, defining addiction as a chronic neurological disorder involving many brain functions, most notably an imbalance in the reward circuitry. This fundamental impairment in the experience of pleasure literally compels the addict to chase the chemical highs produced by substances and excessive behaviours like sex, food and gambling. Addiction is a “bio-psycho-socio-spiritual” illness characterised by; Damaged decision-making (affecting learning, perception, and judgment) persistent risk and recurrence of relapse; Addicts lose control over their addictions: known in AA as “Powerlessness” or Compulsiveness in CBT.
The “destructive and unhealthy” behaviour themselves are all symptoms of the addiction, not the disease itself. The state of addiction is not the same as the state of intoxication or even physical dependency; Substance abuse is considered a form self-prescribing or self-medicating, allowing their users to escape temporarily from the condition that troubles them, from simple stress and/or anxiety to mental disorders. However, the relief or highs provided by drugs and alcohol are short-lived.
Addiction and alcoholism treatment specialists see the latest ASAM definition as a validation of what has, since the publication of Alcoholics Anonymous in 1939, come to be commonly known as “the disease concept” of addiction. “Many people in the population at large see addiction as a moral, social or chosen problem; however understandable this is, it is a dangerous mistake. The world health organisation and many other respected professional bodies have also recognised “Alcoholism” as an illness since the 1950’s.
The Disease Concept and the medical model: Don’t be confused, addiction cannot be cured in the traditional medical sense or in a Hospital. Treatment of addiction and alcoholism means addressing psychological, environmental and social aspects (triggers) of the problem, not just its biological condition. It’s called “medication-assisted therapy” not “therapy-assisted medication” Medication alone fails, the analogy is with depression: If you ask most people what depression is, they’ll answer that it’s a serotonin deficiency disorder and that the solution is to put somebody on a SSRI (antidepressant medication) but that’s a simplistic and short-term way of managing depression. Medication can be helpful, but it needs to be combined with talk therapy and lifestyle change. Also, humans become tolerant to all drugs/medication so a sustainable long-term solution must be found. Addiction is like a cardiovascular disease or diabetes, recognized as a chronic disease, it must be treated, managed and monitored over a person’s lifetime because there is no pill which alone can cure addiction, so choosing “a recovery lifestyle” over unhealthy behaviours is akin to people with heart disease who choose to eat healthier or begin exercising.
NOTE:The human reward system is designed to support survival and has been hijacked by the chemical payoff provided by substance use or addictive behaviours. The reward circuitry bookmarks things that are important: eating food, nurturing children, having sex, sustaining intimate friendships. Use of the substance then starts to happen at the expense of what otherwise would promote survival. Addiction is a condition that changes the way our brain works.
So a quick “Detox” (the acute phase) will certainly never be a lasting answer, it’s a quick fix like the using itself, or “flight to health” as we say and cannot replace addiction and alcoholism treatment. The alcoholic/addict in the longer-term is like a rat that has become habituated by a scientist, to choosing cocaine over food. The rat in the short-term cannot control the neurological impulse to choose the cocaine! The rat will continue to seek it, ignoring food and water! The rat’s nerve-impulse to use the cocaine has nothing to do with free will. The addict cannot control these spontaneous overwhelming neurological impulses to use, any more than the rat can in the short-term.
The neurological impulse is called a craving.
So addiction is a brain disease, not about will power or substances or physical dependency. The problems facing addicts, alcoholics, and their families, who come to Hope Rehab, are miserable, painful, and infuriating, often feeling hopeless. But to imagine an addict can just change when he or she wants to is a common misunderstanding, even when physically clean. Addiction is based on physically altered neurotransmitter balances (brain chemistry) and driven by active neural pathways which have been permanently established, and they will not just disappear or stop. The physical dependence on the substances is secondary but also powerful! Although physical withdrawal does not change the underlying primary neurological addictive disorder it is uncomfortable. After detoxification, long-term overpowering cravings are predictable. These cravings are, in reality, spontaneous nerve impulses. So the early weeks in addiction and alcoholism treatment are when people are most likely to relapse and require a safe place.
One analogy is to consider the brain like a ski slope after a recent heavy snowfall. As skiers begin to traverse the slope, “grooves” or pathways begin to form as skiers follow the same groove or path over and over, think-paths. Eventually, these grooves or paths become so deep and entrenched through behaviour repetition (addiction) it requires a great deal of effort for a skier to traverse the slope onto a new path. If the new path is repeatedly followed, however, it can eventually replace the old groove or path as the automatic choice.
The old groove or path does not go away and can be followed by the skier if they are not intentional about choosing and using the preferred recovery (safe) path. New paths of thinking, feeling, and behaving can be established with help and effort. Old habits may remain available but their power can weaken over time.
Neurologically based impulses to use sometimes stay hidden unless opportunity (triggers) arises. It can be many critical weeks in addiction and alcoholism treatment adjusting to living without the chemicals. Depression, anger, boredom, or happy, excited feelings are predictable. These symptoms follow detox and take time to re-balance and will eventually trigger an uncontrollable impulse in early recovery. There is no way to turn off these inevitable overpowering cravings. During this time help is needed. By learning to accept help, developing patience and tolerance, one can work through these critical challenges in early recovery.
New Environment: Sometimes, relocating to a different environment can change your perspective. From meeting new and interesting people from around the world with different ideals and cultures to the inspiration of new landscapes, addicts sometimes need some beauty and change, and this is often found by travelling to somewhere you’ve never been before, such as Hope Rehab Center Thailand. Addiction is a highly repetitive condition that leaves people feeling like they’re in a never-ending cycle that requires intervention.
Going to a rehab far from where you live: Coming to Thailand you may experience fewer triggers to use, because the brain forms contextual associations during active drug use, those associations can come back to haunt an addict when they see a person they used with, a building or street where they spent a great deal of time or other local triggers that cause the addict to feel a severe compulsion to get high.
Brain Chemistry: Understanding the role of the neurotransmitter dopamine in addiction is helpful so at Hope Rehab Center we teach you about this important subject: Low dopamine levels can not only cause addiction but depression, loss of satisfaction, poor focus and many other symptoms.
What causes low dopamine levels?
Dopamine levels are depleted by stress, certain antidepressants, drug use, poor nutrition, poor sleep and genetic predisposition. People with addictions are low on dopamine. A low dopamine level causes us to unconsciously seek out dopamine raising drugs and behaviours and get addicted to them. All drugs of addiction and addictive behaviours stimulate dopamine release or increase its activity and produce the hedonic response, “I like that” motivation, incentive stimulus and goal-directed behaviours.
The Weather: In fact, you may find that a rehab in a warm-weather climate will achieve a better success rate for you personally, especially if you are someone who suffers from seasonal affective disorder SAD. In Thailand, you are guaranteed the best weather possible, and you will be participating in lots of fun activities as part of your addiction and alcoholism treatment at Hope Rehab Center Thailand.
The healing process comes from an internal dependency shift called pro-addictions, developing new neural pathways. After approx 12 weeks neurological pacification in Rehab the reoccurring compulsion or obsession to use the chemical can be relieved. This is accomplished through a neurological “re-wiring” by working our program. The addict stops thinking they can stay clean by themselves. To effectively “rewire” his or her disordered nervous system, they come to rely mutually upon an external support system. By mentally changing what they rely on, the nervous system undergoes a profound change.
Teenagers and young adult’s brains are still in the process of development, so the chemical “hijacking” of the reward system may result in earlier and more severe problems. Also, we say “Genetics is tendency – not destiny,” our family history can be a factor but not always. Also, psychological factors such as trauma, stress, distorted ideas about life’s meaning, a damaged sense of self, and breakdown in the family are acknowledged as being influences. Many experts believe that approx 60% of addicts are genetically predisposed to the disease of addiction although an environmental factor is usually required to trigger the addiction. At Hope Rehab Centre we get you to explore all these factors in detail.
Also difficulties like fitting in, lacking confidence, academic skills, dyslexia, or lack of direction, simply chronic boredom or ADHD can be enough to make a young person reach for drugs or alcohol. Once they take the drug or drink, the discomfort is relieved. That relief is valuable, and so the drug or alcohol becomes valuable. This value is the only reason the person uses substance again and again. Peer pressure may come from friends or family or through advertising, television, movies, or music videos. When peer pressure combines with relief of the discomfort or problem, drug use becomes acceptable and even desirable. Re-socializing with positive role models can be an important benefit of addiction and alcoholism treatment to reverse this.
Many young people experience pressure to achieve high grades and discover certain drugs enhance their ability to study and pass exams, and this can be a trigger for addiction-performance enhancing substance use.
Post addiction and alcoholism treatment, an independent support network is essential, “one addict can best understand and help another addict”. AA and NA have been yet again reinforced by the scientific community when they say the alcoholic/addict must come to accept that the underlying primary chronic disease consists in always being vulnerable “one is too many and a thousand never enough.”
Dual diagnosis is the term used for anyone with a mental health diagnosis combined with substance addiction. The substance use is often regarded as “self-medicating” the side effects of psychiatric drugs or the symptoms of the MH disorders, these include; depression and anxiety, mood disorders, personality disorders, psychosis and more serious conditions such as paranoid schizophrenia. It is common for people with MH to turn to using addictive and illicit substances to improve coping abilities, to help feel better, or decrease and numb feelings. Putting out fires with gasoline, the problem is that self-medicating works at first. It provides the person with relief from their restless bodies and brains. You have pain and problems that are burning out of control, and what you use to put out the fires is gasoline ultimately making the problems worse.
Richard Lazarus: Positive denial as a defence mechanism helps to manage pain, anxiety and stress, i.e. being optimistic even when faced with a life-threatening disease or grief. The disease has corrupted this defence and now protects the addiction, not the addict. Conscious denials lying and hiding and there are many unconscious denials as well.
Addicts Denial: Just as a person wouldn’t treat a terminal illness at home, an addict/alcoholic should expect to get help at a professional facility as they would with any disease. The most difficult part of the disease of addiction is known as diminished recognition-denial. Addiction Denial (protecting the reward) is defined two different ways;
Conscious denial is when a person sees, understands, and knows that they have a problem. When confronted about the problem they flat out deny it or say they don’t care. This type of denial is outright dishonesty. Many addicts lead a double life and the using is their dirty secret or only shared with a select few.
Unconscious denial is when a person is either partially or totally blind to the problem. Through many forms of self-deception, minimising, rationalisation, justification, and excuse making, a person can convince themselves that they do not have a problem.
Addiction and Alcoholism Treatment at Hope Rehab Center Thailand
We comprehensively explore all possible forms and manifestations of denial as part of the addiction and alcoholism treatment process.
Therapeutic method — Project MATCH began in 1989 in the United States and was sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The project was an 8 year, $27-million investigation that studied which types of alcoholics/addicts respond best to which forms of treatment. MATCH studied three types of treatment offered;
- CBT– coping and thinking skills
- Motivational Enhancement Therapy – readiness to change
- Twelve-Step Facilitation – Philosophical approach
The study concluded that patient-treatment matching is not necessary because the three techniques are effective in their own right. However, the 12 step model is the only one that directly links into a lifelong aftercare program and had a distinct advantage in post-treatment 1-year follow-up stats.
The psychological component of addiction is known as “distorted thinking” that develops as addiction takes hold. CBT therapists call it impaired cognition and AA calls it “Stinking thinking”. Instead of helping overcome problems it gets them deeper into trouble; for example, a gambler might need money yet by gambling he is likely to lose financially. A heavy drinker might want to cheer himself up yet by drinking more alcohol it contributes to his depression. A sex addict may crave intimacy yet the focus on sexual acts may prevent real closeness from developing.
CBT – Cognitive Behavioural Therapy is very similar to the 12-step-method addressing impaired thinking and behaviour change. Addicts can use CBT tools to change their self-defeating thinking patterns.
CBT: What do the letters ABC & DE stand for?
What it stands for:
Activating events or triggers: Significant or insignificant events activate our thinking all day long. Events may have different meanings depending on who you are, as we all have different thresholds. Events push your buttons.
Beliefs or negative self-talk: Beliefs determine how we feel about the events. Our belief system is laid down during childhood mainly and reinforced during adulthood.
Consequence: Both emotional and actions that you take as a result of the triggers. In psychology, we divide negative emotions into two categories: The first are healthy-negative-emotions; sadness, concern, healthy anger, regrets, disappointment, and concern about relationships. The second are unhealthy-negative-emotions: depression, anxiety, destructive anger, shame, hurt, jealousy and envy.
Disputing old beliefs and negative self-talk: The idea is to see if your belief system is rational, healthy and up-to-date.
Effective Philosophy (New): We take actions, paradoxical behaviours, we don’t just try and stop doing negative things we force ourselves into new positive behaviours by practising what we call exposure therapy, facing our fears.
In AA a principle behind step one is “surrender”, this means apart from getting “honest” and admitting being an addict/alcoholic it literally means allowing others to guide one’s recovery. It refers to surrendering the ego as opposed to running on “self-will”. The idea is addicts have fragile, weak or weakened egos either due to early environment or as a result of addiction. The slogan is “surrender to win”, addicts tend to demand and want things their way.
Addiction and Alcoholism Treatment Recovery Support Groups
Addiction and alcoholism treatment support groups were started by two alcoholics desperate for help having exhausted every possible medical, psychiatric, charitable and religious support offered at the time in 1930’s USA and Europe. They formed what we now know as Alcoholics Anonymous (AA), and it quickly grew internationally, a non-professional, self-help group, based on mutual support “one alcoholic can best understand and help another.”
This life-support network is now spread across the globe helping hundreds of millions of people who share a common desire to overcome many different addictions, not just alcoholism. It is said that social interactions increase the probability of success due to collective emotions, energy and common aims releasing brain chemistry during active engagement meetings, producing feelings of contentment naturally. An analysis found group participation increased when the individual members’ beliefs matched those of their support group and found a positive correlation between twelve-step recovery groups, possibly similar to a supporter attending his team’s football matches.
We use the term “in recovery” to identify being abstinent as opposed to being in relapse or active addiction.
In Twelve Step recovery, we understand the paradox that “self-knowledge avails us nothing.” This means no matter how much we learn about addiction theory we still need to commit to treatment and practice basic recovery rituals to stay abstinent; knowledge is meaningless without the action. AA always suggested 90 meetings in the first 90 days, why? This is an important question for psychologists, whether as therapists, life coaches, or as individuals wanting to change. In a recent article by B. Koerner on AA, he explores some of the elements of how AA creates long-term positive behavioural change:
Structure: The most difficult part of change is we tend to revert to what we’ve always done. “The familiar is seductive.” Changing habits is the toughest part of long-term behavioural change. AA is structured to be every bit as habit forming as alcohol.
Being committed: Being committed a key to succeeding in recovery, “half measures avail us nothing”.
New environment: To feel safe and confident to open up and share requires familiarity and consistency gained through regular attendance.
Build self-efficacy: AA gives members constant mutual support to continue their change. In each meeting, they get to hear from others who were in their situation and choose sobriety.
Form groups or relationships: One of the keys to long-term positive behavioural change is the power of the group. Whether through accountability, responsibility or support, individuals are more likely to continue change within a united context.
Making friends: You are more likely to make friends and get over trust barriers by intensive participation and are prone to loneliness in early recovery.
Sudden change: Most addicts and alcoholics have a lot of free time on their hands suddenly and are prone to boredom.
Learning the program: To adopt a new belief system that will go against the addict’s nature it requires intensive reprogramming so as not to use again.
Helping others: Even as relative newcomers can help new or old members by reminding them where they came from. We take pride in being able to help others.
It may seem like a lot of meetings and overwhelming to the beginner. Think of it as medicine. If you are sick or have any other disease, you take your medication, exercise and eat well; it’s no different for alcoholism and addiction. It is a disease. It’s only 7 hours per week, plus, it’s a great time to decompress, think and reflect on what’s happened. One day at a time… and it’s free. At Hope Rehab Center Thailand we will take you to outside meetings, and we have our own onsite meeting.
Here is a brief summary of the AA program:
Step 1: Admit powerlessness over addiction and the unmanageability it causes.
Step 2/3: The so-called “spiritual” steps. We accept outside help to restore control of our lives. We learn to “let go” of “difficult emotions,” Using the phrase “Helping Power” instead of “Higher Power” can benefit some.
Step 4/5: Work through our significant life events, hurts and fears that cause us anxiety and conflict.
Step 6/7: List our dysfunctional behaviour and personality traits.
Step 8/9: Make amends to those we hurt and change our behaviour.
Step 10/11/12: Daily maintenance steps, checking our behaviour regularly, meditation and helping others.
A spiritual program not religious: One of the biggest blocks for many is the use of the word God in the AA literature, although it’s always qualified with “as we understand him” more recently the word Higher Power (HP) is being used. Taken in its original context, written 80 years ago by recovering alcoholics in America they were only trying to convey the message that much of the solution is best described as spiritual. The reason being is to find and nurture hope, faith and optimism, or a sustainable belief in oneself and a willingness to persevere through uncertainty and setbacks in order to remain clean and sober. Many do this by accepting a form of what we now call spirituality or psychologists call positive psychology. Developing a sense of meaning and overall purpose is said to be equally important also.
Positive self-image and rehab: Some people struggle with their “identity” in early recovery and this is an important factor in staying clean. Research suggested that people sometimes achieve this by “positive withdrawal” from old environments. Regulating social involvement in order to only move towards others is a way that feels safe yet meaningful and nurtures personal psychological space that allows room for developing understanding and a broader sense of self, interests, spirituality, etc. It was suggested that the process is usually greatly facilitated by experiences of interpersonal acceptance, mutuality, and a sense of social belonging; and is often challenging in the face of the typical barrage of overt and covert negative messages that come from the broader social context in the wider community.
DSM-1VDiagnostic and Statistical Manual of Mental Disorders-Substance dependence criteria: Addiction is termed substance dependence by the American Psychiatric Association is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring any time in the same 12-month period:
- Tolerance, as defined by:
- Substance is taken to relieve or avoid withdrawal symptoms.
- Substance is often taken in larger amounts or over a longer period than intended.
- There is a persistent desire or unsuccessful efforts to cut down or control use.
- A great deal of time is spent in activities necessary to obtain, use or recover from.
- Important social, occupational, or recreational activities are given.
- The substance use is continued despite knowledge of having a persistent physical or Psychological problem.
History of Rehabs and Therapeutic Communities TC: Synanon was one of the earliest rehabs, founded in California by Chuck Dederich, one of the early members of AA, he wanted to provide a substance-free environment in which alcohol and drug users could rebuild their lives, using the principles of AA along with an intensive social learning model. Residents did this by learning from fellow residents, staff members, and other figures of authority. In the earliest TCs, restrictions, contracts, and extreme peer pressure were commonly used, and have been greatly modified over time, although peer pressure has remained an integral and important therapeutic technique. Treatment is ordinarily provided within a 24-hour, 7-days-per-week highly structured plan of activities and responsibilities. The community’s role in most rehabs is critical to client’s rehabilitation; this is because some clients come from dysfunctional families. Being a member of the community offers the chance to become better at forming relationships. Nearly all activities are considered part of the therapeutic process.
Addiction and Alcoholism Treatment at Hope Rehab Center Thailand
Counsellors working in addiction and alcoholism treatment centers are often recovering addicts/alcoholics themselves or psychologists, they help individuals identify and process behaviours and problems related to their addiction. It can be done on an individual basis, but it’s also common to find it being done in a group setting. They are trained to develop recovery programs that help to re-establish healthy behaviours, boundaries and provide coping strategies whenever a situation happens. It’s very common to see them work also with breaking down denial of the person with the addiction. Denial implies a lack of willingness from the patients or fear to confront the true nature of the addiction. Although all clients have a primary counsellor with whom they work individually, peer-group meetings for everyone in the community are led by a staff facilitator daily. At Hope Rehab Center Thailand our policy is to employ recovering addicts and alcoholics.
For more information or to book your place at Hope Rehab Center Thailand get in touch with us via the contact form below.
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