Rehab is not the cure, it's just a start
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Rehab is not the cure, it's just a start
Cory Monteith's Death Shows Rehab Alone Won't Cure Addiction
Addiction Is a Lifelong Chronic Disease, Doctors Say After Monteith Death
By SYDNEY LUPKIN
July 20, 2013 —
Cory Monteith's death less than three months after finishing a 30-day rehab program has some scratching their heads: Shouldn't rehab have cured the actor of his problem, preventing him from overdosing?
That's not how it works, addiction specialists say.
"People have the impression that treatment is complete when the person is sober. They're not using the drug anymore, so they're all better," said Dr. Stuart Gitlow, president of the American Society of Addiction Medicine. "In chronic lifelong disease, treatment is never complete. It's not at the point where we can cure it."
Gitlow said addiction is much like any other chronic disease, such as diabetes, in that it requires lifelong care. But to their detriment, recovering addicts and the people around them don't always realize that.
Even if an addict isn't actively using drugs, that person still has the discomfort associated with addictive disease, Gitlow said. This can be the result of genetic predisposition, but in many cases, drug use permanently damages the brain.
For example, crystal meth causes a surge of dopamine, the chemical responsible for pleasure, but it permanently damages the brain's dopamine receptors. So someone who uses or used meth can't feel pleasure normally.
Cocaine, methamphetamines and heroin alter brain physiology the most, causing addicts to crave them even years into recovery, said psychiatrist Raymond Isackila, who works at University Hospitals in Cleveland. There are anti-craving medications for drugs like heroin, but not for cocaine or meth.
Dr. Paul Rinaldi, who directs the Addiction Institute of New York at Roosevelt Hospital in Manhattan, said people tend to view rehab as the "gold standard" in drug addiction care, but because of that, they don't think much about what should happen afterward.
"It's a lot easier to be in rehab and be clean," he said. "You come home and you're in an environment with triggers that trigger you to use."
Triggers can be internal or external, said Isackila. Internal triggers include feelings of anxiety and depression, while external triggers can simply involve being in the same place or with the same people that an addict used to use drugs with.
Even though time after rehab is important toward recovery, many people never get help at all, doctors said.
Of everyone in the United States with an addiction problem, only 5 percent get professional help, said Dr. Westley Clark, who directs the substance abuse treatment center at the federal Substance Abuse and Mental Health Services Administration.
This is, in part, because treatment is expensive and not covered by all insurance plans. He said he hopes that the Affordable Care Act will make drug treatment more accessible.
The failure of addicts to get treatment also may be the result of stigmas associated with drug use and people's unwillingness to talk about it, Clark said, adding that the secrecy can be like how cancer patients used to hide their illness.
Isackila said the public doesn't always recognize that addiction is a health problem. Gitlow agreed.
"The public still feels addiction is a choice and not an illness," Isackila said. "So there's not a lot of politicians standing up, saying, 'You know what we need?' ... I've never heard it."
"Public expectation seems to be, 'I can get better on my own or I can get better without seeing a physician,'" Gitlow said. "We would never think twice about someone with diabetes having ongoing care from an endocrinologist. ... That's the kind of treatment necessary for someone with chronic life-threatening disease. If you have addictive disease, that's the kind of treatment that's necessary."
Copyright © 2013 ABC News Internet Ventures
Addiction Is a Lifelong Chronic Disease, Doctors Say After Monteith Death
By SYDNEY LUPKIN
July 20, 2013 —
Cory Monteith's death less than three months after finishing a 30-day rehab program has some scratching their heads: Shouldn't rehab have cured the actor of his problem, preventing him from overdosing?
That's not how it works, addiction specialists say.
"People have the impression that treatment is complete when the person is sober. They're not using the drug anymore, so they're all better," said Dr. Stuart Gitlow, president of the American Society of Addiction Medicine. "In chronic lifelong disease, treatment is never complete. It's not at the point where we can cure it."
Gitlow said addiction is much like any other chronic disease, such as diabetes, in that it requires lifelong care. But to their detriment, recovering addicts and the people around them don't always realize that.
Even if an addict isn't actively using drugs, that person still has the discomfort associated with addictive disease, Gitlow said. This can be the result of genetic predisposition, but in many cases, drug use permanently damages the brain.
For example, crystal meth causes a surge of dopamine, the chemical responsible for pleasure, but it permanently damages the brain's dopamine receptors. So someone who uses or used meth can't feel pleasure normally.
Cocaine, methamphetamines and heroin alter brain physiology the most, causing addicts to crave them even years into recovery, said psychiatrist Raymond Isackila, who works at University Hospitals in Cleveland. There are anti-craving medications for drugs like heroin, but not for cocaine or meth.
Dr. Paul Rinaldi, who directs the Addiction Institute of New York at Roosevelt Hospital in Manhattan, said people tend to view rehab as the "gold standard" in drug addiction care, but because of that, they don't think much about what should happen afterward.
"It's a lot easier to be in rehab and be clean," he said. "You come home and you're in an environment with triggers that trigger you to use."
Triggers can be internal or external, said Isackila. Internal triggers include feelings of anxiety and depression, while external triggers can simply involve being in the same place or with the same people that an addict used to use drugs with.
Even though time after rehab is important toward recovery, many people never get help at all, doctors said.
Of everyone in the United States with an addiction problem, only 5 percent get professional help, said Dr. Westley Clark, who directs the substance abuse treatment center at the federal Substance Abuse and Mental Health Services Administration.
This is, in part, because treatment is expensive and not covered by all insurance plans. He said he hopes that the Affordable Care Act will make drug treatment more accessible.
The failure of addicts to get treatment also may be the result of stigmas associated with drug use and people's unwillingness to talk about it, Clark said, adding that the secrecy can be like how cancer patients used to hide their illness.
Isackila said the public doesn't always recognize that addiction is a health problem. Gitlow agreed.
"The public still feels addiction is a choice and not an illness," Isackila said. "So there's not a lot of politicians standing up, saying, 'You know what we need?' ... I've never heard it."
"Public expectation seems to be, 'I can get better on my own or I can get better without seeing a physician,'" Gitlow said. "We would never think twice about someone with diabetes having ongoing care from an endocrinologist. ... That's the kind of treatment necessary for someone with chronic life-threatening disease. If you have addictive disease, that's the kind of treatment that's necessary."
Copyright © 2013 ABC News Internet Ventures
Nature Girl
Join Date: Mar 2002
Location: By The Lake
Posts: 60,328
I worked in a long term (3-9 months) rehab for 2 years and I saw that it takes at least 30 days for the addicted resident to just get his balance back and get over withdrawals and sickness tied with stopping drug use and then months of individual assessment and therapy for underlying issues, group support and in the case of the rehab where I worked, a 12-step meeting every day and church (of their choice) on Sunday.
It taught structure, life skills such as cleaning and cooking and managing a budget and taking responsibility for debts, understanding contracts (such as leases and employment contracts). It gave them many many tools for dealing with stress, confrontations, loss (such as family and home, which happened often) and more tools to cope with life on life's terms. All this in an environment where they could talk to a counselor 24/7 and where they were in a clean and sober environment filled with support.
Even with all that, the real test came when they left and had to deal with the "real world". Aftercare support was offered to everyone who left and yet only a small percent took up the offer that would help them stay grounded as they began their new life.
And all this was 100% free, in Ontario this kind of rehab is a not-for-profit organization funded by the Ministry of Health and never ever costs any resident a single penny. Each week they would get a small allowance to buy personal items and toiletries and to help with a coffee after meetings where they could meet with their sponsor for more help.
It was an excellent program, one of the best in this province. And even with all that, relapse happened. We had one resident overdose and die 3 days after he finished a 9 month program. It happens. Many go on to lives of sobriety and are still clean years and years later, some struggle along the way and eventually get clean again, some die. There is no guarantee with rehab, but there is hope because it's the best way I have ever seen to help an addict overcome his disease. Many just stop on their own, some stop using support groups and therapy, but rehab is one heck of a good start for anyone stuck in their addiction.
Cory Monteith's death was tragic and sad, and I pray that somehow his death opens dialogue like this, here and with "normies" out there, and most of all with parents raising children today and governments who need to fund more rehabs and offer more help and treatment for those who reach out.
Thank you for posting this, Anvil, and sorry if I rambled on, but I've been around addiction for a long time now and I pray every day that real help will be provided, opportunity to live in sober houses will be available to any addict who is willing to try and live by the rules, and that people like me will understand that, in the end, it's up to the addict and nobody else to do what needs to be done to get clean and stay that way.
Hugs
It taught structure, life skills such as cleaning and cooking and managing a budget and taking responsibility for debts, understanding contracts (such as leases and employment contracts). It gave them many many tools for dealing with stress, confrontations, loss (such as family and home, which happened often) and more tools to cope with life on life's terms. All this in an environment where they could talk to a counselor 24/7 and where they were in a clean and sober environment filled with support.
Even with all that, the real test came when they left and had to deal with the "real world". Aftercare support was offered to everyone who left and yet only a small percent took up the offer that would help them stay grounded as they began their new life.
And all this was 100% free, in Ontario this kind of rehab is a not-for-profit organization funded by the Ministry of Health and never ever costs any resident a single penny. Each week they would get a small allowance to buy personal items and toiletries and to help with a coffee after meetings where they could meet with their sponsor for more help.
It was an excellent program, one of the best in this province. And even with all that, relapse happened. We had one resident overdose and die 3 days after he finished a 9 month program. It happens. Many go on to lives of sobriety and are still clean years and years later, some struggle along the way and eventually get clean again, some die. There is no guarantee with rehab, but there is hope because it's the best way I have ever seen to help an addict overcome his disease. Many just stop on their own, some stop using support groups and therapy, but rehab is one heck of a good start for anyone stuck in their addiction.
Cory Monteith's death was tragic and sad, and I pray that somehow his death opens dialogue like this, here and with "normies" out there, and most of all with parents raising children today and governments who need to fund more rehabs and offer more help and treatment for those who reach out.
Thank you for posting this, Anvil, and sorry if I rambled on, but I've been around addiction for a long time now and I pray every day that real help will be provided, opportunity to live in sober houses will be available to any addict who is willing to try and live by the rules, and that people like me will understand that, in the end, it's up to the addict and nobody else to do what needs to be done to get clean and stay that way.
Hugs
Getting there!!
Join Date: Mar 2012
Posts: 5,750
I have a question.....because addiction is that powerful and sobriety is that difficult to maintain, why are so many against maintenance tools medications?
My husband told me if he can not stay clean this time, he is going to go on naltroxone for life but still work a NA problem. I said "ok, whatever you think is best."
My husband told me if he can not stay clean this time, he is going to go on naltroxone for life but still work a NA problem. I said "ok, whatever you think is best."
Join Date: Aug 2011
Location: "I'm not lost for I know where I am. But however, where I am may be lost ..."
Posts: 5,273
I understand the article, and I also understand and respect what Ann posted. I would just like to point out the tone of the article implies (and often is from the currently addicted people I know) that if one is addicted then their only choice is to fight this and work on it and focus on it every single solitary day of the remainder of their lives. Honestly that fate scares many, and they choose to say "forget it, I'd rather live and die high than live like that."
A lifetime sentence of recovery work is not what everyone envisions or relishes. Many would like to think that they can get some medical intervention and put the addiction behind them and go on to live a happily drug and alcohol free life. In fact, they can do that. Millions do that. I wish this idea were reinforced more. I also wish alternative methods to spiritual solutions were stressed more and presented as options to those that might benefit from them.
A lifetime sentence of recovery work is not what everyone envisions or relishes. Many would like to think that they can get some medical intervention and put the addiction behind them and go on to live a happily drug and alcohol free life. In fact, they can do that. Millions do that. I wish this idea were reinforced more. I also wish alternative methods to spiritual solutions were stressed more and presented as options to those that might benefit from them.
Member
Join Date: Jul 2012
Location: northeast
Posts: 468
Originally Posted by soberlicious 
A lifetime sentence of recovery work is not what everyone envisions or relishes. Many would like to think that they can get some medical intervention and put the addiction behind them and go on to live a happily drug and alcohol free life. In fact, they can do that. Millions do that. I wish this idea were reinforced more. I also wish alternative methods to spiritual solutions were stressed more and presented as options to those that might benefit from them.
I'd love to hear more about this. My 23 year old is over six months sober. He did his 90 meetings in 90 ... probably even 120 in 120 BUT now its more like two to three a week. I get it, I wouldn't want to go all the time either. However, I'm scared if he doesn't keep working his recovery HARD, he'll relapse.
I'd love to hear that people were able to stay sober without working AA hard.
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Join Date: Feb 2008
Location: In a good place
Posts: 4,482
Originally Posted by LoveMeNow
I have a question.....because addiction is that powerful and sobriety is that difficult to maintain, why are so many against maintenance tools medications?
I know my RAD is still seeing her addictionologist and she's 3+ years into recovery (I think). I don't keep track of her business any more, including meds and meetings. It's none of my business!
All I know is that she's not injecting opiates in her veins and she's productive. She's a joy to be around, more so than at any other time in her life, and she's ALIVE.
Life is good
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Thread Starter
Join Date: Feb 2013
Location: W Washington
Posts: 11,589
for this addict i MUST maintain vigilance, for i am always and exactly ONE bad decision away. i cannot afford to be in the wrong place, mentally OR physically, at the WRONG time (bad case of the f*ckits or the "i deserves") and ever let myself get to a place where i'm knowingly within 100 miles of crack cocaine. or just cocaine. my addiction is at best in remission.
while the correlation between addiction and diabetes is overused, i think of it like the type of diabetes that is still manageable by proper diet and exercise, where the patient must maintain vigilance to keep the disease on hold. no twinkies allowed!!!! one must have a healthy respect for what the disease WILL do if allowed to roar back to life, the power and utter devastation that will assuredly follow.
if i keep away from people places and things that will lead me down that path, if i keep a healthy positive mindset and stay right with myself and the world, all will be well.
recovery is not a lifetime sentence....it's the chance to live FREE from addiction. as long as the addict clings to the notion that recovery is somehow a punishment, they'll never "get" it. but when they see it as the key to LIFE, they will trudge that happy road to destiny!
AA isn't a crutch. AA is where one can learn how to live clean and sober by others who ARE living clean and sober. it helps keep fresh what it was like, what happened and what it is like now. and it provides the chance to help others. to extend the hand of welcome. to be of service to others. to stay humble and grateful. and never take recovery for granted. as soon as we do we start to lose it. we really only keep what we have by giving it away to others....if you want what we have............and so on.
while the correlation between addiction and diabetes is overused, i think of it like the type of diabetes that is still manageable by proper diet and exercise, where the patient must maintain vigilance to keep the disease on hold. no twinkies allowed!!!! one must have a healthy respect for what the disease WILL do if allowed to roar back to life, the power and utter devastation that will assuredly follow.
if i keep away from people places and things that will lead me down that path, if i keep a healthy positive mindset and stay right with myself and the world, all will be well.
recovery is not a lifetime sentence....it's the chance to live FREE from addiction. as long as the addict clings to the notion that recovery is somehow a punishment, they'll never "get" it. but when they see it as the key to LIFE, they will trudge that happy road to destiny!
AA isn't a crutch. AA is where one can learn how to live clean and sober by others who ARE living clean and sober. it helps keep fresh what it was like, what happened and what it is like now. and it provides the chance to help others. to extend the hand of welcome. to be of service to others. to stay humble and grateful. and never take recovery for granted. as soon as we do we start to lose it. we really only keep what we have by giving it away to others....if you want what we have............and so on.
Member
Join Date: Sep 2007
Location: Atlanta
Posts: 31,179
I agree with Anvil. I don't wake up, every day, and think "OMG, I've got to stay away from crack!". I live a life that has it's ups and downs, good and bad times, but recovery has just become my way of life.
Sure, I stay away from the people, places and things but it's "normal" now. Some A's need rehab, meetings, maintenance medications, some need one, all or none to find recovery.
To me, I appreciate life more because I could have easily died while "out there". I didn't feel that way at FIRST, but it did happen.
Hugs and prayers,
Amy
Sure, I stay away from the people, places and things but it's "normal" now. Some A's need rehab, meetings, maintenance medications, some need one, all or none to find recovery.
To me, I appreciate life more because I could have easily died while "out there". I didn't feel that way at FIRST, but it did happen.
Hugs and prayers,
Amy
Member
Join Date: May 2012
Posts: 1,927
My husband and I had a good experience with rehab, well as much as you can under the circumstances. His was based on addiction medicine / private therapy & was intended to treat the whole person. My husband had a group of doctors he met with daily, group meetings with other patients, activities to strengthen mind and body, he used naltrexone medication for two months while he was there. They did not use the principles of AA/NA, but did offer access to religious services, and private counseling with clergy.
I think rehabs can do a lot, but in reality some are very limited on what services they actually provide. I agree helping to transition patients back to their real life is critical.
My husband’s use started after an injury and a couple of surgeries that were not quite successful. The rehab had him work with a physical therapist on his injury while he was there, and meet with a specialist.
They also assigned me a therapist; I worked with her on Skype a couple times a week because his treatment was out of state, and in-person when I was visiting.
When he was about half way through his program, they wanted to start us on marriage counseling. So I actually moved to be near the rehab for about 7 weeks. I could have done it long distance, but in person for this was a lot better. Part of marriage counseling was so that he was coming home to a stable environment where we had worked through a lot of our issues, and were reconciled so to speak. We continued marriage counseling for the first year after rehab.
My husband was working before he went into treatment, so in the last few weeks while he was there, they had him travel home for a meeting with his employer, meet with coworkers, get caught up on things, and then he was able to come back and explore all those feelings with his doctor. So when he got home and went back to work it was much more relaxed, and safer for him.
They also had him do outpatient the last couple weeks while I was there, and we lived in the place I rented with our little boy. He would talk to his doctors every day, and we still did counseling and it also helped with the transition.
They had him have sessions with family and friends mostly by phone or Skype because of the distance issue. But all of it was intended to make coming home easier. To mend bridges, or at least understand clearly where he stood in terms of past relationships.
The rehab also helped set him up with a doctor for therapy when he came home. That was his mode of follow up care. They picked one, updated him, and did joint sessions while he was still in rehab. So when he got home it was a smooth transition with this doctor and he felt comfortable. After he came home, his primary doctor continued sessions with him by phone/skype for about 3 months; just checking in, and being available for support. They also helped create relapse prevention plans, and plans in the case of an actual relapse.
My husband and I view addiction as a type of chronic illess. However the good news is that it can be put into lifelong remission. My husband is no longer addicted. He does not look over his shoulder for addiction to come sneaking up on him, because he is in control of his addictive tendencies. He still works with a therapist for ongoing support and really just tries to lead an overall healthy life.
We are both aware he could relapse, but we do not focus on it. Relapse to us, is like a relapse in any other chronic disease; you go to your doctor, you get more treatment, figure out what went wrong and fix it. He has plans in place for prevention, and there are actions we both know to take in case of relapse.
Around the 4th of July ever year his rehab has a Freedom Celebration; reunion party of sorts. Last year he was just finishing his treatment and we attended. This year, we traveled there, he spoke and told everyone about how his year had been. It was amazing to be there standing by his side. He has 15 months clean now.
I think rehabs can do a lot, but in reality some are very limited on what services they actually provide. I agree helping to transition patients back to their real life is critical.
My husband’s use started after an injury and a couple of surgeries that were not quite successful. The rehab had him work with a physical therapist on his injury while he was there, and meet with a specialist.
They also assigned me a therapist; I worked with her on Skype a couple times a week because his treatment was out of state, and in-person when I was visiting.
When he was about half way through his program, they wanted to start us on marriage counseling. So I actually moved to be near the rehab for about 7 weeks. I could have done it long distance, but in person for this was a lot better. Part of marriage counseling was so that he was coming home to a stable environment where we had worked through a lot of our issues, and were reconciled so to speak. We continued marriage counseling for the first year after rehab.
My husband was working before he went into treatment, so in the last few weeks while he was there, they had him travel home for a meeting with his employer, meet with coworkers, get caught up on things, and then he was able to come back and explore all those feelings with his doctor. So when he got home and went back to work it was much more relaxed, and safer for him.
They also had him do outpatient the last couple weeks while I was there, and we lived in the place I rented with our little boy. He would talk to his doctors every day, and we still did counseling and it also helped with the transition.
They had him have sessions with family and friends mostly by phone or Skype because of the distance issue. But all of it was intended to make coming home easier. To mend bridges, or at least understand clearly where he stood in terms of past relationships.
The rehab also helped set him up with a doctor for therapy when he came home. That was his mode of follow up care. They picked one, updated him, and did joint sessions while he was still in rehab. So when he got home it was a smooth transition with this doctor and he felt comfortable. After he came home, his primary doctor continued sessions with him by phone/skype for about 3 months; just checking in, and being available for support. They also helped create relapse prevention plans, and plans in the case of an actual relapse.
My husband and I view addiction as a type of chronic illess. However the good news is that it can be put into lifelong remission. My husband is no longer addicted. He does not look over his shoulder for addiction to come sneaking up on him, because he is in control of his addictive tendencies. He still works with a therapist for ongoing support and really just tries to lead an overall healthy life.
We are both aware he could relapse, but we do not focus on it. Relapse to us, is like a relapse in any other chronic disease; you go to your doctor, you get more treatment, figure out what went wrong and fix it. He has plans in place for prevention, and there are actions we both know to take in case of relapse.
Around the 4th of July ever year his rehab has a Freedom Celebration; reunion party of sorts. Last year he was just finishing his treatment and we attended. This year, we traveled there, he spoke and told everyone about how his year had been. It was amazing to be there standing by his side. He has 15 months clean now.
Join Date: Aug 2011
Location: "I'm not lost for I know where I am. But however, where I am may be lost ..."
Posts: 5,273
I'd love to hear that people were able to stay sober without working AA hard.
I do not attend AA, and I put drinking behind me over 6 years ago. I will not ever drink again. I do lots of things to improve my life, and I can do that now that I am no longer addicted to alcohol. I am a non drinker. I need support for a lot of things in my life, but I don't need a support for a behavior that I stopped and will not ever resume.
I am by no means an exception. There are lots of people like me.
I just like a strong message of hope for those that find themselves addicted. I like the message that although you may be addicted, you are not defective, not diseased. You are not lacking, and although you've made bad choices, you are not stupid. You are capable of taking your life back if you so desire.
An addicted individual will only end their addiction when the consequences become too great to continue it. Here's the rub...that's different for each individual. For one health consequences are enough, for some the threat of losing family. For some, they choose to die that way. Why? No one really knows that.
For those that work a 12 step model, I think that's great. I'm always happy for a fellow traveler to experience freedom. I just want to point out that there are other views on this. Choosing not to participate in a 12 step program does not mean that one cannot recover. Not by a long shot.
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Join Date: Apr 2013
Posts: 1,405
Anvil,
I was reading an article a few nights ago that cited a 2010 study published in NJP that stated since they redefined addiction as a disease to a brain disease that the associated stigma of "bad character" actually increased in the publics view from 49% in a prior study to 65%. Also, that when the uninformed hear "brain disease" they associate it with other neurobiological diseases of the brain like Alzheimer's which at this point is somewhat treatable, but always progressive and fatal.
Soberlicious,
The same article also cited a 2002 study of 4000+/- alcoholics. 18.2% remained sober a year later and of the 18.2%, 75% had received no treatment and had not participated in any program of recovery.
I was reading an article a few nights ago that cited a 2010 study published in NJP that stated since they redefined addiction as a disease to a brain disease that the associated stigma of "bad character" actually increased in the publics view from 49% in a prior study to 65%. Also, that when the uninformed hear "brain disease" they associate it with other neurobiological diseases of the brain like Alzheimer's which at this point is somewhat treatable, but always progressive and fatal.
Soberlicious,
The same article also cited a 2002 study of 4000+/- alcoholics. 18.2% remained sober a year later and of the 18.2%, 75% had received no treatment and had not participated in any program of recovery.
Member
Join Date: Jun 2012
Posts: 349
I just like a strong message of hope for those that find themselves addicted. I like the message that although you may be addicted, you are not defective, not diseased. You are not lacking, and although you've made bad choices, you are not stupid. You are capable of taking your life back if you so desire.
I like your statement Soberlicious! It is my hope that my RAS sees life this way and spends his time staying busy and enjoying life with healthy activities.
I like your statement Soberlicious! It is my hope that my RAS sees life this way and spends his time staying busy and enjoying life with healthy activities.
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