“My boyfriend John drinks too much, and he needs to go to rehab…but we just don’t have the money for it, and he has depression so I don’t want him to just go cold turkey. I guess we should just wait,” Karen Edwards says. Inpatient addiction rehabilitation, commonly known as “rehab” can be an expensive process—running thousands of dollars a month—but it’s not the only effective treatment. There are many options available when treating addiction.
Karen may worry about her boyfriend, but first, he needs to believe there’s a problem. People with addiction continue to abuse drugs and alcohol even while their lives fall apart around them. Cindy Levy, adult outpatient services coordinator at Colonial Behavioral Health, says it’s usually one of four things that shake people enough to seek help: “lovers, livers, livelihood and the law.” Family and friends may pressure the person to quit (lovers), or they may develop health problems (livers). Their habits may affect their jobs (livelihood) or they may be arrested (the law).
There’s a Problem, is Rehab my Only Option?
First, John has to stop using, but he doesn’t need to stop suddenly without support, commonly known as “going cold turkey.” Medications can suppress withdrawal symptoms and re-establish normal brain function. Medications for opioids (like heroin or morphine), tobacco and alcohol addiction exist. Treating addiction with medication seems counter-intuitive, but they can help diminish cravings and prevent relapses.
But after weaning off addictive substances, he’ll need to change his lifestyle and his thinking. Behavioral treatments, including peer support groups, counseling, cognitive therapy and programs, like Alcoholics Anonymous and Narcotics Anonymous can help.
Jan Brown, executive director of Spiritworks Foundation, a peer recovery and support agency in Williamsburg, Va., runs programs where people in recovery form small circles of influence. “Although they don’t have professional experience, peers have ‘lived experience.’ I think we’ve spent far too long trying to force people to one form of recovery,” she says.
Spiritworks’ philosophy is that no one recovers from addiction alone. The circles of influence support each other and share regularly. Each person makes a plan, and if they stray from it, they expect to be held accountable by their peers.
Brown points out one of the newer prevailing beliefs: recovery is an ongoing process. “It’s a problem based in your brain, so you can’t cut it out. You aren’t cured of it. You may need to address your triggers to continue your recovery plan,” she says.
Whatever behavioral path is taken, Levy says the process of change matters most. “In the 1990s, motivational interviewing and recognition of the stages of change revolutionized treatment practices. When people confront behaviors that they need to change, it works,” says Levy. John might need to make a plan that includes adding in healthier social activities, continuing counseling and dealing with temptation.
Addiction or Mental Illness?
Will John’s depression worsen if he stops drinking? Will his addiction need to be treated differently than someone else’s? The National Association of Mental Illness cites recent studies that nearly one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses also experience substance abuse. The correlation of a “dual diagnosis” is not clear though.
Rick Jackson, executive director at Riverside’s Center for Excellence in Aging and Lifelong Health and supervisor of substance abuse prevention program Screening, Brief Intervention and Referral to Treatment (SBIRT), says it can be “a chicken and egg argument.” “If a doctor discovers you’re drinking too much and depressed…Are you depressed because the alcohol is making you depressed? Or drinking to self-medicate your depression?” he says.
“We are finding more evidence that what’s under most people’s addiction is mental illness, and they’d been attempting to self-medicate. This is causing tension between the abstinence-based model and medication model, because what’s keeping people from abusing drugs is taking medication for their mental illness,” says Brown.
Karen can’t change John’s addiction, but she can help him find the best choice for him—and there’s no need to wait. There is help available now, many paths to the same goal of treating addiction.
