Addiction Treatment Recovery
The Recovering Patient & the Primary Caregiver
Primary Care, Treatment Basics, Recovery Stages
Studies have shown that physician knowledge, support, and monitoring of the recovering patient significantly improves long term treatment outcome. The involvement of a primary caregiver in a patient’s ongoing recovery is an extremely important source of support for the patient.
This article is an attempt to help aid the primary care physician in dealing with the unique medical and psychological needs of the patient recovering from drug or alcohol addiction. It is a resource to turn to when questions arise, and an invitation for continued communication and support from the addiction specialists who have cared for your patient from the beginning of his or her recovery process.
Disease of Addiction
Since 1956, the American Medical Association has recognized and defined alcohol addiction as a primary disease, not a secondary symptom of an underlying psychological or medical illness. Since then, this definition has been extended to define all chemical addictions as “chronic, progressive diseases characterized by significant impairment that is directly associated with persistent and excessive use of psychoactive substances. Impairment may involve physiological, psychological, or social dysfunction.”
Research into the neurochemical basis of addiction points to the dysfunction of one or more of six major neurotransmitter types as being the basis of the symptoms of addiction, withdrawal, and drug cravings. Studies have shown strong genetic predisposition to some types of chemical dependency regardless of social environment.
The basic fact remains: the patient who has exhibited the symptoms of chemical dependency functions physiologically and psychologically in a way different from the general population. This is the reason life-long abstinence from all psychoactive substances is the goal of treatment for this patient.
The main thrust of the LMRC program is to assist the alcoholic or addicted patient in recognizing that theirs is a primary, progressive disease, rather than any manifestation of a moral failing, character weakness, or psychological dysfunction. We teach alcoholics and addicts to approach their disease as a treatable condition with a high potential for lasting recovery.
The Basics of Treatment
The recovering patient you are caring for has most often started his or her recovery by entering some type of “treatment.” It is vital that a patient’s physician realize that treatment is the beginning of recovery, where the patient first obtains knowledge of the disease of addiction and the behavioral tools needed to live life without drugs. Recovery is a life long process of managing the chronic disease of addiction.
Several levels of initial treatment exist. The most intensive treatment is inpatient treatment. This is often used for the patient needing medical detoxification, suffering from complicating medical or psychological factors, for the patient unsuccessful in less intensive treatment, and for the patient who must be removed from his present “using” environment for any chance of recovery. The length of inpatient treatment depends on treatment response, and can vary from as few as 7 to as many as 45 days.
Less intensive is outpatient treatment. This commonly consists of a month of daily treatment for 3-4 hours a day while the patient continues to live at home. Both levels of treatment are often followed by up to 6 months of continuing care as deemed clinically appropriate.
Treatment starts by allowing patients to begin detoxifying from the acute effects of their drug use and commence the physical healing and neurochemical adjustments needed for sobriety. The next step is educating the patient through lectures, films, and group therapy on the concept of addiction as a disease along with the physical and emotional consequences of addiction. This helps the patient realize that many of their past behaviors are common and predictable symptoms of the disease and not irreversible character flaws, thus allowing the patient to get past the guilt and shame of the past and begin to assume an active role in managing their illness. Individual and group therapy sessions give the patient the knowledge and the behavioral tools to support changes that allow them to begin living and functioning effectively without drugs or alcohol. Continuing Care is the vital outpatient follow up, monitoring and bonding with support groups such as Alcoholics Anonymous, Narcotics Anonymous, and Cocaine Anonymous. It is in continuing care that physicians have one of their most important roles.
The Stages of Recovery
It is important that physicians monitoring the recovering patient realize that many patients go through fairly predictable stages of addiction and recovery, each with their own difficulties.
Recovery can take up to two years to become firmly established. Early recovery spans the first six months for most patients, and is the time when the risk of relapse is the highest. This is the time the patient is struggling with the major adjustments he must make. He begins to deal with the environmental and social cues to drink or use again; he develops new ways of dealing with stress at work and in personal relationships; he learns to deal with the mood swings and depression common in early recovery; he must begin the process of building a sober support system through attendance in AA or other support groups; and he starts developing sober social circles and activities.
Middle Stage Recovery
This occurs during the second six months of sobriety. During this time the patient must learn to deal with the physical, social, and psychological adjustments of sobriety. New relationships must be forged with loved ones because the behaviors of the past have changed so in recovery. The patient commonly goes through a grieving process, both over losses that occurred during drug use and also over the loss of their “old life” and old friends. Reestablishing the ability to experience emotion is important, because addiction causes abnormal responses to loss. Part of recovery is learning to deal with past unresolved loss.
Late Stage Recovery
The third stage of recovery begins after one year. By this time, the patient has gone through the adjustment process of early- and middle-stage recovery. He has gained confidence that the support systems and tools learned in treatment and recovery work. This is a time of stability and of becoming comfortable with recovery. However, abstinence alone does not necessarily mean a successful recovery is underway. There is a difference between being “Dry” (abstinent) and “Sober” (in successful recovery).
The “Dry” patient is not presently using alcohol or drugs, however, he has not changed his past using lifestyle, nor come to comfortable terms with the need for permanent sobriety. He is ambivalent about life, where the “Sober” person looks forward to his new life of sobriety. The “Dry” patient feels abstinence as a constant sacrifice and frequently thinks about using. The “Sober” patient sees abstinence as a gift to himself. The “Dry” patient continues the self-centered ways of his past, maintaining old behaviors, friends, and activities. He doesn’t take care of himself physically or psychologically and continues to suffer from guilt and shame because he has not come to terms with his past or present life. Patients who are merely “Dry” have a much higher risk of relapse than those “Sober” patients who have made major life changes necessary for successful long-term recovery.