DRUG ADDICTION COUNSELING, Part II

This posting is provided by Michael Mariano a Licensed Professional Counselor and a Licensed Clinical Alcohol and Drug Counselor. He has worked at First Hospital Wyoming Valley in Pennsylvania, Beth Israel Medical Center Methadone Maintenance Treatment Program in New York City, and is currently at Bergen Regional Medical Center in Northeast New Jersey.

No counseling program for drug/alcohol addiction will work without a committed and motivated client. Family members who drag the addict kicking and screaming into counseling learn this harsh fact very quickly. If, however, you are convinced you have a drug problem and are ready to devote yourself to hard work in dealing with the problem, there are many successful counseling/rehab programs and strategies that can serve you well.

Medically Managed Intensive Residential Treatment. This level of care is what most programs call “detox.” There are some drugs such as cocaine, marijuana, and hallucinogens that don’t have physical withdrawal symptoms and thus don’t require this level of care. However, those who actively use opioids (Heroin, Percocet, Codeine), alcohol, and benzodiazepines (Xanax, Klonopin, Ativan) require this level of care before they are referred to any other program because these substances result not only in painful withdrawals, but can be fatal.

Residential Inpatient Treatment. This level of care can be anywhere from 14 days to a year depending on type of payment for services, willingness to remain in treatment, access to available treatment, and appropriateness. Short term programs are typically 14 to 60 days. Any program more than two months is long-term treatment. These programs are in controlled environments that involve a structured schedule of group and individual counseling, recreational therapy, self-help meetings, and possibly psychiatric medication under the care of a psychiatrist.

Intensive Outpatient (IOP) and/or Partial Hospitalization Program (PHP).  IOP programs are mostly 3 days a week 3 hours a day. They include group and individual counseling, random drug testing, and weekly Alcoholics- and/or Narcotics-Anonymous meetings. PHPs are mostly 5 days a week 8 hours a day with group and individual counseling,  random drug testing, required weekly AA or NA meetings, medication management, transportation, and meals. Both of these programs typically have step procedures, which is when the treatment team determines someone no longer has to come to a day of treatment because they are making progress. PHPs are appropriate if you have mental health issues like depression, bipolar disorder, or schizophrenia.

Outpatient Counseling. Outpatient treatment is a one day session that focuses on relapse prevention, medication management, and random drug testing to help victims maintain their recovery. I have found that most clients also benefit greatly from individual counseling.

Early Intervention. The purpose of this level of care is to take preventive measures to reduce the probability of addiction, and to engage those with early substance abuse issues. For example, I have conducted outreach programs at high schools to increase drug and alcohol awareness. It is especially important with teenagers to show them how to identify problematic drug use and get help.

Self-Help Meetings. Some individuals are able to detox on their own and attend self-help meetings such as Alcoholics or Narcotics Anonymous. In my opinion, most of these folks should also get professional help to identify unresolved conflicts that are causing their addictive actions. We noted some of these issues earlier under risk factors. Many of them, like schizophrenia or sexual abuse, can be quite complex and require the assistance of a trained mental health professional to deal with them.

Mindfulness Exercises . Mindfulness can be loosely defined as being aware, focusing on the present, and approaching that moment with compassion. The more we are mindful, the less we are mindless. When we are able to focus on the present, the more we have control in our choices. I have taught many clients meditative practices from breathing exercises to full body scans to strengthen their mind-body connection. Most individuals in substance abuse treatment crave instant gratification, and I have had individuals with decades of drugs and alcohol abuse feel relaxed after a 40-minute meditation session. Often clients tell me that they are able to relax for the first time without an outside substance.

Medication Assisted Therapy. This approach uses medication like suboxone or methadone while engaged in counseling. Vivitrol can also help addicts maintain their sobriety while in an outpatient treatment. Whatever the medication used, the client must also be engaged in some form of additional treatment to receive the full benefit.

Relapse Prevention Plan. Recovering addicts must acquire the tools to help them deal with the stress of everyday life. You can start your own plan by identifying triggers to substance abuse that are around you, such as particular people, places, things, and emotions. You can also work on developing coping skills like those covered in this blog to help you avoid a relapse. It is important to remember, however, that following a prevention plan does not give you permission to relapse any more than wearing a seatbelt  gives you permission to get in an accident.

No matter what your program, it is important for your recovery to find and nurture meaningful connections with others. Such connections will greatly facilitate your recovery. It is basic human nature to want to feel needed and loved. Feeling connected to those around you, whether in group therapy or life in general, will keep you motivated toward your goals. In self-help groups like AA and NA, getting a trusted and supportive sponsor is an essential step in helping you feel connected. Those feelings will make you more engaged in your recovery and at a lower risk of relapse. Once you feel connected you will feel more open and honest in your communication with others. Throughout your recovery, having meaningful connections with others will give you support and validation needed when coping with cravings for drugs and alcohol.