Saturday, January 8, 2011


'they try to make me go to rehab, I say NO, NO, NO'  Amy Winehouse

Drug rehabilitation is a term for the processes of medical and/or psychotherapeutic treatment for dependency on substances such as alcohol, prescription drugs, cocaine, heroin or amphetimines. The intent of rehab is to enable the patient to cease the substance abuse in order to avoid the psychological, legal, financial, social and physical consequences that can be caused, especially by extreme abuse.

Psychological dependency is addressed in many drug rehabilitation programs by attempting to teach the patient new methods of interacting in a drug-free environment.  Patients are encouraged not to associate with friends who still use addictive substance.  Twelve-step programs encourage addicts not only to stop using alcohol or drugs, but to examine and change habits related to their addictions.  Many programs emphasize that recovery is a permanent process.  For legal drugs such as alcohol, complete abstention, rather than attempts at moderation, which may lead to relapse, is emphasized. One is too many, and a thousand is never enough.
Various types of programs offer help in drug rehab, including residential treatment (in-patient), out-patient, local support groups, extended care centers and recovery or sober houses.  Newer rehab centers offer age and gender specific program.  Traditional addiction treatment is based primarily on counseling, however, recent discoveries have shown those suffering from addiction often have chemical imbalances that make the recovery process more difficult.  Counselors help individuals to identify behaviors and problems related to their addiction.  It can be done on an individual basis, but more commonly in group settings which can include crisis-counseling, weekly or daily counseling and drop-in counseling supports.  They are trained to develop recovery programs that help to re-establish healthy behaviors and provide coping strategies whenever a situation of risk happens.  They also work with family members who are affected by addicts, in a community to prevent addiction, and to educate the public.
Counseling is also related to intervention, a process in which the addict's family requests help from a professional in order to get this person into drug treatment.  This process begins with a goal of breaking down denial of the person with the addiction.  Denial implies lack of willingness from the patients or fear to confront the true nature of the addiction and to take any action to improve their lives, besides that of continuing the destructive behavior.  Once this has been achieved, the professionals coordinate with the family to support them on getting this family member to rehab immediately, with concern and care for this person.   
typical day in treatment

~ hygiene in morning, before and after meals and before bed
~ school - academics, gym/weight room, art
~ group counseling
~ down time
~ evening meetings - AA/NA or speaker
~ spirituality talks, church services
~ evening treatment education
~ phone to home or visitation
~ recovery garden walks, outside recreation
~ meet with primary counselor/nurse/phychiatrist
~ chores - make bed, keep room and day area clean

This system is used with the goal to help patients and families begin the process of recovery by providing the necessary education and support to begin healing the hurts caused by addiction and foster the desire to continue that recovery once they leave the doors of a rehab center.  They are providing the tools needed to work recovery in the home, in school, on the job and in the community.
Treatment works.  Compared to other chronic illnesses, addiction treatment can have very positive outcomes. 

Heroin addiction ~ 60% success rate with medical compliance
Diabetes ~ 50% success rate with medical compliance
Hypertension ~ 30% success rate with medical compliance

Post-Acute Withdrawal Syndrome (PAWS)

A person recovering from addiction can experience two different types of withdrawal.

  Acute ~ the body may experience physical withdrawal from the absence of substance abuse.
Brain damage ~ withdrawal experienced during sobriety: alcohol/drug use causes damage to the nervous system. 

The onset of PAWS may begin 7 to 14 days into sobriety.  Many people use substances to help cope wth stress in their lives.  People in recovery experience a great deal of stress and have to learn to live life on life's terms without the use of substances.  Stress aggravates the damage to the nervous system and can worsen the intensity of the symptoms being experienced.  Not everyone experiences PAWS, it depends upon whether the nervous system was damaged by substance use.  PAWS can be experienced from about 6 months to 2 years.  After abstinence begins, the symptoms tend to peak in intensity at 3 to 6 months.  The damage done to the nervous system can be repaired over time.  The healing process does not occur rapidly and tends to take anywhere from 6 to 24 months with the aid of proper treatment and a healthy recovery program.  For people who experience PAWS symptoms, it is crucial to recognize and manage the symptoms in order to achieve long term recovery. 
Symptoms of PAWS

Inability to think clearly ~ may experience short attention span and can't concentrate on a task for more than a few minutes; rigid and repetitive thinking ~ struggle with having the same thoughts repeating over and over

Memory problems ~ short term memory problems ~ one understands what is being presented and explained, but he quickly forgets it;  the brain has difficulty storing the information in long term memory; may even have difficulty remembering significant events that occurred in his life

Emotional overreaction or numbness ~ he overreacts to a small situation that would  normally not matter much ~  on a scale of 1 to 10, one would react to something that was a 3 as if it were at 10; some people experience so much stress that they emotionally shutdown and become numb ~ a person may not be able to identify how he is feeling or may have significant mood swings without knowing why.

Sleep problems ~ a majority of people, in the beginning stages of recovery, experience strange or disturbing dreams; the dreams can create difficulties with a person's ability to get sleep; the dreams occur less and are less intense the longer a person is in recovery; one may have trouble falling or remaining asleep (insomnia.)

Physical coordination problems ~ this is the least common symptom of all the PAWS symptoms dizziness, trouble with balance, poor eye hand coordination, slow reflexes, accident prone; these symptoms can give the appearance of being drunk without drinking.

Stress sensitivity ~ difficulty in managing stress, unable to determine low stress situations from high stress situations; overreact when experience low stress situations.
When a person in recovery experiences stress, all the PAWS symptoms can get worse.  It is important to decrease and manage stress by getting enough rest, being relaxed, eating balanced meals and having healthy relationships.  A person experiencing PAWS may feel that he is going crazy because he feels confused, can't concentrate and can't solve simple problems.  The person is not going crazy.  These symptoms are normal in recovery and will get better in time.

People that are high risk to experience PAWS symptoms are those that don't work a solid and stable recovery program and don't properly care for themselves.  People who learn to effectively manage levels of stress in their lives can control PAWS.

Stabilization includes finding ways to interrupt the PAWS symptoms and bring them under control

Verbalize ~ talking about feelings with someone who will not judge, criticize or downplay what you say. 

Ventilate ~ even if feelings seem irrational and do not make sense, express it. 

Reality test ~ ask if what is being said makes sense; sometimes a person is too emotional to appropriately perceive what is happening. 

Problem solving and goal setting ~ brainstorm ideas to solve the problems being experienced at that time and take action to change the problems and decrease the level of stress experienced. 

Backtracking ~ think back about what happened, how it started, what could have been done differently and how it was dealt with in the past that was effective.
A recovering person should gain education about addiction and recovery. The person should learn what his triggers to stress are and the symptoms that result from the stress.  One should learn effective coping skills to assist in managing stress levels. A recovering person should retrain memory skills by writing down what he wants to remember.  One should ask questions when he doesn't understand what is being explained.

The recovering individual is solely responsible for his recovery and needs to protect himself from anything/anyone that may threaten the recovery.  The person has to learn what causes him to experience stress ~ then to change it, avoid it and/or not overreact.

Poor nutrition, including not eating, can lead to emotional and overraction to stress and intensify PAWS.  A person in recovery needs to eat well-balanced meals three times a day and have nutritious snacks between meals.  It is recommended not to have sugar and caffeine, as these ingredients can trigger levels of stress. 

Exercise can reduce stress and rebuild the body.  It helps the brain to naturally produce chemicals that relieve pain, anxiety and tension.  It increases a person's ability to feel good, concentrate and remember.  People in recovery gain significant benefits from daily exercise. 

People in recovery need to find ways to laugh, have fun and play to reduce/cope with stress.  Find activities that you enjoy.  Take a bubble bath, go for a nature walk, get a massage and learn meditation.

While a person is in rehab, they may undergo a series of emotions in addition to physical changes, and at times want to leave, or convince themselves they are ready to leave.  Here are a few tactics they may use to avoid accountability, which should be discussed and dealt with professionally.

~ continually point out the other person's inadequacies

~ build yourself up by putting down others

~ tell others what they want to hear and not what is the truth

~ lying by omission; distorting the truth and disclosing only what benefits you

~ vagueness: making statements such as "I will think about it, maybe, or if I feel like it"

~ attempt to confuse others

~ divert attention away from yourself by changing the subject or talking about irrevelant information

~ minimizing the situation: making statements such as, "no, it's alright, you just got into a little trouble."

~ agree to say yes without really meaning it

~ silence

~ pay attention only to what suits you

 ~ make a big deal about something minor

~ put off doing something by saying "I forgot"

~ put others on the defensive - argue about a word, attempt to embarrass

~ use anger to intimidate

~ ignore - be totally inattentive

~ accuse others of misunderstanding

~ claim that you have changed just because you did it right one time

One final thought about rehabilitation is a saying from Rosecrance in Rockford, Illinois:

"we are not bad people becoming good, but sick people becoming well"

Serenity Prayer

God grant me the Serenity
 To Accept the things I cannot change
Courage to change the things I can;
And Wisdom to know the Difference...xo