Saturday, May 16, 2009

Same dis-ease, different drug

Multiple addictions. We know that many people don't have just one addiction, they have a cluster of them. Indeed, some addictions seem to go together. Sexual addiction is often associated with drug abuse; anorectics and bulimics are often compulsive exercisers. Some compulsive spenders are workaholics, and gamblers often overeat. One addiction seems to fuel the other.

As more and more people have found, stopping one addiction does not automatically "cure" others. In fact, it often results in the emergence of a new one. Like a bump in a rug, when it's flattened out in one place it simply pops up somewhere else.

What is the common denominator in every instance of addiction? It's not one particular chemical, then, or whether the substance causes withdrawal, or how specifically it affects the brain. All of these vary considerably from one addiction to another. But what's present in every case of addiction is the addict! It's our "dis-ease" within--our lack of ease--that renders us so vulnerable to addictions, not the substances or activities themselves. The true source of addiction lies within us.

What are our drug treatment programs doing to address multiple addictions?

If you're interested in this subject, check out the book I co-authored, Willpower's Not Enough by Arnold Washton and Donna Boundy, published by Harper-Collins.

12-step programs and "after-care" plans...

12-step programs: what do you think? While there are still many roads that lead to "Rome," let's face it: the 12-step programs have as good a track record, or better, than many professional programs. I've been thinking about what they provide, which seems to be everything from:

  • Hope. Seeing others who are successfully dealing with their addiction means that recovery is possible.
  • A non-judgmental support system.
  • Feedback. "Two heads are better than one, providing they're not on the same set of shoulders."
  • A spiritual foundation. Since addiction is fueled by a lack of meaning an purpose in life, the spiritual aspect of self-help programs can be an antidote.
  • A chance to help others. Contact with beginners in the program is an great reminder of our continual vulnerability. and helping others gives our lives a greater sense of meaning.
  • A sense of belonging. Since isolation fosters addiction, this is another antidote.
  • A new framework for looking at the problem. By admitting "powerlessness" over the compulsive drive, one paradoxically begins to regain more control through the support of the program.
  • Round-the-clock support. Where can you find a program that lets you call your counselor in the middle of the night? Self-help groups provide a telephone network 24 hours a day!
  • No time limit on help. People can continue attending self-help meetings for as long as they wish (whereas professional treatment is usually time-limited)
  • Free of charge!
What do you think? Do you introduce your clients to 12-step programs? Are there other supports in the community that you find helpful?

Can Drug Dealing be an Addiction?

So often, recovering addicts spend weeks and months in drug treatment programs and never address the one behavior most likely to pull them back into drug use and illegal activities: involvement in the drug trade. While few figures are available, anecdotally, I believe that perhaps as many as 1/3 of those in substance abuse treatment programs also had some involvement in drug sales. While in drug treatment, they may explore childhood traumas, anger problems, family issues, relapse triggers, but somehow never address the central issue of their past involvement in drug dealing.

Yet for an addict, a return to drug dealing is a virtual guarantee of relapse to drug use as well. Drug dealing itself can be an addiction, I believe, akin in some ways to gambling. The lure of "quick, easy money" and some past experience that reinforces this belief is almost too much to resist. (Especially for someone just out of rehab or prison, yearning to have "things" again, who hasn't much legal work history and the notion of working at minimum wage is tough to swallow...) In addition, drug dealing delivers a habit-forming adrenaline rush of excitement, access to sex, a kind of power and "respect," status, and material pleasures. It's a pretty powerful pull!

We at Reelizations made a ground-breaking video, Getting Out of the Game: The Trap of Drug Dealing to address this important subject. It includes interviews with former drug dealers who successfully made the break and "got out of the game," detailing the strategies they used to counter the inevitable pull back to the streets and dealing.

Love to know what you think about this topic. Most drug treatment programs don't address it at all. Yet many addicts through the years have told me this is their central addiction.

What is "Gender-responsive treatment?"

Hey, this is an issue I've been thinking a lot about lately, since I'm consulting at the moment for a women's treatment program. Really, this particular program has been a therapeutic community that just happens to be segregated by gender, so it's all women. But until now, it hasn't been designed to really be responsive to women's particular needs in treatment. So what IS a good women's program? I'd love to hear from you, especially if you're involved in a program you feel is really "gender-responsive" (either gender). Some of the things I think of about creating an effective women's program include these kinds of ideas:

  • Inspirational and empowering environmental cues (pictures, sayings by women from history through contemporary, etc.)
  • Good leadership among staff, positive role models
  • Staff trained to understand the effects of trauma on so many women, and what this means for treatment... (like hypervigilence to being screamed at, etc.!)
  • Good integration of a mental health component, since many women in residential treatment (at least) have co-occurring mental health concerns like depression, anxiety disorders, etc.
  • Family involvement, support for parenting, etc.

What do you think makes a good women's treatment program? A good men's treatment program? Or do you think coed treatment is best??

Wednesday, May 13, 2009

Calling everyone "in the trenches" of addiction treatment!

Welcome to Addiction Treatment Central! This is a place in cyberspace where addiction treatment professionals of all modalities and persuasions can gether around a "virtual water cooler" and share thoughts, frustrations, challenges and strategies relevant to treating addictions.

Let me introduce myself and why I'm even doing this... My "reel" name is Donna Boundy, I'm author of Willpower's Not Enough (HarperCollins) and When Money is the Drug. I started in the drug treatment field, well, 30 years ago (yeah, do the math...). I'm also a partner in Reelizations, a video/DVD production company that specializes in good, relevent, "meaty" (raw, realistic) programs on recovery. OK, blah, blah, blah. There's more to find in my profile is you care...

OK, so some of the topics we'll debate and discuss in this blog could include...
Gender-responsive treatment--what is it? Does it make sense?
  • The latest on Suboxone
  • Therapeutic Communities--are they still relevant? Can they be changed? Should they be?
  • Is drug-dealing really an addiction in itself?
  • Why do Americans have this insatiable appetite for drugs, as Hillary Clinton noted?
  • What really works in treating adolescents?
  • Anger management for recovering addicts--why is it crucial?
  • How urban inner-city addicts can avoid relapse, even in such a challenging environment with cues and triggers all around!
  • Are the 12-step programs still the best aftercare plan of all?
  • "Trauma-informed treatment" --what is it? Why is it important?

Hopefully, you the readers will contribute more ideas and topics. Where do you want to start?