A SOBERING STORY: Seeking change key to renewal
Recovery from addiction is, in fact, possible. It’s not easy, and it’s not an overnight process, but it is achievable, according to addiction specialists.
“I see people recover every day,” said Mike Krafick, the certified recovery specialist supervisor at the Armstrong-Indiana-Clarion Drug and Alcohol Commission. “I’ve seen people turn it around and lead completely different lives.”
Krafick said the first step toward recovery is committing to recovery.
“The desire to change is a starting point,” he said.
Or, alternatively, it’s recognizing the need to change once the consequences, the impaired health, the ruined careers and the lost relationships, begin to arise, said Vince Mercuri, executive director of The Open Door Alcohol and Other Drug Treatment Center.
But regardless of what is motivating a person, recovery will require effort all the same.
“It takes energy, action and intention,” Mercuri said. “It can’t be something that you do (half-hearted). You need to pour as much energy into getting sober as you were trying to use.”
Recovery also is likely to take some time. After all, the addiction wasn’t developed overnight. But how much time varies, according to Dr. Kenneth Thompson, medical director at the nonprofit Caron Treatment Centers, based in Berks County.
“The recovery rate is different for everyone who uses drugs,” he said. “And it is also contingent on the quality of the recovery program and their engagement in that recovery process.”
Thompson said there is no straight path to remission.
“Healing is a process that goes through stages, regardless of what type of wound a person suffers from,” he said.
“For instance, if one has a deep cut in the skin, the healing process sometimes hurts. And, if the healing wound is irritated by something such as pulling on the injured skin, the process is slowed; this is similar to returning to drug use for an addict.”
Unfortunately, relapse is a common occurrence for those in recovery.
“Like any other chronic condition, addiction rarely abates after a single course of medication or other treatment or after a single attempt to alter one’s lifestyle or behavior,” according to a 2012 study by the National Center on Addiction and Substance Abuse at Columbia University.
“As is true of other chronic conditions, individuals with addiction can have symptom-free periods and periods of relapse,” researchers wrote.
Relapses, when they occur, shouldn’t be taken to mean that the person in recovery has failed; rather, it suggests they may need a different type of treatment. In terms of effectiveness, not all treatments are equal, and because recovery is variable, what works for one person might not work for the other.
A relapse may also suggest that the addict simply needs more treatment.
Too often, Krafick said, addiction is treated as an acute injury, like, for instance, a broken leg, and not a chronic disease for which there is no cure.
The Columbia study noted this problem as well.
“Very few people with addiction actually receive adequate, effective, evidence-based treatment, and the usual approach to treatment involves brief, episodic interventions rather than a model based on long-term chronic disease management. As a result, high rates of relapse, while comparable to other chronic diseases, may be due at least in part to inadequate or ineffective interventions and treatments,” researchers wrote.
Treatment can take a variety of forms. For some, treatment might be an extended stay in a residential program. For others, it might be ongoing participation in outpatient counseling sessions. For others still, it might be medically monitored detoxification. And it might also involve prescription medication to either help reduce cravings or to replace the abused substance.
And actually treatment is only the beginning of recovery. Like a person with diabetes or asthma, management of the disease requires diligence.
“Recovery is like walking up a down escalator. The minute you quit walking toward the top, you’re going to start going backwards toward relapse,” Mercuri said. “If you’re not moving toward recovery, you’re moving toward relapse.”
Sometimes the steps to relapse are so small the addict doesn’t realize he or she is heading in that direction.
Therefore, Krafick said, it’s extremely important to be wary of the thinking that says that you have returned to normal, that maybe you can have a beer socially or that you can take that painkiller without consequence.
“The one thing about the disease of addiction is that it’s the only disease that tells you you don’t have a disease or you don’t have a disease any more,” Krafick said.
Abstinence is but one part of an effective continuing care plan, said Mercuri, who refers to what he calls the ABCS of such plans — abstinence, behavioral changes, counseling and spirituality.
Probably the most difficult of those, he said, is the behavioral changes.
“That’s where the rubber hits the road,” Mercuri said. “We’re telling people to change their lifestyle. And changing your lifestyle is extremely difficult to do.”
He said lifestyle changes involve removing oneself from the people, places and things associated with the past use. So for an alcoholic it might mean avoiding the bars. Or for a drug user, it might mean severing ties with those with whom he or she used.
In some cases, those people may be family.
Mercuri said that although a goal of treatment is to unify families, not drive them apart, there are circumstances under which some hard choices may have to be made in support one’s recovery.
But, he said, the addict first should try to include his or her family in treatment. And, if necessary, set boundaries and limits with family.
Mercuri said that aside from lifestyle changes, recovery involves learning new ways to deal with everyday matters, things such as emotions, relationships, sexuality, authority and family.
And again it takes diligence because addiction is a chronic disease. And it’s chronic because of changes that have occurred in the brain.
Even for those who seem to be in full remission, changes in nerve connections and gene expression remain, Thompson said.
“This, we speculate, may be one of the reasons why when someone returns to drug use, there are rapid and dramatic changes in the brain, as if they had never stopped using drugs,” he said.
“A switch, so to speak, has been permanently turned on in the brain which controls an area of the brain that lies in wait for the next drug. Addiction is a chronic disease that can be treated, but never cured.”
That having been said, Thompson said some reversals do occur, which science knows because they have been observed. In other cases, there may be changes that only are partially reversed, he said.
Ruben Baler, health science administrator with the National Institute on Drug Abuse, a part of the National Institutes of Health, said drug addiction is in essence a learning process, a maladaptive one to be sure, but a learning process nevertheless. In that process, the brain adapts to changes in the neurochemistry caused by the drugs.
So in one sense, addiction is not unlike learning a new skill, such as riding a bicycle.
And that’s why addiction specialists stress the importance of abstinence in adolescence — at that time in life, the brain is keenly attuned to new learning and experiences, and so it’s much easier for long-lasting habits to be formed.
But those habits, through therapy, can be unlearned, he said, and the connections and pathways created through the addiction, the “trenches,” he said, may be filled in. However, they are difficult to completely cover up, Baler said.
“Deep or shallow, the traces of those trenches are likely to remain just under the new learning,” he said. “This is why recovering addicts face such an enduring risk of relapse.”