Understanding Addiction Treatment

The NIDA (National Institute on Drug Addiction) states: “Addiction is a complex but treatable disease that affects brain function and behavior. Drugs of abuse alter the brain's structure and function, resulting in changes that persist long after drug use has ceased. This may explain why drug abusers are at risk for relapse even after long periods of abstinence and despite the potentially devastating consequences.” It is important to note here, that there is virtually no difference between alcoholism and addiction and, in fact, the two are interchangeable in terms of definition, obsession and long-term consequences.

When considering treatment, it’s important to match treatment settings, interventions, and services to an individual's particular problems and needs. This is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. There are several significant aspects to consider:

1. Treatment needs to be readily available. Alcoholics and addicts, by virtue of their tendency to procrastinate and deny, are invariably uncertain about entering treatment. Therefore, a treatment program must be taken advantage of immediately. If the one chosen is not available, an effort needs to be made to find a facility that is. The longer one is able to put off treatment for any reason, the greater the odds they will not enter when the time eventually comes. Many a potential patient has been lost while waiting for a bed to open up.  As with other chronic diseases, the earlier treatment is offered in the disease process, the greater the likelihood of a positive outcome.
2. Effective treatment must address itself to the multiple needs of the individual, not just his or her drug abuse. Rarely has there been an alcoholic or addict with only one issue. Besides the obvious, many suffer from associated medical, psychological, social, vocational, and legal problems. It is also important that treatment be appropriate to the individual's age, gender, ethnicity, and culture.
3. Remaining in treatment for an adequate period of time is critical. As with any type of medical and rehabilitative care, the duration of treatment depends upon the individual’s particular condition and needs. Nevertheless, research indicates that most addicted individuals need at least 3 months in treatment to reduce and stop their drug use and begin preparation for a life that is no longer dependent upon alcohol and drugs. Recovery is a long-term process – a marathon as opposed to a sprint. Relapse does not have to be a part of recovery, but it sometimes is, and to insure the client the best possible opportunity for a full and lasting recovery, no artificial limit should be placed on an individual patient’s stay.
4. Counseling—individual and/or group—and other behavioral therapies are crucial to treatment. Behavioral therapies vary in their focus and may involve addressing a patient's motivation to change, providing incentives for abstinence, building skills to resist drug use, replacing drug-using activities with constructive and rewarding activities, improving problem solving skills, and facilitating better interpersonal relationships. Also, participation in group and individual therapy as well as other peer support programs such as Alcoholics Anonymous and Narcotics Anonymous can help maintain abstinence.
5. Medications can be important element of treatment for many patients, especially when combined with counseling and other behavioral therapies. For example, particularly in the detoxification process (usually 8-14 days) buprenorphine can be effective in helping individuals addicted to heroin or other opioids stabilize their lives and reduce their illicit drug use. Naltrexone is also an effective medication for some opioid-addicted individuals and some patients with alcohol dependence. Other medications for alcohol dependence include acamprosate, disulfiram, and topiramate. These medications are introduced early on in treatment in order to ease the more serious withdrawal symptoms. They are then tapered down (or “titrated”) gradually until the patient us ultimately free of all chemicals.

Alcoholism and drug addiction is an extremely complex and serious illness characterized by intense and, at times, uncontrollable cravings, along with compulsive substance seeking and use that persists no matter how devastating the consequences. It’s vital that family members and loved ones understand that, even though drinking and using originated as voluntary behavior, for the alcoholic and addict, it can quickly turn into an uncontrollable desire that overtakes their conscience and destroys the lives of others along with their own.

Because alcoholism and addiction is so complex and illogical, treatment is not simple. That is why truly effective treatment programs must incorporate many of the components listed above.  Because addiction is typically a chronic disease, people cannot simply stop using drugs for a few days and be cured. Most patients require long-term or repeated episodes of care to achieve the ultimate goal of sustained abstinence and recovery of their lives.

What Is Alcoholism?

Alcoholism, also known as "alcohol dependence syndrome exhibits the following characteristics:
•    Craving:  An overpowering desire to drink
•    Loss of control: The lack of the ability to stop drinking once they have begun.
•    Physical dependence: This occurs when the consumption of alcohol is stopped and withdrawal symptoms begin. These can include, but are not limited to: nausea, sweating, shakiness, and anxiety. Relief from these symptoms can only be accomplished by drinking or by taking sedative drug.
•    Tolerance: The need for increasing amounts of alcohol in order to get "high."
   
      No matter what one drinks or how long they’ve been drinking, it is the person’s uncontrollable need for alcohol along with the consequences that befall them as a result that defines alcoholism.
   
    This is why most alcoholics can't just use their willpower to stop drinking. They are frequently in the grip of a powerful craving for alcohol, a craving that can be as strong as the need for essentials like food and water.
   
    If you think you or a loved one may be an alcoholic, the following twenty questions can be a helpful indicator. If three or more can be answered in the affirmative, chances are that person is an alcoholic.
1.    Do you lose time from work due to your drinking?
2.    Is drinking making your home life unhappy?
3.    Do you drink because you are shy with other people?
4.    Is drinking affecting your reputation?
5.    Have you ever felt remorse after drinking?
6.    Have you gotten into financial difficulties as a result of your drinking?
7.    Do you turn to lower companions and an inferior environment when drinking?
8.    Does your drinking make you careless of your family's welfare?
9.    Has your ambition decreased since drinking?
10.    Do you crave a drink at a definite time daily?
11.    Do you want a drink the next morning?
12.    Does drinking cause you to have difficulty in sleeping?
13.    Has your efficiency decreased since drinking?
14.    Is drinking jeopardizing your job or business?
15.    Do you drink to escape from worries or troubles?
16.    Do you drink alone?
17.    Have you ever had a complete loss of memory (blackout) as a result of your drinking?
18.    Has your physician ever treated you for drinking?
19.    Do you drink to build up your self-confidence?
20.    Have you ever been in a hospital or institution on account of drinking?

      Although there are occasionally individuals who are able to recover without assistance, the vast majority of alcoholics require help to recover from this disease. Dr. Harry Thiebout, a psychiatrist in the late Thirties, described alcoholism as a “disease of the body and of the mind.” That is what makes it so difficult to treat and why relapse is such a problem.
      The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
published by the American Psychiatric Association, defines it as a disease as well.
        It has been scientifically proven that it is an inherited disease that can be passed down from generation to generation and can affect one member of a family, none or several. It can even skip a generation.
       Nevertheless, it’s also the conditions present in one’s environment, such as one’s “lower companions” (i.e. bar buddies) and easy access to alcohol that can be very influential in the making of an alcoholic. Therefore, both genetic and environmental influences can put a person at risk.
      Therefore, it is prudent for those in whose families alcoholism has been prevalent to be vigilant and aware of any of the above symptoms of alcoholism and to take action should they arise and become a problem.
There is no known cure for alcoholism at this time, but there are definitely effective and proven methods of treatment.  There are various treatment programs that use both counseling and medications to help a person stop drinking. Most, if not all alcoholics need help to recover from their disease. With the proper support and treatment, many people are able to stop drinking and rebuild their lives.
      Alcoholism treatment works for many people. But just like any chronic disease, there are varying levels of success when it comes to treatment. Some people stop drinking and remain sober. Others have long periods of sobriety with bouts of relapse. And still others cannot stop drinking for any length of time. With treatment, one thing is clear, however: the longer a person abstains from alcohol, the more likely he or she will be able to stay sober.
      Many people feel that they should be able to cut down if they think there might be a problem. This is highly unlikely if they have been diagnosed as an alcoholic.  Alcoholics who try to cut down almost never succeed because it has become a true compulsion, over which they have no control. Therefore, abstention is the only truly effective course for recovery.
      This can be a challenge. An alcoholic can't be forced to get help except under certain circumstances, such as a violent incident that results in court-ordered treatment or medical emergency. But you don't have to wait for someone to "hit rock bottom" to act and get them into a drug rehab. Many alcoholism treatment specialists suggest the following steps to help an alcoholic get treatment:
•    Stop all "cover ups." Family members often make excuses to others or try to protect the alcoholic from the results of his or her drinking. It is important to stop covering for the alcoholic so that he or she experiences the full consequences of drinking.
•    Time your intervention. The best time to talk to the drinker is shortly after an alcohol-related problem has occurred--like a serious family argument or an accident. Choose a time when he or she is sober, both of you are fairly calm, and you have a chance to talk in private.

      Recovery starts with admitting there is a problem with alcohol.  There are many reputable and highly professional treatment programs available, but one doesn’t necessarily have to seek professional help or check into a program in order to get better – especially if finances is a factor.
Peer support groups can be an invaluable source of guidance, assistance, and encouragement. Alcoholics Anonymous (AA) is the most well-known and widely available self-help group for alcoholics in treatment and recovery. AA uses fellowship and a set of guided principles—the 12 steps—to help members achieve and maintain sobriety.
      A key part of a 12-step program is choosing a sponsor, a recovering alcoholic who has time and experience remaining sober. A good sponsor helps you understand and work the steps to alcohol recovery and provides support when you are feeling the urge to drink.
Other addiction support groups such as SMART Recovery and Secular Organizations for Sobriety (SOS) have different philosophies about alcohol treatment and recovery, yet offer the same benefits of group support.
These are a few of the most popular alcohol support groups:
•    Alcoholics Anonymous
•    Secular Organizations for Sobriety
•    SMART Recovery
•    Women for Sobriety

      Some people can stop drinking on their own without a doctor’s help, while others need medical supervision in order to withdraw from alcohol safely and comfortably. Which option is best for you depends on how much you’ve been drinking, how long you’ve had a problem, and other health issues you may have.   If, for example, someone has been drinking heavily and frequently for an extended period of time, they will have become physically dependent on alcohol. When they suddenly stop drinking, the body goes through withdrawal. Some of the “milder” symptoms of alcohol withdrawal are:
•    Headache
•    Shaking
•    Sweating
•    Nausea or vomiting
•    Anxiety and restlessness
•    Stomach cramps and diarrhea
•    Trouble sleeping or concentrating
•    Elevated heart rate and blood pressure

     Withdrawal symptoms usually start within hours after you stop drinking, peak in a day or two, and improve within five days. But in some alcoholics, withdrawal can be life threatening. Some of the most severe symptoms are:
•    severe vomiting
•    confusion and disorientation
•    fever
•    hallucinations
•    extreme agitation
•    seizures or convulsions

      Call 911 or go to the emergency room if you experience any of these! They may be a sign of a particularly ruthless form of alcohol withdrawal called delirium tremens, or DTs. This rare, emergency condition causes dangerous changes in the way your brain regulates your circulation and breathing, so it’s important to get to the hospital right away.
      If you are a long-term, heavy drinker, you may need medically supervised detoxification. Detox can be done on an outpatient basis or in a hospital or alcohol treatment facility. As part of the alcohol detoxification process, you may be prescribed medication to prevent medical complications and relieve withdrawal symptoms.
      There are three oral medications--disulfiram (Antabuse), naltrexone (Depade, ReVia), and acamprosate (Campral) currently approved to treat alcohol dependence. In addition, an injectable, long-acting form of naltrexone (Vivitrol) is available. These medications have been shown to help people with dependence reduce their drinking, avoid relapse to heavy drinking, and achieve and maintain abstinence. Naltrexone acts in the brain to reduce craving for alcohol after someone has stopped drinking. Acamprosate is thought to work by reducing symptoms that follow lengthy abstinence, such as anxiety and insomnia. Disulfiram discourages drinking by making the person taking it feel sick after drinking alcohol.
      Other types of drugs are available to help manage symptoms of withdrawal (such as shakiness, nausea, and sweating) if they occur after someone with alcohol dependence stops drinking.
Although medications are available to help treat alcoholism, there is no "magic bullet." In other words, no single medication is available that works in every case and/or in every person. Developing new and more effective medications to treat alcoholism remains a high priority for researchers.
      Once again, most reputable alcoholism treatment programs also include meetings of Alcoholics Anonymous (AA), which describes itself as a “worldwide fellowship of men and women who help each other to stay sober.” While AA is generally recognized as an effective mutual help program for recovering alcoholics, not everyone responds to AA's style and message, and other recovery approaches are available. Even those who are helped by AA usually find that AA works best in combination with other elements of treatment, including counseling and medical care.
      To reiterate, alcoholism is, at this time, an incurable but highly treatable disease. That means that even if an alcoholic has been sober for a long while and has regained health, he or she remains susceptible to relapse and must continue to avoid all alcoholic beverages. “Cutting down” on drinking doesn't work; cutting out alcohol is necessary for a successful recovery.
      However, even individuals who are determined to stay sober may suffer one or several “slips,” or relapses, before achieving long-term sobriety. Relapses are very common and do not mean that a person has failed or cannot eventually recover from alcoholism. Keep in mind, too, that every day that a recovering alcoholic has stayed sober prior to a relapse is extremely valuable time, both to the individual and to his or her family. If a relapse occurs, it is very important to try to stop drinking once again and to get whatever additional support is needed to abstain from drinking.

For more information on alcohol abuse and alcoholism, contact the following organizations:
Al-Anon Family Group Headquarters
1600 Corporate Landing Parkway
Virginia Beach, VA 23454-5617
800-356-9996
www.al-anon.alateen.org
 
Alcoholics Anonymous (AA) World Services
475 Riverside Drive, 11th Floor
New York, NY 10115
212-870-3400
www.alcoholics-anonymous.org

Signs and Symptoms of Heroin Addiction

            In recent years, prescription pain killers, such as oxycontin, fentanol, vicodin, etc. were the drugs of choice for those addicts who favored opiates because they were easier to get than heroin and less expensive. Because of their popularity through efforts to clamp down by the FDA, they have become less accessible and more expensive.  As a result of our military presence in Afghanistan, where opium poppies grow in abundance, there has been an alarming influx of cheap heroin into the country. In response, the Mexican drug cartels are also flooding the market with cheap, “black tar” heroin. As a result, heroin addiction has become, once again, an epidemic in the U.S. and people are dying from overdoses in alarming numbers.

            If you believe someone you know or love is using heroin, what follows are the top 20 questions to assess heroin addiction symptoms:

1. Has their appearance changed; do they not appear to care how they look?

2. Are they eating properly?

3. Have they lost or gained weight?

4. Are there needle marks on their arms or legs?

5. Have they markedly slowed down?

6. Do they have the shakes?

7. Are their hands cold and sweaty?

8. Have you smelled something on their breath, or their clothing?

9. Do their eyes appear red?

10. Are their pupils dilated?

11. Is their face puffy?

12. Is their skin tone flushed or pale?

13. Do they have a blank stare?

14. Has their physical coordination changed? Are they staggering?

15. Have they missed a lot of school, or work?

16. Have their sleep habits changed? Are they always tired?

17. Have they become lazy?

18. Are they hyper?

19. Do they lapse into rapid speech patterns? Do they slur their words?

20. Have you seen heroin paraphernalia such as needles, syringes, used cotton, etc.?

This list is by no means complete, and even if they have these symptoms, it doesn't necessarily mean that person is addicted. Don’t assume the worst, but don't deny the obvious!

Along with the above signs and symptoms there are several other factors connected to heroin use to consider:

·        Health: There are a whole host of physical signs that can point to heroin abuse. Are they consistently lacking in energy – especially young kids? They don’t like getting up in the morning in the first place, but they don’t always refuse to get moving. Fluctuations in weight is also a sign.

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·        Appearance: With kids, this can be a difficult area because fashion is as fashion does, and what adults feel is acceptable is often, if not always, the opposite of what teenagers and young adults like. Kids want to fit in and there is peer pressure to influence the way they dress. Girls, especially, are bombarded with images on appearance For adults, careless dressing, lack of hygiene and a general slovenly appearance and loss of interest in how they look  is considered a sign.

·        Attitude and Behavior: As children enter their teen years it is natural for them to want to break away from the family. When kids go to extremes to make sure you don’t know who they are with or what they are doing, this is definitely a red flag. When they become secretive and guarded, when their privacy at home prevents your open access to them, there may be something beyond mere adolescent rebellion. Perhaps their only interaction with the parents is to ask for money, and when asked why they need money they refuse to answer, or become indignant. Worse yet, they may steal items from home to buy drugs. The eyes are often an indicator. Has the life gone out of their eyes, or is there a major change?  With all addicts, there is an old saying; “You can tell an addict is lying because their lips are moving.” If the adult has not generally played fast and loose with the truth, it is a pretty good indication that if lying accompanies a number of the previously stated symptoms, drug abuse is probably a factor.

·        Why do some drug users become addicted, while others don’t? As with many other conditions and diseases, vulnerability to addiction differs from person to person. Genes, age when one started taking drugs  and family and social environment all play a role in addiction. Risk factors that increase vulnerability include:

1.      Family history of addiction.

2.      Abuse, neglect, or other traumatic experiences in childhood.

3.      Mental disorders such as depression and anxiety.

4.      Early use of drugs.

More signs and symptoms of drug abuse

If one believes they have issues with heroin or other opiates, they need to consider if the following are taking place:

• Responsibilities are being neglected at school, work, or home (e.g. flunking classes, skipping work, neglecting your children) because of drug use.
• Drugs are being used under dangerous conditions or risky behavior is taking place while high, such as driving while on drugs, using dirty needles, or having unprotected sex.
• Drug use is resulting in legal trouble, such as arrests for disorderly conduct, driving under the influence, or stealing to support a drug habit. 
• Drug use is causing problems in relationships, such as fights with a partner, family members, an unhappy boss, or the loss of old friends.

• A tolerance to drugs has been built up. More of the drug is required to experience the same effects that were reached with smaller amounts.
• Drugs are used to avoid or relieve withdrawal symptoms. If one goes long without drugs, symptoms such as nausea, restlessness, insomnia, depression, sweating, shaking, and anxiety are often experienced.
• Complete loss of control over drug use. Doing drugs or using more than planned, even though promises were made to self or others to quit or slow down. The addict may want to stop using, but feels powerless.
• Life revolves around drug use. A lot of time is spent using and thinking about drugs, figuring out how to get them, and recovering from the drug’s effects.
• Once-enjoyable activities have been abandoned, such as hobbies, sports, and socializing, because they get in the way of drug use.
• Even though it’s causing major problems, the drug use continues despite the knowledge that it’s seriously damaging one’s life —blackouts, infections, mood swings, depression, paranoia—all are occurring but the use continues anyway.

The overwhelming sign of heroin addiction, however, is the repeated need for the drug in ever-increasing quantities. Without obtaining a regular dose, addicts begin withdrawal, which causes severe cravings. This craving and drug-seeking behavior trump normal commitments and behaviors. The sole focus of the user will be getting their “fix.”.

The consequences of addiction then stem from both the seeking activities and using the heroin itself. Because heroin is illegal in all forms, arrest and incarceration are real risks, but even without getting caught, addicts face risks of infection and overdose.

One of the more obvious signs of heroin addiction is the presence of “track marks.” These are areas where the skin and blood vessels have been damaged by injection. While users will attempt to use the smallest needle possible (diabetic syringe) and vary the sites of injection, heroin is caustic and will damage veins or capillaries no matter what technique is used. And because of the strong pain-killing effect of the drug, the user often does not feel the damage or ignores it in favor of injecting into a convenient location.

Additionally, when the needle penetrates the vein through to the other side, abscesses can be the result. An abscess is a collection of pus in any part of the body that, in most cases, causes swelling and inflammation around it. Abscesses occur when an area of tissue becomes infected and the body's immune system tries to fight it. White blood cells move through the walls of the blood vessels into the area of the infection and collect within the damaged tissue. During this process, pus forms. Pus is the buildup of fluid, living and dead white blood cells, dead tissue, and bacteria or other foreign substances. Abscesses in the skin are easy to see. They are red, raised, and painful. Treatment varies, but often surgery, antibiotics, or both are needed – they do not go away on their own. In cases where addicts have ignored these abscess, a clot can form, thereby becoming very dangerous. If it breaks off and travels to the heart or brain, it can cause stroke, heart attack and even death.

After prolonged intravenous drug use, the veins collapse entirely and the skin develops hard scar tissue in the area. The tracks then become a series of injection sites along the line of a vein. While this may be the clearest sign of IV heroin use, some addicts inject in locations that are not readily visible – such as between the toes or under the tongue.

Constricted pupils are another accompanying sign of heroin use, as is lethargy, respiratory ailments, depression, and confusion. However, those who are experienced with the drug may be able to conceal these signs. Some are not discovered until an “outfit” is found. This is a kit containing their paraphernalia and drug. Addicts never venture far from their next hit.

Other medical conditions may point to IV drug use. AIDS, hepatitis C, infections at the injection site – all can result from repeated injections, especially when needles are shared. Another common symptom is constipation.

There are many ways to treat heroin addicts. A long-term user often has to use methadone or a form of buprenorphine for a long time to diminish the strong withdrawal symptoms of the addiction. By using this substance, patients can stabilize and start revalidation or rehabilitation. However, some patients will never be able to stay abstinent for a long time. In that case, it is better to focus on decreasing the physical risk and the chance of death.

Psychosocial treatments are effective parts of a total treatment plan of patients with opiate disorders. Cognitive behavioral therapy, behavioral therapy, psychodynamic therapy, group therapy and family therapy can be effective with heroin dependence. The choice for a certain treatment should be made after it is obvious what the patient wants, what problems should be solved, whether there are any other psychological problems and what have been the results of earlier treatments.

A patient with mild or moderate withdrawal symptoms can sometimes deal with these problems at home. The treatment of a heroin withdrawal syndrome is usually focused on relief of the critical symptoms and the motivation to take part in a long-term treatment of heroin addiction. Methadone or buprenorphine can be prescribed temporarily and also clonidine (originally intended to help reduce high blood pressure) can be used to suppress the withdrawal symptoms. The use of other narcotics can interfere with or complicate the attempt to kick the habit.

The success of the treatment depends on various things:

• The quantity and the kind of substances used.
• The severity of the disorder and the consequences.
• Simultaneous physical and/or psychological disorders.
• The strong and weak characteristics of the patient.
• The patient's motivation
• The social surroundings of the patient (friends, acquaintances, colleagues, family, etc.)

 

 

 

What Is a Residential Treatment Center?

THE RESIDENTIAL TREATMENT CENTER

Facts, Fiction, Questions and Answers

A residential treatment center, or RTC, sometimes called a rehab, is a live-in health care facility providing therapy for a combination of substance abuse, mental illness and/or other behavioral problems. Residential treatment should, in many cases, be considered the "last-ditch" approach to helping a child, friend or other loved one suffering from severe problems. RTC’s vary widely in price depending upon their location and the services offered. Monthly fees range from no-cost in some nonprofit facilities to as high as $100,000 per month for what is often referred to as “high-end treatment.” These are self-described “luxury” facilities specializing in clientele who are often celebrities, professional athletes, top corporate executives or members of extremely wealthy families who wish to keep a low profile. These facilities also offer lavish amenities in order to justify the expense. Generally, though, there are more than enough low to mid-priced RTC’s currently in operation offering the standard services necessary to give the client the best possible opportunity for recovery. There are many factors to consider when selecting an RTC and include:

1. Do they have detoxification facilities?
2. What is their program like?
3. Is it coed or gender-specific?
4. Do they just treat alcoholism and addiction or other medical and/or mental disorders as well?
5. Are they licensed and for what?
6. Are they accredited and what does that mean?
7. What is their location and how is that important?

 Finally,

8. What is their recovery philosophy?

Let’s begin with #1, detoxification. First, alcohol detoxification. This is a process by which a heavy drinker's system and body is brought back to normal after chronic and extended alcohol use and abuse. Prolonged alcohol addiction decreases the body’s production of GABA, a reuptake inhibitor, because alcohol acts to replace it. Rapid and/or medically unsupervised withdrawal from long-term alcohol addiction can cause severe health problems and can be fatal, primarily due to the danger of seizures. It’s important to state her that alcohol detox is not a treatment for alcoholism – merely the first step in a long treatment process.

Drug detoxification is a process by which withdrawal symptoms are reduced or relieved while helping the addicted individual adjust to living without drug use. Like alcohol detox, drug detoxification is not meant to treat addiction but is, rather, the precursor to long-term treatment. Detoxification may be achieved with or without the aid of other medications. In many cases, drug detoxification and treatment will occur in a community program stretching over a time period of several months and take place in a RTC as opposed to a hospital.

Drug detoxification varies depending on the location of treatment, but most detox centers provide various forms of treatment to stave off the symptoms of physical withdrawal to alcohol & other drugs. Counseling and therapy during detox to help with the consequences of withdrawal is usually provided, but be sure to ask the facility when investigating it. The detox phase of treatment typically runs 7-10 days, depending on the substance abused and client’s particular needs. For example, opiate detox generally runs 8-10 days, while someone with a long-term benzodiazepine (xanax, atavan, valium, etc.) habit may need 2-3 weeks or more. No matter what type detox, it should be administered by a physician, assisted and monitored by a licensed nursing staff. The doctor will support the patient by prescribing the most effective detox protocol for each individual client, while the experienced staff ensures the client’s safety by regularly taking vitals and watching carefully for any anomalies.

      There are several different types of drug detoxification, which include:

• Medical Detox is a process that provides gradual, decreased doses of a drug similar to the drug being abused.
• Rapid Detox involves the administration of opiate blockers such as Naloxone, Naltrexone or Methodone while the patient is under general anesthesia. This process usually takes 4 to 8 hours.
• Ultra Rapid Detox is an accelerated process conducted while the patient is under general anesthesia, combined with administration of Naltrexone. Detox can be achieved within 30 minutes, but can be a painful or risky procedure.
• Stepped Rapid Detox is a gradual process of administering oral doses of Naltrexone or subcutaneous administration of Narcan. This method offers a more controlled approach to detox because the patient is awake and communicative.
• Acute detox is generally provided within a hospital or medical unit where the staff is specially trained to recognize the signs, symptoms and behavior of withdrawal along with standard medication protocols for the treatment of alcohol, opiate and benzodiazepine withdrawal and their complications. Often, large doses of medication will be prescribed in order to maintain the patient’s vital signs and bodily functions within normal limits, followed by a gradual tapering (or titrating) of the dosage.

Sub-acute detox is a step down from acute detox and does not necessarily need to take place in a medical unit. It is normally utilized to complete a medication protocol begun in acute care and can take place in the first week or so of residential treatment in a special unit of the facility where there is a registered nurse, physician presence and supervision as well as patient observation every 20 minutes. 

            There are nearly as many different types of programs as there are facilities. The important thing to remember is that the patient’s time is productively and adequately utilized. Therefore, it is helpful to ask the facility for a copy of their weekly activities.

             Another factor to consider is the characteristics of the population of the RTC itself. This is a personal choice that only the patient and their family can make. Many facilities are coed and still others are gender-specific. Depending upon individual comfort level and the nature and factors contributing to the patient’s disorder, it may be preferable to choose one over the other.

            Many treatment centers claim to treat a variety of disorders beyond alcoholism and substance abuse. There are also facilities that concentrate on gambling, eating disorders and sexual addictions as well. Still others state they specialize in “co-occurring disorders” or “dual diagnosis.”  The vast majority of addicts also suffer from some other form of accompanying primary mental or emotional disorder such as depression, anxiety disorder, bipolar disorder, ADHD, autism spectrum disorders, anorexia nervosa, bulimia nervosa, etc. In addition, several personality disorders such as borderline personality disorder, paranoid personality disorder, antisocial personality disorder, narcissism, histrionic personality disorder, obsessive-compulsive personality disorder, and intellectual disabilities are often present. As a result, RTC’s that offer these services should provide psychotherapeutic services by licensed professionals such as therapists and psychiatrists. Other centers simply treat the substance abuse disorders and are generally staffed by addiction and peer counselors in a supportive environment. Depending upon the patient’s needs, this information is important to consider.

            Licensing and certification is required in most states for RTC’s. In California, for example, the department of Alcohol and Drug Programs (ADP) provides a rigorous licensing process and regulates all treatment centers and can be found at: http://www.adp.ca.gov/Licensing/index.shtml . For a complete explanation of all states’ requirements, a free review can be ordered from the federal agency known as the Substance Abuse and Mental Health Services Administration (SAMHSA) by contacting their website at:  http://store.samhsa.gov/product/BKD517. Be wary of other unlicensed and unregulated facilities such as group and sober living homes that purport to offer inpatient treatment as well.

            Some RTC’s are also accredited. This means they have chosen to go through a scrupulous course of requirements and inspections by an agency that specializes in hospitals and institutions. It also means they are generally on several insurance panels and PPO’s and are able to take and bill insurance directly. Many RTC’s say they will take insurance clients but often require full payment up front and merely provide the patient with a super bill to submit on their own. The two most common accreditation bodies are the Joint Commission Accrediting Hospital Organizations (JCAHO), found at: http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx  and the Commission on Accreditation of Rehabilitation Facilities (CARF), found at: http://www.carf.org/home/.   Both are legitimate and well-respected and their approval is not easily earned. Generally, but not always, a RTC that is in the business for the long haul will seek and obtain accreditation.

            Location can be very important as well. Besides the pros and cons of being near or far away from home, other factors to consider are whether it is in or near a large metro area or a rural setting. Both have their upsides and downsides. For example, a city offers easy access to hospitals, mental health professionals and a wide choice of activities. It can also mean easier access to illicit drugs and the company of those who provide them. A rural setting can be much quieter and peaceful, with fewer distractions, but a long distance from some vital resources. Once again, it is a matter of choice, but a thorough investigation is always advisable.

            Finally, what is the recovery philosophy of the RTC? For nearly all of human history, people have been finding ways to become intoxicated and for nearly that long they’ve been searching for ways to stop. There are innumerable protocols that have been developed for this purpose. Some are more well-known than others, such as Alcoholics Anonymous and its myriad of offshoot 12 Step Programs. Others involve various treatments that utilize processes such as cognitive behavioral therapy, harm reduction theory and the like. Still others offer “cures” involving various combinations of positive thinking, nutrition, designer drugs and the like while others are religiously-based.

The important thing to remember is it has generally been proven that there is no easy way to get clean and sober and recover from alcoholism and drug addiction. It is a long, arduous road that requires a tremendous amount of dedication and work from all concerned. So no matter what philosophy you feel comfortable with, if you and your loved one commit fully to it, the chances of success are greatly increased.

What Are The Signs And Symptoms Of Alcoholism?

Signs and Symptoms of Alcoholism

There are many signs and symptoms related to drinking problems. Alcoholism is a progressive disease, so the symptoms and negative effects of drinking become exponentially more serious as time goes on.

For those who use alcohol, they may begin to show signs of a problem early on, and then progress to some of the more serious symptoms of alcohol abuse. Should their drinking escalate, increasingly more symptoms of alcoholism will appear. 

Here are twenty questions commonly asked by many chemical dependency counselors of those who think they may have a problem. By answering three or more of these affirmatively, it is generally advised the person seek help sooner rather than later:

1. Do you lose time from work due to your drinking?
2. Is drinking making your home life unhappy?
3. Do you drink because you are shy with other people?
4. Is drinking affecting your reputation?
5. Have you ever felt remorse after drinking?
6. Have you gotten into financial difficulties as a result of your drinking?
7. Do you turn to lower companions and an inferior environment when drinking?
8. Does your drinking make you careless of your family's welfare?
9. Has your ambition decreased since drinking?
10. Do you crave a drink at a definite time daily?
11. Do you want a drink the next morning?
12. Does drinking cause you to have difficulty in sleeping?
13. Has your efficiency decreased since drinking?
14. Is drinking jeopardizing your job or business?
15. Do you drink to escape from worries or troubles?
16. Do you drink alone?
17. Have you ever had a complete loss of memory as a result of your drinking?
18. Has your physician ever treated you for drinking?
19. Do you drink to build up your self-confidence?
20. Have you ever been in a hospital or institution on account of drinking?

Early signs of alcoholism can include regular and consistent intoxication, heavy drinking and risky drinking, such as while driving. Other sure signs of alcoholism include frequent blackouts and extreme mood swings while under the influence – the “Jekyll-Hyde Effect.”

Symptoms of Alcohol Abuse

One of the first symptoms of alcohol abuse is when an individual continues to drink even though it has caused problems many times. To persist in this behavior even after consistently missing work, driving while intoxicated, getting in trouble with the law and abrogating one’s responsibilities to oneself and loved ones indicates serious alcohol abuse.

The Diagnostic and Statistical Manual of Mental Disorders, IV (DSM IV), defines alcohol abuse as continuing “to consume alcohol despite the knowledge that continued consumption poses significant social or interpersonal problems for them (e.g. violent arguments with spouse while intoxicated, child abuse).”

Symptoms of Alcoholism

            For someone who is an alcoholic, the symptoms can include all of those associated with alcohol abuse (above). But alcoholics also continue to drink in spite of those problems.

When alcohol abuse reaches the alcohol dependence stage, the person also experiences at least three of seven other symptoms, including neglect of other activities, excessive use of alcohol, impaired control of alcohol consumption, persistence of alcohol use, large amounts of time spent in alcohol-related activities, withdrawal symptoms and tolerance of alcohol.

If an individual consumes alcohol simply to feel good, or to avoid feeling bad, their drinking has already become problematic. Alcoholism and alcohol abuse is, in the words of Alcoholics Anonymous, “cunning and baffling,” and sneaks up on its victims. This is why it’s important to know the warning signs and immediately take stock of the situation if they become apparent.  

Most substance abuse experts make a distinction between alcohol abuse and alcoholism. Unlike alcoholics, alcohol abusers have some ability to set limits on their drinking. Nevertheless, their alcohol use is still self-destructive and dangerous to themselves or others. 

Common signs and symptoms of alcohol abuse include:

• Repeatedly neglecting responsibilities at home, work, or school because of drinking.
• Using alcohol in situations where it’s physically dangerous, such as drinking and driving, operating machinery while intoxicated, or mixing alcohol with prescription medication against doctor’s orders.
• Experiencing repeated legal problems on account of drinking.
• Drinking as a way to relax or relieve stress. Many drinking problems start when people use alcohol to self-soothe and relieve stress. Getting drunk after every stressful day, for example, or reaching for a bottle every time you have an argument with your spouse or boss.

The path from alcohol abuse to alcoholism

Not all alcohol abusers become full-blown alcoholics, but it is a huge risk factor. Sometimes alcoholism develops suddenly in response to a stressful change, such as a breakup, retirement, or another loss. Other times, it gradually creeps up as the tolerance to alcohol increases. If one is a binge drinker or drinks every day, the risks of developing alcoholism are even greater.

Alcoholism is the most severe form of problem drinking. Alcoholism involves all the symptoms of alcohol abuse, but it also involves another element: physical dependence on alcohol. When an individual relies upon alcohol to function or feel physically compelled to drink, that person is an alcoholic. There are two major warning signs of alcoholism:

Tolerance: The First major warning sign of alcoholism

There are two sure signs of alcohol tolerance:

1. When an individual needs considerably more alcohol than when they first started drinking to get high or even feel relaxed.

2. When the individual can drink everyone else in the room “under the table,” often without even getting drunk themselves.  

These signs of tolerance are pretty good indicators of early alcoholism. Tolerance simply means that, over time, more and more alcohol is required to feel the same effects.

Withdrawal: The Second major warning sign of alcoholism

Withdrawl from anything can be uncomfortable. With alcohol it can be painful and extremely dangerous. For example, getting the shakes the morning after is a sign of withdrawl and needing a drink to calm oneself only reinforces that fact.  Drinking to relieve or avoid withdrawal symptoms is a sign of alcoholism and a huge red flag. When you drink heavily, your body gets used to the alcohol and experiences withdrawal symptoms if it’s taken away. These symptoms can include:

• Anxiety
• The shakes
• Sweating
• Nausea and vomiting
• Insomnia

• Depression
• Irritability
• Fatigue
• Loss of appetite
• Headache

In severe cases, withdrawal from alcohol can also involve hallucinations, confusion, seizures, fever, and agitation. These symptoms can be dangerous, even fatal, so it is important for the heavy drinker who wants to quit to consult their doctor and consider checking into a medical detoxification program where they can be safely monitored by trained professional personnel.

 

Five myths about alcoholism

Myth #1: The alcoholic can stop drinking anytime they want to.

Maybe they can; more than likely, they can’t. Either way, it’s just an excuse to keep drinking. Telling oneself they can quit makes the alcoholic feel in control, despite all evidence to the contrary and no matter the damage it’s doing. 

Myth #2: “My drinking is my problem. I’m the one it hurts, so no one has the right to tell me to stop!”

This is true in that the decision to quit drinking is up to the individual. But the alcoholic is engaging in self-deception if they think their drinking hurts no one else but them. Alcoholism affects everyone around the alcoholic, particularly the people closest to them. The alcoholic’s problem is their problem as well.

Myth #3: “I’m not a daily drinker, so I can’t be an alcoholic! Plus, I only drink wine or beer – no hard liquor”  

What one drinks, where they drink it and how much they drink is not what defines an alcoholic. Rather, it is the result of their drinking that defines whether or not it is a problem. If drinking is causing problems in the home or workplace, a drinking problem exists and one is most probably an alcoholic.

Myth #4: I’m not an alcoholic because I have a steady job and am good provider!”

Just because an individual isn’t homeless and lying in a gutter doesn’t necessarily mean they’re not an alcoholic. Many alcoholics are able to hold down a job, finish school and function at a reasonable level of subsistence. Some even become successful in their field. But that doesn’t mean they’re not putting themselves or others at risk as a result of their dangerous and self-destructive behavior. Ultimately, the effects of alcoholism always catch up to the individual – unfortunately for some, it is often too late.

Myth #5: Drinking is not a “real” addiction like drug abuse.  

Alcohol is a drug, and alcoholism is equally as damaging as hard drug addiction. The body and brain are severely damaged by alcohol addiction and, over time, the effects on one’s health are overwhelming, catastrophic and often fatal if gone unchecked. Plus, alcoholics go through physical withdrawal, just like drug users do, when they quit.

In summation, alcoholism and alcohol abuse seriously affects all aspects of a person’s life.  Long-term alcohol use causes serious and debilitating health complications and adversely affects literally every organ in the body, including the brain. Problem drinking also can devastate one’s emotional stability, finances, career, and the ability to build and sustain satisfying relationships. Alcoholism and alcohol abuse also destroys relationships with friends, co-workers and, especially, one’s family, putting an incredible strain on all the people closest to the alcoholic.

Often, family members and close friends feel obligated to cover for the person with the drinking problem. So they take on the burden of cleaning up their messes, lying for them, or working more to make ends meet. Pretending that nothing is wrong and hiding away all of their fears and resentments can take an enormous toll. Children are especially sensitive and can suffer long-lasting emotional trauma when a parent or caretaker is an alcoholic or heavy drinker. Co-dependence and enabling run rampant in families and relationships involving alcoholics and alcoholism.  Once again, it bears repeating that alcoholism is a progressive disease. As such, it is important to take action as soon as any of the preceding signs and symptoms is identified. However, unless the alcoholic truly wishes to do something about his malady, the chances for success are very limited.

The Efficacy of The Twelve Steps in Recovery Psychotherapy

THE EFFICACY OF THE TWELVE STEPS IN RECOVERY PSYCHOTHERAPY

For the past 25,000 or so years of human history, people have been finding ways to get intoxicated, and for nearly as long, they have been trying to stop. Many methods have been tried and failed or met with limited success. In May of 1935, Alcoholics Anonymous was born when a stockbroker and reformed drunk from New York named Bill Wilson met Dr. Bob Smith (another drunk) in Akron, Ohio. They discovered that the idea of one alcoholic talking to another went a long way towards keeping them sober. It became the first structured psychosocial program to treat alcoholism, and to this day remains the most widely used methodology for recovery from chemical and behavioral addictions worldwide.

It has helped countless numbers of alcoholics and addicts get sober and on the road to recovery and, when combined with psychotherapy, exponentially increases the odds against relapse.

Let’s start with Step One, which states: “We admitted we were powerless over alcohol, that our lives had become unmanageable”  (Alcoholics Anonymous, 1953 p.21) This is a two-part effort. The first is the admission of being powerless and the second is recognizing that one’s life has become unmanageable. In addition, it internalizes, then externalizes the thought process. This is an interesting continuum which is a basis for successful therapy.  Many patients can and have, admitted one without the other. For example, they may confess to a definable problem but also claim their life has not been adversely affected by it, saying things like, “Well, I still have a job, a roof over my head and food on the table, so it can’t be all that bad.”  This is classic denial and the patient must be helped to understand that a manageable life consists of far more than the basics needed for physical survival. For example, the ability and willingness to express oneself honestly to oneself and others can arguably be included in the definition of a manageable life. The idea here is that existence for existence’s sake is merely a shell and not a definition of a life and that one’s admission of personal powerlessness is “firm bedrock upon which happy and purposeful lives may be built”. ( Alcoholics Anonymous, 1953 p.21)

The second part of this idea is expressed in Step Two, “Came to believe that a Power greater than ourselves could restore us to sanity.”  Once more, the process is externalized and is a very difficult dilemma for a lot of patients to consider. Many construe this as being reduced to a state of helplessness and complete reliance upon something or someone about which they have no proof or knowledge. ( Alcoholics Anonymous, 1953 p.25)  The argument here is that it appears they had no knowledge of that which had a grip on their soul or psyche, for if they had they could have stopped it (or not, depending upon the nature of their disorder). Therefore, why not stop fighting the idea of it and give it a try? After all, it is completely up to the patient to interpret what that Power is. The point, once again, is to stop fighting and start feeling. “The minute I stopped arguing, I could begin to see and feel. Belief means reliance, not defiance.” ( Alcoholics Anonymous, 1953 p.27)  

This is also where the idea of humility is first introduced. To be able to accept the suggestion that one needs help and is not in a position to help oneself is humbling. Intellectually, many patients see it is a sign of weakness and disgrace, but they must be helped to understand that it is not. There is a huge difference between humility and humiliation. AA holds that humility and intellect are compatible, provided humility is placed first. ( Alcoholics Anonymous, 1953 p.30)

Step Three is one of the toughest of all of them to incorporate into a workable therapeutic frame, “Made a decision to turn our will and our lives over to the care of God as we understood Him”  Back to internalization. Even for those patients with an abiding faith in a Higher Power, this concept can be difficult to accept. The reason is that most people, while believing in God, have rarely considered completely turning their will over to Him or Her or It. The popular notion that everyone has been endowed at birth with a free will is essentially correct. In the context of those suffering from alcoholism and substance abuse, however, it is that very same (flawed) free will that led them into the predicament they’re in. The idea in this respect is that those people have pretty much abused their free will to the extent that it has been “broken” into so many pieces it has become all but irretrievable. Therefore, the choice is obvious; turn over what’s left of it to a power greater than oneself that is better able to make the right choices. This is essentially a life and death decision. In cases where it has not come to that, the idea of turning one’s life and will over to anything is much more difficult to accept and will take much longer. That is why some in Alcoholics Anonymous express the idea that “the lower the bottom the greater the gratitude and, thereby, the better the chances at redemption.”

Given all of the above, it is worth noting, however, that this level of willingness can be life-changing, in that it leads the patient into action and it is only by action that one can begin to cut away the self-will that has gotten them into trouble in the first place. ( Alcoholics Anonymous, 1953 p.34)  Therefore, it is a matter of fact that unless the patient is aided in some way to develop this quality of willingness, he will be unable to make the decision to exert himself. This in itself is an act of one’s own will and all the Steps from this point on depend upon a sustained and personal effort pertaining to this principle.  ( Alcoholics Anonymous, 1953 p.40)

Step Four, “Made a searching and fearless moral inventory of ourselves.”, is a key component in the arsenal of the therapist. This is an intensely personal and internalized process. “Nearly every serious emotional problem can be seen as a case of misdirected instinct. When that happens, our great natural assets, the instincts, have turned into physical and mental liabilities. Step Four is (our) vigorous and painstaking effort to discover what those liabilities in each of us have been, and are.” ( Alcoholics Anonymous, 1953 p.42)

The scientist, philosopher and religious teacher Emmet Fox once wrote, “Fear is the cause of all our problems in this world.” (The Power Of Constructive Thinking, Fox, 1928 p.9)  In the words of AA, “pride, leading to self-justification, and always spurred by conscious or unconscious fears, is the basic breeder of most human difficulties, the chief block to true progress. These fears are the termites that ceaselessly devour the foundations of whatever sort of life we try to build.”

( Alcoholics Anonymous, 1953 pp.48-49) 

The following is an example of written work the patient should be given in order to uncover and explore these fears and liabilities in their own life:

I. What am I resentful about? What do I fear? What am I angry about? Who are these people and things?	II. What did this person, experience, etc. do to make me angry?	III. How did all this affect me?	IV. What was my role in making all this happen?

One of the core beliefs of The Twelve Steps states that it is from their unhealthy relationships with family, friends and society in general that most of Alcoholics and addicts have suffered the most.  ( Alcoholics Anonymous, 1953 p.53) This of course includes especially those incidents which occurred during their childhood as they relate to psychodynamic, attachment, object-relations theory, etc.  This exercise serves to uncover the nature of those relationships in their entirety as well as gaining insight into what role the patient played (however innocently) in the pitfalls generated from them. Since the most common symptoms of emotional insecurity are worry, anger, self-pity and depression, and stem from causes which are generally within the patient as opposed to without, the patient needs to consider carefully all personal relationships which bring continuous or recurring trouble. (Alcoholics Anonymous, 1953 p.52)

This “inventory”, however painful, must be thorough. It is wise to advise the patient to write all questions and answers they may have as aids to clear thinking and honest appraisal. It is the first tangible evidence of the patient’s willingness to move forward.  (Alcoholics Anonymous, 1953 p.54)

Step Five, “Admitted to God, to ourselves and to another human being the exact nature of our wrongs.”  Here the process is externalized once again in an effort to deflate the ego. In the context of alcoholism and drug abuse, the patient is always very reluctant to take this step because it lays bare a tremendous amount of shame. Telling this to someone, however familiar, is extremely revealing and takes a tremendous amount of courage. So intense is the fear and reluctance to do this, that many A.A.’s try to bypass the step completely, which is extremely inadvisable. Within therapy, however, the patient is already engaged with the therapist and while courage is still required, the environment for the exchange has already been established. 

“The practice of admitting one’s defects to another person is, of course, very ancient. It has been validated in every century and it characterizes the lives of all spiritually centered and truly religious people.” ( Alcoholics Anonymous, 1953 p.56)  But religion is not the only venue in modern society where this practice is encouraged. Few psychiatrists or psychotherapists would disagree that there is a deep need felt by every human being for practical insight and knowledge of their own personality flaws and for a discussion of them with an understanding and knowledgeable person. ( Alcoholics Anonymous, 1953 p.56)

Holding in one’s secrets is terribly isolating. Patients who persist in keeping these to themselves are tortured by the loneliness they must endure. ( Alcoholics Anonymous, 1953 p.57) By taking this step, they are not only freed of that isolation and loneliness but can begin to have hope for the first time that they could be forgiven, no matter what they had thought or done.  Moreover, they can enable themselves to forgive others, no matter how deeply wronged they feel. (Alcoholic Anonymous, 1953 p.58) Once again, humility is the watchword as execution of this step brings the patient face to face with his defects, thus setting him “on the road to straight thinking and solid honesty.” (Alcoholics Anonymous, 1953 p.59) Only by being honest with another person can the patient be truly certain he can be honest with himself.

Step Six in and of itself is purely spiritual, “Were entirely ready to have God remove all these defects of character.”  This is an internal question of faith in the grace of God, and for those who have that, it has been extremely liberating. However, not all patients do, and for them it would be inadvisable to attempt to force this upon them. Nevertheless, the step does impart some very useful information. 

Recognizing one’s defects is a part of the processing and exploration of self that we as therapists should encourage our patients to do. It is a “venture into open-mindedness” that enables the patient to set loftier goals in terms of how he treats himself and others and to be ready to walk in that direction. “It will seldom matter how haltingly we walk. The only question will be ‘Are we ready?’” ( Alcoholics Anonymous, 1953 p.68) Getting them ready is our job, taking the walk is theirs. At the very least, the patient is encouraged to come to grips with his worst character defects and take action towards their removal.  ( Alcoholics Anonymous, 1953 p.69)

Step Seven, “Humbly asked Him to remove our shortcomings” is once more about faith in a higher power and not for everyone. But it is also about the attainment of greater humility, which bears mentioning here.

For the patient suffering from a disorder of the spirit as well as the mind, it is useful to bring into perspective that character-building and spiritual values are of great importance and that material satisfactions are not the purpose of living.  ( Alcoholics Anonymous, 1953 p.71) The patient needs to see that material satisfactions are not the desirable final end and aim of life. Many more problems have arisen for individuals as the result of unreasonable demands for security, prestige, power and money than have been solved. ( Alcoholics Anonymous, 1953 p.71)  Even for the patient who is unable to muster a healthy regard for humility as a desirable personal virtue, they should, if at all possible, begin to recognize it as a necessary aid to survival – and that is at least a beginning. ( Alcoholics Anonymous, 1953 p.74)  Moreover, humility can be a healer of pain. As the patient begins to fear pain less, the desire for humility is bound to increase. ((Alcoholics Anonymous, 1953 p.75)

Step Eight, “Made a list of all persons we had harmed, and became willing to make amends to them all.” and Step Nine, “Made direct amends to such people wherever possible, except when to do so would injure them or others.” are crucial, but are also way down the line in regards to therapy. Much work has had to have been done for the patient to be able to deal with the realization of how much damage he has done to others and to be willing to admit it to them. The most important thing here is for the patient to start with forgiving himself. That is the beginning of the end of their isolation from others.

 ( Alcoholics Anonymous, 1953 p.82)

As far as others, one must be very careful not to confuse one’s own peace of mind with what is best for them. Sometimes, it is better to leave well enough alone and carry out one’s amends to a particular person by doing right by others.

Step Ten, “Continued to take personal inventory and when we were wrong promptly admitted it.” is essentially a recipe for constant self-examination. Rather than allow resentments and guilt to build up, the patient is encouraged to take a good look at oneself at the end of each day and ask if there was anything they did wrong or anyone who was given short shrift by them. If so, they are counseled to make it right at the earliest possible time, thus “keeping their side of the street clean” for the next day. (Alcoholics Anonymous, 1939, p.85)  “An honest regret for harms done. A genuine gratitude for blessings received and a willingness to try for better things tomorrow will be the permanent assets we shall seek.”  ((Alcoholics Anonymous, 1953 p.95)

The last two Steps deal with God and taking the message of Alcoholics Anonymous to others, and while they are not particularly applicable to therapy, the spirit, especially of Step Twelve can be. It states, “Having had a spiritual awakening as the result of these Steps, we tried to carry this message to alcoholics and to practice these principles in all our affairs.”  

As a result of these Steps, or put another way, by virtue of working within this particular therapeutic frame, the patient can, in many ways transform him or herself. This is because he or she has been able to “lay hold of a source of strength which, in one way or another, has been hitherto denied to them.” ((Alcoholics Anonymous, 1953 p.107) It’s as if the patient has received a gift and is obliged to pass it on. In this way, the patient is able to “experience the kind of giving that asks no rewards.” ((Alcoholics Anonymous, 1953 p.106)  It’s one of the rarest of all occurrences – a win/win situation. It also needs to be practiced in a thoughtful, respectful way in that it should never be proselytized or forced on anyone. Only if someone has asked for assistance is the giving meaningful. Otherwise, it is just another instance of one’s own self-will deciding what is best for others.

The patient will always have ups and downs in his or her life and troubles are a part of that, but by continuing to practice this final “step” throughout their life, they will have the ability to “take these troubles in stride” and move through rather than up against them. (Alcoholics Anonymous, 1953 p.114)

Author’s Note: The emphasis here is on growth and change, especially spiritual. To conclude, I would like to quote two of my personal favorite passages from the material referenced. “If we place instincts first, we have got the cart before the horse; we shall be pulled backwards into disillusionment. But when we are willing to place spiritual growth first – then and only then do we have a real chance.” ((Alcoholics Anonymous, 1953 p.114)  And finally, “For me, A.A. is a synthesis of all the philosophy I’ve ever read, all of the positive, good philosophy, all of it based on love. I have seen that there is only one law, the law of love, and there are only two sins; the first is to interfere with the growth of another human being, and the second is to interfere with one’s own growth.” ((Alcoholics Anonymous, 1939, p.543)