Hello, chicagorunner-ga!
First of all, you are to be commended for directing your father to a
program which might help him overcome his addiction and for caring
enough to ask about what else you might do to facilitate the process!
It is extremely hard to watch someone you love go through the grips of
addiction....and the all-too-common attempts of trying, and failing,
and trying again to beat it.
I hope your dad is successful. I will try to cover all the bases for
you, so that you have some alternatives to think about if he needs
further help when he is released from the rehab facility.
The 12-step program is one of several methods used to help overcome
drug addiction. I am not sure if the rehab program your dad is
involved in includes medications like methadone to help withdrawal, or
if it is just an inpatient program with a "cold turkey" type of
withdrawal. If your father is severely addicted, as you have
indicated, he may need something more than a simple 12-step approach.
Therefore, I have listed some of the most common methods used for
opiate withdrawal below, so the usefulness of the 12-step program can
be considered in a more informed light.
==
The Commonwealth Addiction Treatment Center in Virginia has a good
overview of the different methods use to combat addiction, and the
pros and cons of each method.
http://www.virginiadetox.com/ultram.asp
Cold Turkey:
===========
Using no drugs and doing it on your own is called cold turkey and as
mentioned that this is so uncomfortable that most patients are unable
to tolerate it and it is not successful. Sometimes people are pushed
into cold turkey by being put in jail or in another situation where
the drug is not available.
Inpatient detoxification:
========================
Can be expensive and is still painful unless other drugs are given.
Usually insurance companies will not pay for people to stay in
inpatient long enough to be fully detoxified.
Methadone
=========
The most common method of detoxification is to use Methadone in an
approved clinic and slowly taper the patient down from his usual dose
to zero over a period of approximately 21 days. Unfortunately, the
success rate is not particularly high because the withdrawal is still
uncomfortable and patient usually uses drugs during the withdrawal
period.
Ultra Rapid Detoxification
==========================
(URD) involves putting patients under anesthesia and while asleep,
giving them a drug called Naltrexone which blocks all of their
endorphin receptors and pushes them into 100% detoxification within a
5-30 minute period. This is an extremely painful process but under
anesthesia, it is tolerable. The success rate of Ultra Rapid
Detoxification is 100% but its drawbacks include a high cost, and
there are some risks associated with it.
Outpatient Ultram detoxification
=================================
This is a 4-5 day process that is comfortable, cheaper and yet still
successful at getting patients onto Naltrexone (blocking) therapy.
*******
It is important to note that no matter what the method used, it is
recommended that the patient follow-up with a 12-step program.
*******
What happens after detoxification?
==================================
"We believe strongly that detoxification without appropriate follow-up
and treatment is almost always unsuccessful. Therefore, we insist that
all of our patients be willing to participate in an appropriate
treatment program as part of their after- care. This should include
12-step programs and professional therapy. We expect that all patients
will identify and begin therapy with an appropriate substance abuse
treatment facility in their area as soon as possible following the
detoxification. They will also need to be involved with a physician
who specializes in substance abuse."
==
Although the Commonwealth Addiction Treatment Center commonly uses an
accelerated detox procedure, they have an excellent article on
"aftercare."
http://www.virginiadetox.com/aftercareprogram.asp
I have excerpted the portions that relate to life after withdrawal,
no matter what method is used.
The first portion I want to highlight, for your own awareness, is
that a severe opiate addict can expect withdrawal to last for several
years!
Post Acute Withdrawal Syndrome
===============================
"This third phase of withdrawal can last up to one to two years. This
sounds formidable, but in reality the symptoms are so mild that
they’re extremely tolerable and during this phase patients feel better
than they have for years and so it’s really not a major problem. It is
more of a situation that as patients look back they realize that by
the third month they are a lot calmer, more relaxed and happier and
self assured than they were one month earlier. At a year they have
improved even more. Patients are even more calm and relaxed as things
continue to get better and better, provided they work their program."
The following is also extremely important in light of your father's
long-term recovery:
Long Term Recovery
===================
"It is important to remember that what we are essentially providing
is a detoxification. Our long-term goal is obviously long-term
recovery. Through some modern medical techniques we now have a fairly
good idea of what causes cravings and relapse."
A. Craving and relapse
Modern PET scanners can actually take pictures of the brain and the
pleasure center. These studies show that cravings are related to
releases of Dopamine in the brain. Dopamine is the chemical that is
found in the pleasure center and all drugs of abuse release cause
secretion of extra amounts. When patients are in recovery and
drug-free we find there are three specific things that release
Dopamine in the brain, as if the patient had taken a small amount of
drugs. This increase of Dopamine is associated with the patient
feeling cravings for the drugs. These three things that release
Dopamine in the brain and cause cravings are as follows:
1. Any mood altering drug - we know that it is absolutely essential
for narcotic addicts to be completely abstinent from alcohol, pot,
cocaine, amphetamines and other addictive drugs. All of these drugs
release Dopamine into the brain and all of them will make the brain
have cravings for heroin and other drugs. It is essential that all
patients pay very close attention to this and be completely abstinent
from all mood-altering drugs.
2. Things that were associated with the drug experience. Any
environmental stimulus that was associated with the drug experience
will actually release Dopamine in the brain. This means old friends,
old places where people used to use, seeing drug paraphernalia,
driving down the wrong street, getting a paycheck, seeing an ATM
machine, hearing a song that was associated with using drugs, etc. All
of these things will actually produce cravings in addicts. Eventually
these will go away, but it may take years before these stimuli do not
produce releases of dopamine in the brain. It is essential that all
patients pay extremely close attention to this so that the brain has
the best chance of staying drug-free.
3. Intense moods and emotions - Strong feelings, including sadness,
grief, loneliness, depression, happiness, joy, and boredom can all
release Dopamine in the brain and produce cravings for drugs. It is
essential that patients work with therapists, and 12-step groups in
order to keep themselves as even keeled as possible, especially in the
early days of recovery.
6. Essentials for a Good Recovery Program
A. Naltrexone therapy (I don't know if this will apply to your
father's program or not!)
We believe that the cravings for narcotics are so intense and the
length of time it takes the brain to heal is so long that most
narcotic addicts will relapse back to drugs very quickly if they do
not have Naltrexone therapy for additional support. We recommend
Naltrexone therapy for twelve months. This prevents patients from
relapsing back to narcotic use and gives patients a chance to start
making changes in their life and building up a support system. We
highly recommend at least two Naltrexone implants. We recommend more
pellets if circumstances warrant closer support. Following implants,
we recommend a two to four month period of taking oral Naltrexone in a
supervised fashion, where the patient takes oral Naltrexone observed
by a support person. It is best if the Naltrexone is crushed, mixed
with water and then swallowed. If the patient is in recovery and is
proceeding smoothly after six months or so, patients can usually take
their own oral Naltrexone for the balance of the twelve months.
B. Twelve step groups
We cannot over emphasize the importance of 12-step groups. These
programs provide support, philosophical material, and education to
learn about and deal with all aspects of recovery. The groups take
patients away from the usual using friends and usual using situations
and put them into contact with people who are serious about their
recovery. It may be that in your local area Alcoholics Anonymous (AA)
is a stronger group than Narcotics Anonymous (NA). It may also be
necessary to experiment with different groups to find a good strong
group. Most locations have many, many groups and with only a small
amount of experimentation you can easily find 12-step groups that are
very supportive.
C. Substance abuse therapy
Patients have a lot to learn about living and staying drug-free.
While support groups are helpful, it is our experience that
professional therapists can add significantly, by being a little bit
more educational and confrontive. They can also help patients to
understand relapse and understand deeper psychological issues that may
start becoming apparent during early recovery. Usually we recommend
intensive outpatient programs, which meet in a group session three
times a week. Depending on the circumstances individual therapy may be
appropriate. If more intensive therapy is needed, then an inpatient
stay can be helpful. Sometimes an extended care, halfway house is the
best fit depending on how dysfunctional the patient’s lives have been.
D. Medical care
All patients need to follow up with physicians who are experienced in
both substance abuse and mental health. This physician may be a
psychiatrist, family practitioner or internist, provided that he/she
is familiar with substance abuse, mental health, narcotic addiction
and Naltrexone therapy. We can help provide lists of physicians who
may be available in your area. This is particularly important since it
is more and more apparent that after a patient gets drug-free a
variety of mental health issues arise. It is very common that patients
have periods of depression or anxiety. Sometimes there’s even bipolar
illness, or other serious mental health problems that may require
medications. As mentioned earlier if emotions are not kept on an even
keel, then relapse is extremely common.
7. Final Notes
I believe that all substance abusers can achieve long term sobriety.
Frequently, however, patients cannot or will not completely give 100%
to their recovery program. Recovery from these drugs is the hardest
thing that patients will ever do. If however, they’re able to get on
top of it, the rest of their lives will be smooth sailing related to
drug abuse. The more work they do in the early months the more likely
they are to be successful. We almost never see someone relapse who
completes ninety AA or NA meetings in ninety days. Most patients,
unfortunately, are under the false illusion that they will be
different and they don’t need to work quite as hard on their recovery.
This is a mistake.
==
How successful is the 12-step program?
**************************************
Again, since you did not mention whether the 12-step rehab facility
offers anything other than a "self-help" sort of approach, I am
including an excerpt from the following article which indicates that a
12-step program, by itself, may NOT be enough for a serious addict.
From "Utilization of Proven Treatment Approaches."
http://www.modelplan.org/fulltext/treat_approaches.html
"Twelve Step Facilitation:
Also known as the Minnesota Model, the approach is highly structured
and involves detoxification, psychological evaluation, general and
individualized treatment planning, group therapy, lectures, and
individualized counseling. (Winters,1989) Group counseling is a key
therapeutic technique which involves using more advanced residents to
pass on knowledge, experience, and values to newer patients. The 12
steps are carefully studied, and patients are referred to the meetings
of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) as part of
their therapy after treatment to prevent relapse (Winters and
Schiks,1989).
Many studies have been completed to evaluate the outcomes of the 12
Step Facilitation method. 12 step programs such as AA, NA, or CA do
not constitute treatment in-and-of-themselves. There are indications
that some county judicial systems have mandated 12 step programs in
lieu of treatment to cut costs. 12 step programs are not AOD
treatment, and lack the basic services required by severely dependent
individuals.
Therapeutic Community (TC):
"The TC is a social-psychological form of treatment for addictions and
related problems. In the TC model, substance abuse is a symptom of
much broader problems; TCs use a holistic treatment approach in a
long-term residential setting where peers and professional staff serve
as therapists in the treatment process.
** A key difference between TCs and 12 Step Facilitation is the belief
that the individual is responsible for their own addiction or
recovery.**
==
From "Self Help - 12-Step Programs." Alcohol and other Drug Addiction
Services.
http://alcohol-drug-treatment.net/aa_na.html
"The 12-Step approach is a great program (support group) for the arena
it was created in, and could serve as a support group in an
addicts/alcoholics aftercare plan."
"It would NOT be the preferred choice in initial treatment or an
immediate solution for someone currently using in the dependency stage
of his or her addiction."
==
Also read "MINNESOTA MODEL-BASED REHABILITATION PROGRAMS." Factsheet
#16. Friends of the Addicted for Comprehensive Treatment.
http://216.239.39.100/search?q=cache:DNODuYEB1PIJ:www.factadvocates.org/factsheets/facts16.html+%2B12-step+programs+%2Bsuccess+rate&hl=en&ie=UTF-8
"FACT believes that Minnesota Model treatment can be extremely
helpful to some addicts and many members have found them a useful
pathway into 12 Step programs and continuing recovery. As with
methadone and therapeutic communities, however, we believe that those
addicts who don't find 12 Step programs useful should be given other
options. We also think that there are many addicts who need in-patient
treatment who are presently being barred from it due to insurance
difficulties and we support efforts to make coverage of addiction care
and other mental health care mandatory, as is coverage of physical
illnesses."
===
I truly hope that the treatment program your father is currently
attending will do the trick. If not, you might want to consider the
more serious alternatives, like rapid detox.
If you need further help in finding some facilities close to your
area which offer some other alternatives, I will be happy to help. You
can either address the question "to umiat" in the heading, or leave it
open for another researcher.
In either case, please let me know if you need further clarification
and I will be happy to help if I can! And once again, "thank you" for
caring enough about your father to find him some treatment.
umiat-ga
Google Search Strategy
+success rate +opiate 12-step programs
+opiate 12-step programs
+12-step programs +success rate |
