Call a Drug Rehab Directly
When we are desperate for help with drug addiction and alcoholism, the emergency department of a local hospital isn't always a great avenue into drug rehab. Doctors are now being trained in special procedures for addressing substance use disorders, and those procedures aren't warm and fuzzy.
The federal Health and Human Services Administration’s Substance Abuse and Mental Health Services Administration promotes a training protocol called SBIRT for medical professionals. (Stay with me: it’s HHSA’s SAMHSA’s SBIRT.)
SBIRT stands for “Screening, Brief Intervention, and Referral to Treatment” but I’m going to call it “Talk Fast” or TF for short (that’s a pun).
It’s actually pretty funny (and achingly sad) if you pay close attention to the language, and imagine how fast the ED doctor needs to jabber to cram all this into 5-10 minutes.
“Brief Intervention is a time-limited, patient-centered strategy that focuses on changing a patient’s behavior by increasing insight and awareness regarding substance use. Depending on severity of use and risk for adverse consequences, a 5-10 minute discussion…provides the patient with personalized feedback showing concern over drug and/or alcohol use. The topics discussed can include how substances can interact with medications, cause or exacerbate health problems, and/or interfere with personal responsibilities. Brief intervention is designed to motivate patients to change their behavior and prevent the progression of substance use. During the intervention, patients are:
- Given information about their substance use based on their risk assessment scores.
- Advised in clear, respectful terms to decrease or abstain from substance use.
- Encouraged to set goals to decrease substance use and to identify specific steps to reach those goals.
- Taught behavior change skills that will reduce substance use and limit negative consequences.
- Provided with a referral for further care, if needed.
Brief interventions are typically provided to patients with less severe alcohol or substance use problems who do not need a referral to additional treatment and services. In addition to behavioral health professionals, medical personnel (e.g., doctors, nurses, physician assistants, nurse practitioners) can conduct these interventions and need only minimal training.”
In some states, they talk really fast. A medical consulting firm defines the BI in SBIRT as:
“A brief intervention, also referred to as a brief motivational conversation. Efficacy and effectiveness has been found for brief interventions lasting 3-5 minutes. However, one needs to provide a minimum of 15 minutes for payment under CPT and HCPC rules. Brief interventions consist of feedback about personal risk, explicit advice to change, emphasis on patient’s responsibility for change, and provides a variety of ways to effect change. Brief intervention techniques include an empathetic style and support for the patient’s perception of self-efficacy or optimism that they can change.”
SAMHSA’s SBIRT does go on to note that “In the case of patients with addictions, more intensive interventions may be needed.” Whew. Because I was getting a little nervous for the patient with the life threatening brain disease of addiction who'd gone to the ED desperate for help. There is hope for help in hospital emergency departments now that more and more hospitals are employing recovery coaches who can offer more personalized assistance for longer than the 5 to 10 minutes allotted to SBIRT.
THE TAKEAWAY: When turning to a healthcare professional for help with addiction, ask if the provider practices “Brief Intervention.” If the answer is yes, keep your expectations low. Often, it's simply more efficient to skip the ED and just call a drug addiction rehab directly.
Reprinted with permission from www.whenweloveanaddict.com. Copyright 2016
Drug Addiction Intervention Strategies
When someone we love is destroying themselves with drugs, alcohol, and destructive behavior, we can be desperate to get them into effective drug addiction treatment. Often, the first step to successful drug rehab is intervention. Debra Jay, a well-known professional interventionist and an Oprah favorite, offers a personal and concrete approach to preparing for an intervention when someone we love is destroying themselves with drug addiction or alcoholism. In her book, No More Letting Go: The Spirituality of Taking Action Against Alcoholism and Drug Addiction, Jay “personifies” the addiction, separating it from the person inflicted and referring to it as a powerful third party intruding upon our interactions with the addict we love:
Whether we realize it or not, we are continually negotiating with the addicts and alcoholics in our lives. Negotiation is our attempt to reach agreement or solve a problem. But most families are poorly prepared to negotiate with an addiction and end up losing to the addiction. We forget that it is the addiction doing the negotiating in an attempt to protect itself.
She then goes on to define the five typical negotiating styles we might find in a family challenged by drug addiction or alcohol dependence:
Reading her descriptions makes me wonder if she’s been spying on my family Thanksgivings.
“Adversaries are the addictions themselves. They take a defensive stance in an attempt to protect the addiction and avoid pain. The thought process is that addiction is a solution, and attempts to handle it are not help, but attack.
Aggressors are those convinced that their approach toward handling the addict is the best . They commonly try to bully the addict into sobriety and control the family’s approach. They frequently create more problems and friction within the family, making a handling increasingly difficult.
Appeasers try to smooth over the current crisis, often at the expense of an ultimate resolution. They tend to submit to the addict’s threats while trying to convince themselves that the situation is improving. Appeasers tend to lose the respect of others while settling for an increasingly difficult life.
Avoiders ignore problems and conflict. When a negotiation or fight surfaces, they leave. They make family communication and intervention difficult as they provide no support. They live with increasing fear and isolation.
Analysts try to understand and explain. The risk with this approach is that they tend to delve into explaining the problem rather than confronting it. They often search for the root cause and end up mired in logic that does nothing to handle the situation. Over time, they will tend to become increasingly emotionally detached.”
Jay suggests that before organizing an intervention, each of us takes the time to identify which style(s) we tend to use (I’m multi-lingual in all five). She asks us to set aside our favored style in order to adopt a new style of negotiation: that of ambassador. And here’s where she really personifies the disease in order to cut through its crap:
“Ambassadors are able to operate outside the addiction’s sphere of influence. They understand the difference between the addiction and the addict and do not grant the voice of the addiction any power. Instead, they come from a position of love and direct their intention toward the person behind the addiction while keeping the ultimate goal at the forefront.”
I cried when I first read that. Somehow, for me, Jay’s simple concept of ambassador melts anger and resentment and defensiveness. It brings dignity and recognition to our loved one struggling with addiction. As an approach to intervention for drug addiction, it lights a path home to hope.
Republished with permission from www.whenweloveanaddict.com. Copyright 2016
Opioid Dependence and Opioid Addiction
In the context of drug treatment, we seem to understand that you can be opioid dependent without being opioid addicted (in, say, the case of a terminally ill cancer patient).
We seem to understand that opioid dependence and opioid addiction are directly linked.
But sometimes we forget – with the encouragement of insurance companies – that opioid addiction is still very much a problem even if we are no longer opioid dependent.
The person who is no longer opioid dependent -- as a result of successful detox – is still very much opioid addicted.
The journal Addiction Science and Clinical Practice defines dependence as the need to keep taking drugs to avoid the physical discomforts of withdrawal.
The journal defines addiction as abnormalities in the brain caused by past drug use that provoke intense craving and compulsive use; both the cravings and the compulsion to use can still be triggered -- even after successful detox -- by environmental triggers such as stress, old memories of pleasure, and psychological conditioning. The brain abnormalities that define addiction "can produce craving that leads to relapse months or years after the individual is no longer opioid dependent."
While both dependence and addiction are the result of abnormal changes in the brain caused by chronic opioid misuse, the symptoms of opioid dependence clear up within a few weeks of detox. The neurobiological impairments of opioid addiction are long-lasting and wide-ranging.
Prescribing the Right Course of Treatment
Opioid dependence can be successfully treated by short-term or acute care.
It’s the opioid addiction that requires long-term drug rehab and extended recovery care.
Experts in every realm of addiction science – medical, academic, and governmental – unanimously agree that recovery from drug addiction requires 90 days or more of residential, long-term recovery care. The brain requires 90 days or more to heal, to resolve the abnormalities caused by drug use, to learn to cope with the stress of everyday life and to withstand the cravings triggered by factors outside of the recovering person. The healing of addiction goes on long after the healing of dependence.
Based on standards of care established by health insurance providers, people addicted to opioids are prescribed a course of treatment suitable to the treatment of opioid dependence.
This is like going to the doctor with an ax in your skull and being offered an aspirin because your head hurts.
Until diagnosis and dose of treatment become aligned with both opioid dependence and opioid addiction, we will continue to hear about the remitting, relapsing nature of this chronic, life-long brain disease.
Successful Drug Addiction Treatment takes 90 days or more
A great article published in PsychCentral a few years ago outlines the benefits of long-term drug treatment by asking "How Long Is ‘Long-Term’ Drug Rehab?" The article, written by David Sack, MD, is a near-prophecy for the comprehensive program developed by Riverbank House in Laconia, NH. Here are excerpts:
There is a growing consensus that for those who can manage it, long-term addiction treatment is the most effective option. Thirty days of residential treatment used to be the generally accepted standard in treatment. Why 30? Not because research showed its effectiveness, but because that was the average length of stay covered by insurance. Now, the National Institute of Drug Abuse has declared 90 days of treatment the 'gold standard.'
Dr. Sack goes on to explain that "research shows that people completing at least 90 days of treatment have significantly lower relapse rates than those who stay for shorter amounts of time."
Specific Benefits of Long-Term Recovery Care
The Four Guiding Principles of Riverbank House:
- Effective Addiction Treatment Requires Long-Term Care
- Responsible Recovery Care Addresses the Brain Impairments that Can Hinder Success
- Responsible Addiction Treatment Promotes Many Pathways to Recovery
- Successful Recovery Requires Practice within a Safe Community
Like Riverbank House, Dr. Sack promotes long-term care because, he notes -- the brain needs time to heal, clients need time to practice practical application of new skills, new habits need time to take root, and relapse plans need to be lived with real-world exposure.
Sack, D. (2012). How Long Is ‘Long-Term’ Drug Rehab?. Psych Central. Retrieved on August 1, 2016, from http://blogs.psychcentral.com/addiction-recovery/2012/05/long-term-drug-rehab/
republished with permission from www.whenweloveanaddict.com. Copyright 2016.