Advice and Optimism Regarding the Opiate Crisis

In light of National Overdose Awareness Day, which took place over the weekend, I wanted to write about some of the things I have observed and been told over the years that seem to be effective in preventing opiate and opioid deaths. I counted over fifteen clients on my caseload that have over a year in recovery from opiates, most of whom were IV heroin users. A couple of weeks ago I began asking some of them what they thought were some important pieces of their recovery, and how they have gone from being another sad statistic to happy, productive members of their families and communities.

Each of my clients who are in recovery from opiates have been admitted to at least one inpatient treatment center, most of whom required at least two or three admissions before finally becoming sober for good. They speak of relapse as sometimes being part of the process in order to realize the severity of their addiction, pointing to the financial sacrifice of their families who understood that relapsing is often part of the recovery process. Many of them also relate that staying in a treatment center for an extended period of time (usually 2-3 months) was key to finally turning the corner and beginning to see progress. The reason long term treatment is so key is that it gives the brain time to heal, allowing for better executive functioning instead of being enslaved by the addicted brain which operates from a primitive level of craving and immediacy.

Nearly all of those who are abstinent spent a period of time in a good recovery house after they discharged from treatment. The recovery house serves many purposes, but some of the most important are accountability, structure, and a living environment where the use of alcohol and drugs is prohibited. Yes, sometimes people do relapse in recovery homes, but if the ownership of the house implements a zero tolerance policy  those who relapse are quickly identified and either asked to leave or readmitted to a treatment center or detox ward. There is also the Tennessee Alliance of Recovery Homes  that sets standards and practices that ensure that supportive housing is implementing best practices.

All of my clients utilize or have utilized 12 step recovery. Some no longer attend meetings, but most do. 12 Step recovery is not the only method for sustained or early recovery, but in my experience it is the most effective for overcoming the incessant pull of addiction and teaching the recovering person how to navigate the world without the use of consciousness blunting substances. I have worked with many clients who have a strong aversion to AA or NA meetings, some who have felt they encountered a heavy-handed approach to spirituality. Most of the time these clients can work through their resistance, encouraged to find meetings that are less rigid and open to many different approaches in regard to finding a healthy way to interact with the principles of the 12 steps. Buddhist recovery groups have become widely available in the last ten years, and there is also Celebrate Recovery, which caters to those who wish to have their recovery focused around their Christian faith.

The efficacy of opiate antagonists such as Naltrexone and Vivitrol have been well documented. I have had clients tell me that these medications have been “a game-changer” in regard to reducing the cravings and obsessive thoughts associated with addiction. In the last year I have recommended these treatments to almost all clients who meet criteria for severe opiate and alcohol use disorders. Additionally, medication assisted therapies such as Suboxone can also be implemented, especially for clients who have had repeated overdoses and who have not responded to abstinence based treatment.

Finally, I will advocate for the implementing of a licensed alcohol and drug counselor or addiction trained therapist to assist in the recovery process. The importance of helping a client cultivate their strengths, reduce anxiety, and guide them to needed resources cannot be understated. UTILIZING A GOOD THERAPIST OR COUNSELOR IS AS IMPORTANT FOR FAMILY MEMBERS AS IT IS FOR THOSE WHO ARE FIGHTING THEIR ADDICTION.

In my experience, a realistic, optimistic, holistic, medically appropriate approach will eventually solve the addiction crisis that has decimated this country for not just the past ten years, but since its inception. The lethality of drugs such as heroin, fentanyl, and opioids have raised the stakes, forcing ourselves and our families to stop ignoring how our culture glorifies and glamorizes the use of alcohol and drugs.

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