Want to Help Someone Stop Using Alcohol or Drugs?
Get Better Solutions From Better Information
I know you want to make a difference in someone’s life; that is why you are reading this. You want to help someone with an alcohol or drug problem.
I can help you improve treatment outcomes by as much as 90%.
I know - you are thinking that a 90% improvement is an outrageous claim!
Nobody believes a 90% success rate - until they see it with their own eyes.
Here is the secret to a 90% success rate.
You have to apply all of the most important information to the problem at the same time.
You can’t let someone else have that responsibility. You have to understand what has to be done.
Why do you have to know what to do? Because no one else is more dedicated than you are in helping this person. But, wanting to help is not enough. You have to know how to pull together all of the things that make a difference.
Here are some areas that you have to pull together.
Treatment is fragmented. Here are just a few examples of how fragmented:
Who treats the medical consequences of drinking? There are real risks and complications from detoxifying from alcohol and some drugs.
Who treats the psychological consequences from years of drinking?
Who chooses the treatment setting? What criteria are used to make a recommendation for the different types of treatment? What are the advantages and disadvantages of inpatient and outpatient treatment.
What is the success rate of the recommended treatment provider and how do they define success?
When the type of treatment setting changes - say inpatient to outpatient - what kind of planning is completed before the change? Is there a dropout rate when going between treatment programs?
What influence will insurance have in recommending treatment and how much of the total bill will they cover?
What is the role of family in the treatment process? Is family included as part of the primary treatment process? How many times is the family seen as part of the treatment process? Will the program explain how the family is supposed to help? Does the treatment provider include information from the family when they evaluate their client?
Is the cost of treatment a barrier to starting or finishing treatment? If transportation is involved, will it be available when needed? If childcare is needed, can it be arranged? Will employment interfere with the treatment schedule? Are there medical problems that must be treated first? Are there disability problems that must be considered in the treatment planning?
You need to know the answers to all of these questions and many, many more.
Now all of the most important information is available to you. In one continuous supply of information you will know what is most important at that moment and how to apply it.
Let me start with the biggest pitfall to success. There are several, but let’s start with the biggest. Some programs have what is called a “waiting list”. This is a list of individuals who have requested treatment but who will not be treated immediately because the treatment capacity is filled. So, everyone who needs treatment NOW is expected to wait until the program has room for them. Usually programs that are funded by public funds have waiting lists. They will tell you they are under-funded and the problem is unavoidable.
This is completely the opposite of “best practices” for treating alcohol or drug problems! There is only a brief “window of opportunity” when someone with a problem will ask for help. If they begin the treatment process immediately - which is called “treatment on demand” - the chance of starting treatment is very good. If they have to wait more than a few days, their chance of starting treatment goes down quickly.
Don't miss an opportunity
Do some searching to find a program that can provide services immediately. Usually, inpatient programs have the most limited treatment availability. The Intensive Outpatient Programs are usually more available. For more information about the different levels of treatment and the reasons one would be recommended over another, please read the Types of Treatment article.
If funding to pay for treatment is an issue, look around for additional help. Does the program offer a discount if half of the costs are paid in advance? Will one or more family members help spread out the cost of treatment by paying for a part of the costs? Does the program offer partial scholarships or extended payment plans? If the employer is involved in the referral process, can they assist with costs?
Let me say that some requests for treatment are manipulations to avoid consequences. Someone may ask for help, but the goal isn't so they can stop the use of alcohol or drugs. This may not be the best reason to begin treatment. But, if compliance with treatment protocols including monitored abstinence is agreed to, it can be an effective starting point. Living without the effects of consistent exposure to alcohol or drugs is a positive experience. The exposure to information about the progression of the disease and the supportive group interactions can help to increase motivation and involvement in a community support system.
The next big pitfall is isolation. Trying to stay abstinent without any support except treatment makes the effort more difficult and reduces the chance of success. Make sure you are working with treatment providers that encourage and support community based abstinence activities . This can include 12-Step meetings like Alcoholics Anonymous or Narcotics Anonymous, church supported discussion groups, and resumption of friendships and activities that were never drug or alcohol related.
Medications are a double-edged sword. They can help the recovery process when used correctly and they can destroy the recovery process when used incorrectly.
This information is not intended to be a substitution for medical treatment. Consult a licensed health care professional experienced in treating alcohol and/or drug dependence about how and when medications will be used. That said here is some general information about the use of medications.
If detoxification is provided, close medical supervision and supervised dispensing of medication is needed. Individuals addicted to one substance are at great risk of over-using medications that will relieve withdrawal symptoms. They need to be supervised when they take medication.
On the first day of medication it is usual medical practice to medicate slightly beyond the point of symptom control. The patient may be mildly sedated. This establishes the baseline of medication from which the individual will be detoxified. This is done to avoid under-medicating, which could result in seizure or delirium tremens. From the baseline, medication is decreased over a series of days in dose reductions that control withdrawal symptoms without continued sedation. It is a fine line. Once the danger of withdrawal has passed, no further sedating medications are used.
Psychiatric medications are an important adjunct to stabilization. In early treatment pre-existing medications need to be continued to preserve the baseline of psychiatric stability. Sometimes, psychiatric medications are initiated in early recovery to increase emotional stability. The medications that are not central nervous system depressants have less potential for abuse. Valium, Ativan, Klonopin, Xanax, Ambien, and others are central nervous system depressants. The potential for dependence problems are high with these types of medications because of cross-addiction. I recommend that a second opinion by a physician who is a certified addiction specialists (Addictionologist) be consulted if this class of medication is recommended. Second opinions are widely used in medicine to avoid mistakes. Do not hesitate to ask for a second opinion.
Medications for chronic medical problems (high blood pressure, heart function, blood sugar regulation etc.) need to be continued and monitored for possible adjustment. Some conditions improve with abstinence and medications may need a corresponding adjustment. Also keep in mind that some medications have side effects that may mimic milder forms of withdrawal (tremor, sleeplessness, itching, nausea, etc.) and a distinction between withdrawal and medication side effects needs to be made by the prescribing physician.
Poor Physical Condition
I had thought to include this topic under the Pitfalls section. But, I wanted it to stand out. This entire section is the most often overlooked aspect of early recovery. It is very basic stuff, which is probably one of the reasons it is overlooked.
Lets start with an examination of the lifestyle immediately prior to treatment. Most of the time positive health habits have been reduced or completely ignored. Good nutrition complete with vitamins, minerals and balanced meals are deficient.
Sleep, with a good quality of restfulness and length has been lost. Weight control, prevention of medical problems, treatment of medical problems, medication compliance, and physical fitness is less than ideal. Correction of these problems is inexpensive and can add tremendously to the quality of recovery and feelings of well-being.
Positive Health Practices
Blood sugar regulation, weight control, and good appetite control is easier to maintain when three nutritional meals and two small snacks are eaten each day. Multi-vitamin supplementation including an extra B-complex can help restore nervous tissue and function if a deficit had developed. This use of balanced meals and vitamins can contribute to reduced agitation, increased concentration, improved memory, greater energy, faster recuperation, and better rest. Control of caffeine intake will promote better quality sleep and calmer feelings throughout the day.
Exercise appropriate for the baseline of fitness will improve cardiovascular function, some blood chemistries, mood regulation, energy levels, stamina, and possibly contribute to weight loss. This attention to self-care and setting of positive priorities will have additional benefits.
It is easier to follow medication schedules when they are part of a larger, daily schedule of healthful practices. In addition, compliance with medical follow-up visits is easier when improvements in general health can be demonstrated. All of these are important, are relatively easy to complete, and will result in noticeable increases in well-being when implemented.
Asking open-ended questions about ongoing treatment progress provides the best support for positive communication. One quick example: “Have you noticed any differences in how you feel after your walking” is a good open-ended question. “Did you walk today” is a closed-ended question that can be answered in one word and reduces communication. Generally, people like to talk about themselves, particularly if they are doing better. So, open-ended questions are a better way of inviting comments and supporting the positive behavior. Look for upcoming articles on communication skills.
Logistical supports are the practical necessities that make attendance at treatment possible. They include everything from work or school schedules, to childcare arrangements, to transportation, to special accessibility needs, to medical appointments, and the variety of issues that can interfere with treatment attendance. All of these issues have to be quickly resolved. Sometimes government agencies or community organizations can provide additional supports when family resources are strained.
If you are seeking treatment or are planning to support someone who needs treatment, please use this information as a rough draft checklist for some of the starting points for treatment. Be sure to check the list of articles for other useful information that applies to the ongoing stages of treatment and recovery.
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Copyright © Stephen Buchness 2005