Excerpts

1. The Missing Element We have a problem. Fifty to 90 percent of alcoholics and addicts relapse in the first year after treatment. In the face of such grim figures, it's easy to toss around blame. Treatment doesn't work. The addict isn't doing what she should. Doctors are the new drug pushers. But the truth lies elsewhere, for the most part, and requires a new conversation. Relapse is caused by underestimating what it takes to stay sober. Addicts, their families and society minimize what is required for successful recovery. Addicts can't simply think their way out of addiction. Recovery requires action. It's much more than leaving the drug behind, whether it is alcohol, cocaine, marijuana, heroin, pain medications or tranquilizers. Recovery is about changing behaviors, which leads to changes in thinking. It's about honesty and willingness and letting go of resentments. It's about taking a fearless look at one's self and the wrongs of the past. It's about cleaning house and making amends. Recovery is about more than abstinence; it's about becoming the kind of person who can engage in healthy relationships. Abstinent without recovery, the addicted person is haunted by the past, suffers in the present and can't see a promising future. The control centers in the brain are being depleted by the constant internal battle not to pick up a drink or a drug. Relationships with family are frayed and getting no better. Relapse is just a matter of time. An old adage says it best: "When a heavy drinker stops drinking, he feels better. When an alcoholic stops drinking, he feels worse." For alcoholics and addicts to begin enjoying life again, they need to work a 12-step program of recovery, because addiction is a chronic disease that affects the mind, body and spirit. There is no cure. If we don't understand this basic tenet of success, we don't understand recovery. When we believe treatment centers are the heart of recovery, we base our hopes and dreams upon a flawed assumption. Treatment isn't recovery, and clinical teams don't know who will stay sober and who won't. Stellar patients drink on the flight home and seemingly hopeless cases never drink again. Treatment staffs know what works, but no one knows who will follow directions and do what it takes to stay sober. Recovery doesn't officially begin until treatment ends. It isn't dished out by doctors or teased out by therapists. It happens in a community and not just any community. It requires working a 12-step recovery program with other alcoholics and addicts. Recovery requires broad changes in how addicts live their lives, the kind of changes that would be tough work for anyone. They are attempting it with a brain so compromised by addiction that images of cerebral matter look like Swiss cheese. With decision-making abilities impaired and emotions turbulent, it's no wonder so many don't get very far before they crumble. The purpose of treatment is specific. It is designed to attend to the acute stage of this chronic illness. Involvement with patients is relatively short. A team of professionals administer to the most intense and severe symptoms, most notably, physical, emotional and spiritual. And many do an excellent job of it. But the scorecard we use to rate the success or failure of these facilities erroneously holds them responsible for patients' sobriety once they return home. But addiction is a chronic disease. There is no cure. It must be managed by working a daily 12-step program. This is something treatment centers prepare their patients to do, but cannot do for them. Many addicts don't follow the directions and relapse. Misconceptions about treatment coupled with the frustration of relapse has families throwing up their hands and proclaiming, "Enough! Treatment doesn't work!" And once they reach this verdict, hopelessness settles in and the only question left is, "Now what?" But what if I told you there was a group of addicted people who almost never relapse in the years following treatment. As a matter of fact, 78% never have a single relapse. Less than 15% have one relapse, but not a second. And those with more than one relapse? A whopping 7%. Not only that, but these folks are some of the most difficult addicts to treat. When I worked inpatient treatment, having them assigned to our caseload would elicit groans of despair. "They're the worst patients!" We knew our work just doubled. But these patients are getting something our loved ones aren't: a team who works with them for five years after treatment to make sure they build a solid program of recovery and make the prerequisite changes that lead to lasting sobriety. Because when alcoholics and addicts are left to their own devices--in spite of the universal cry that they can do it on their own--the odds are they'll be drinking and drugging again. Author Stephen King, in his column for Entertainment Weekly, writes about just this point: "Managing good sobriety without much help…is a trick very few druggies and alcoholics can manage. I know, because I'm both. Substance abusers lie about everything and usually do an awesome job of it. I once knew a cokehead who convinced his girlfriend the smell of freebase was mold in the plastic shower curtain of their apartment's bathroom. She believed him, he said, for five years (although he was probably lying about that, it was probably only three)…Go to one of those church-basement meetings where they drink coffee and talk about the Twelve Steps and you can hear similar stories on any night, and that's why the founders of this group emphasized complete honesty--what happened, what changed, what it's like now…If my own career as a drunk both active and sober has convinced me of anything, it's convinced me of this: Addictive personalities do not prosper on their own. Without unvarnished, tough-love, truth-telling from their own kind -- the voices that say, "You're lying about that, Freckles"--the addict has a tendency to fall back to his old ways." The problem is, of course, that alcoholics and addicts don't want to work a program of recovery, which requires very specific actions. They're convinced they have changed with surprisingly little effort and in a remarkably short amount of time, and they often convince their poor gullible families of the same. Alcoholics always have a better idea, which usually entails staying sober on their own, and eventually lands them back in the liquor store or crack house or doctor's office looking for a script. But what if we, as families, could initiate a program with our loved ones that models programs used by the recovery winners--those people who almost never relapse? What if we could provide the missing element that makes it much tougher to relapse? Once we appropriately define treatment as first responders, not as a stand-alone solution that does all the work for us, our expectations of treatment change. No doubt, treatment has a vital job to do, but it's not the only job to be done. Treatment centers can keep alcoholics and addicts only so long and then there is a hand off, sending them back home to us. Families and close friends have a tremendous amount of influence in an alcoholic's life, but usually don't know it. As a matter of fact, families not only don't understand their power, but often believe they are powerless. They feel mistreated, disregarded, even hated. The very people an alcoholic needs most are the people he fights against. Or appeases, only to break the promises made. Or ignores, pretending he simply doesn't care. The addiction not only abuses the people he cares about, but it abuses him. He breaks promises to himself. He pretends none of the pain matters. He begins losing everything he holds dear and can't stop it. He is filled with shame as he strikes out in anger. He doesn't understand what is happening inside himself. That's what it's like to live under the tyranny of addiction. Stick With the Winners So who are these winners who mostly never relapse in the first five years of recovery? And why do they get exceptional support that safeguards them from relapse? They are doctors. No one can imagine an opiate-addicted cardiologist or alcoholic neurosurgeon left to their own devices once discharged from treatment. If they are going to see patients, they must be sober. Right about now, I can hear people objecting, "Of course they stay sober. They're doctors. They know better than to relapse." But remember what I told you: they are the toughest patients in treatment. The belief that addicted doctors take direction well or commit to do what is required to stay sober is largely fictional. In truth, doctors are at even higher risk for relapse. Let's put a doctor's risk for relapse into perspective by looking at something else they struggle with: hand washing. For the last thirty years there's been an ongoing effort to persuade doctors to wash their hands between seeing patients with little sustainable change. As a result, according to the Centers for Disease Control and Prevention, we spend $30 billion fighting unnecessary infections in the United States every year. Almost 100,000 people die. The fix? Soap and water. Knowing this fact has not produced improved physician hygiene practices. So hospitals have been forced into action. They've trained hand-washing coaches and installed video cameras that send images halfway around the world so workers in India can monitor our doctors. They require doctors to wear radio-frequency ID chips that register each time they walk by a sink. Good hand-washers are rewarded with cash. Another false belief is that success is correlated with the fact that doctors have a medical license to lose. After all, retaining their privileges to practice medicine is a big motivator for staying sober. Most of us are concerned about loved ones who do not have the threat of losing a medical license looming over their heads. But our addicted family members have things they value too. Things they do not want to lose. Topping the list is family. With few exceptions, alcoholics and addicts love their families. However, for most alcoholics and addicts, consequences in the distant future have little impact on what they do today. Whether it's someday losing a medical license or someday losing their family, the immediate pull of addiction has far greater power. The need to snort cocaine today obliterates concerns about tomorrow. Whether you are a doctor or not, the negative consequences that get your attention are the ones that happen right away, not in some far off time. A drug court in Hawaii found that the future threat of a ten year prison sentence was a poorer deterrent than being immediately sent to jail for three days upon failing a drug test. Timing of consequences is more effective than the size of a consequence. Doctors entering treatment tend to be sicker than most due to a seemingly inexhaustible supply of drugs and the ability to more easily hide their problems from others. People look away and enable addicted doctors more than the average addict. Intervening on a doctor usually occurs only after the addiction is impossible to ignore. Consequently, addiction's progression is quite serious before most physicians find themselves in treatment. This makes their long-term successes all the more compelling. It appears they've found the Holy Grail of recovery. Excerpted from It Takes a Family: A Cooperative Approach to Lasting Sobriety by Debra Jay All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.