An Intimate Perspective on Addiction Recovery & Treatment

At earlier stages of addiction, treating an emerging addiction tends to be easier, less costly, and less disruptive, at later stages when severe adverse effects on major life areas are manifest, more intensive treatment is required. It’s similar to taking care of a serious infection— painful, but necessary to facilitate healing and a return to health. Suppose you get a small cut on your arm that for whatever reason was not disinfected with soap and treated with antibiotic ointment. The cut is no big deal and nothing to be concerned about in and of itself. However, because its proper care was neglected, it then becomes infected. The infection spreads so gradually that its existence and progression may not even be noticed. However, over time the cut becomes discolored, inflamed, and increasingly painful. You begin to feel weak and feverish as the effects start to impair other aspects of your health. At this point, the infection needs professional medical attention, probably treatment as an outpatient in a doctor’s office. If you continue to deny and minimize the infection’s significance and avoid seeking treatment, it will continue to worsen, as the surrounding tissue becomes necrotic. Now, much more intensive medical intervention is required. Without it, gangrene may set in, necessitating amputation and potentially placing your life at risk. At that point, the infection must be effectively cut out through surgery, the entire area scraped clean and then treated with intravenous antibiotics. This process is costly, inconvenient, and painful. But without it, the infection will continue to progress, making recovery less possible, and premature death more likely. Inpatient treatment creates an incredibly intense environment. When it works well it provides a therapeutic milieu—a group setting that combines elements of support, structure, repetition, and consistent expectations to produce a physically and emotionally safe and trusting environment. Such an environment can expedite healing in several ways. It gives clients respite from the demands and stresses of their daily lives, providing a concentrated opportunity to focus on getting better. Clients feel comfortable enough to take the healthy risks of discussing deeply held secrets and experiment with healthy behavioral changes. By exposing clients to each other’s struggles, the milieu also facilitates mutual support and identification. This can help build connection, compassion, empathy, and understanding; reduce feelings of isolation; and generate new ideas and potential solutions regarding the challenges that brought them to treatment. The other side of this coin is the increased levels of stress, anxiety, and upset that are commonplace when clients receive treatment in the same physical space where they reside twenty-four/seven, fenced in by an independence-inhibiting structure with foreign rules and expectations. The interpersonal dynamics and interactions between staff and clients, and among clients, are often highly emotionally charged. Factor in clients who are steeped in the drama and trauma of active addiction, all of whom are either going through detox or are just out of it, when they are at their most raw and vulnerable, in addition to some who are struggling with co-occurring physical and/or psychiatric challenges, and the environment can easily become superheated. To say that addicts struggle with delaying gratification should be an obvious understatement. We generally don’t respond well to not getting what we want when we want it. From a personality perspective, we are typically rebellious and oppositional; uninterested in adhering to rules and other social conventions, believing them to apply to other people rather than to ourselves. Disrespect for rules/laws ranges from the extremely serious to the minor who-really-cares variety. Not surprisingly, many people have difficulty following the numerous rules inherent to inpatient treatment. Some people end up leaving treatment prematurely against medical advice (AMA). Others find themselves administratively discharged for violating red-line rules, such as bringing drugs on-site, physically fighting with other clients, becoming aggressive or threatening toward staff, or having sex with another client. Behavior that compromises the physical or emotional safety of the environment threatens the therapeutic value of treatment for everyone who shares that environment and disrupts the recovery process. Recovery creates the potential to regain many of the important things that are lost during active addiction. However, there is one loss that the recovery process requires without exception—the loss of the substances upon which addicts have depended so much for so long. Even if one has reasonably healthy primary relationships, substances become a best friend, a lover, close confidante, and constant companion. For many people, active addiction was the most (in some cases, the only) intimate relationship they had. This particular loss tends to be under-recognized and grossly underappreciated—by those entering recovery in addition to those around them, and sometimes even by treatment professionals. Most people assume an attitude along the lines of “Good riddance! You’re so much better off without that stuff. Now you can get your life together.” What is typically missed or minimized is the reality that this is a huge and painful loss, one that leaves a gaping hole in the lives of most addicts. Grief is a natural emotional state attached to loss. The conscious and unconscious suffering intrinsic to unresolved grief can contribute to both active addiction and chronic pain. Healing from grief involves mourning the loss to reach an acceptance of it. Mourning is a process of saying good-bye to, and letting go of, that which we have lost. Mourning and healing from grief is a process of regaining balance that takes time (months to years generally) and is different for each individual. This healing process requires that we allow ourselves to fully feel all the uncomfortable, painful emotions that are part and parcel of saying good-bye to and letting go of people and things that have been important in our lives, but are no longer available to us. Achieving acceptance of a significant loss does not mean that there will no longer be distress related to it. Losses that are fully accepted can still be painful, but they no longer create emotional imbalances that hinder health and healing. Much like a physical injury that has healed, there may always be a scar. Yet, the greatest emotional pain comes not from making meaningful life changes, but from mobilizing and maintaining resistance to such changes. As the Tao Te Ching states in Verse 23: “If you open yourself to loss, you are at one with loss and you can accept it completely.” This blog post is an excerpt from Some Assembly Required – A Balanced Approach to Recovery from Addiction and Chronic Pain by By Dan Mager, MSW; Published by Central Recovery Press (CRP).