Reentry Central would like to thank David H. Kerr for sharing the following with us.
The Chronic Nature of Addiction Sheds Light on the Appropriate Treatment and Recovery Protocol
The close trusting long-term professional relationship developed between coach and recovering person is critical and often the best addiction relapse preventer.
By David H. Kerr January 14, 2016
According to a study from the National Library of Medicine, National Institutes of Health, Addiction Science and Clinical Practice, December 4, 2007, p45-55, addiction is a chronic condition. Its chronicity provides some clear indicators that short treatment or interventions, from two weeks to two years, must be extended to meet the long-term needs of the addict. Here are two brief paragraphs taken from the Addendum below. One is from the Abstract and the other from the Conclusion (see the complete article below in the Addendum
“This article reviews progress in adapting addiction treatment to respond more fully to the chronic nature of most patients’ problems. After reviewing evidence that the natural history of addiction involves recurrent cycles of relapse and recovery, we discuss emerging approaches to recovery management, including techniques for improving the continuity of care, monitoring during periods of abstinence, and early reintervention; recent developments in the field related to self-management, mutual aid, and other recovery supports; and system-level interventions. We also address the importance of adjusting treatment funding and organizational structures to better meet the needs of individuals with a chronic disease.”
“The growing body of empirical evidence demonstrating the chronicity of SUDs, coupled with increasing awareness among various stakeholders about the need for change, represents genuine progress. Formal and informal efforts to address the problems continue to expand; it is hoped that this enhanced awareness will lead to increased dialogue and action among the numerous stakeholders to improve the treatment and long-term management of chronic SUDs.”
We should not continue policies and funding that only support short term “treatment and release” programs, or what I call the T&R mentality. In fact the government and private funding cycles for long-term treatment and recovery programs continue to shrink so that the public view of treating addiction is closer to two to four weeks! Two to four weeks to treat a chronic lifelong disease! Try that for diabetes.
To add to the confusion, addiction is not treatable in the traditional counselor/client paradigm. The day-to-day “insulin” that an addict in recovery needs is regular support and human contact and concern. The long-term relationship built between coach and recovering person is critical!
My experience with addicts goes back to the 1960’s and points directly to the addict for understanding, accepting, internalizing and initiating his/her own plan of recovery. The first and final piece of wisdom spoken by the addict must be this: “I am an addict and I need to seek help. Once I find it and learn more about my disease I will know that I alone have the responsibility to work on it and to move into recovery with the support, mentoring and guidance of others.” The most influential mentor to the newly recovering addict is often another addict with long-term clean and sober recovery lifestyle experience.
Faith leaders, trained professionals and others in long-term recovery can only point to the road to recovery though. When engaged with an addict in recovery the counselor should ask “what have you done and what have you accomplished towards your recovery since we last met? What self-set goals have you created? Is your daily account (journal) of efforts to remain in recovery up to date?” Most of the tens of thousands of addicts whom I have met have tremendous capability, talent and above average intelligence. Their strengths are deeply buried though as they move from one counselor to another, jail to jail, detox to treatment, they learn about their problems and disorders. Soon they are a believer. They learn that they are “flawed,” often with a mental health label, and they are not to forget it! But do they have anything going for themselves on the positive side?
My experience shows that this is the wrong way to start a helpful/coaching relationship with a needy recovering person. This is often the “flawed” approach: “Here’s what’s wrong with you. Do you agree? Good, now we’re on the same page. Let’s find some treatment for you.” Addicts that I have met are disarmed when I tell them to stop the self-defacing ranting about their past failures. “Give me some strengths.” Wow. What a different conversation it becomes starting with a long period of silence while they try to figure out even one strength they possess. Finally they say without much authority, “well I have a wife and two children.” They quickly follow saying “but I haven’t been good to the kids. My work is sporadic and I can’t go to all my son’s soccer games.” Then he follows that “my wife and I have different interests so we don’t have much to talk about.” I ask, “do you both read the paper?” “Yea and we sometimes talk about the news from the paper or the TV.” Do you ever ask “how was your day?” “Sure and allot of times her answer is ‘miserable.’” Sometimes I do follow up though with some questions and she may start talking to me.” …and on and on it goes.
Imagine that one or both of these hypothetical husband and wife are in recovery and yet they tend to pick on each other’s faults and soon that typical hurtful behavior or attitude emerges as a regular conversation topic. People without addiction experience don’t thrive on continued reminders of their faults any more than do recovering addicts. I can tell you with a fair degree of assurance that this type of fault picking will eventually destroy recovery. But it goes further. Those who are clean and sober and wanting to stay that way are often reminded of their faults by the trained guy trying to help them to stay clean and sober! The idea behind this is to try to prevent that all so common framework of “denial.” Does the counselor understand that the addict seeking help knows much about himself? He knows he’s an addict but he needs to know why and how to stop the drugs and alcohol lifestyle.
Just because the addict has abused drugs and alcohol for 20 years doesn’t mean he is stupid. As a matter of fact, studies have shown the addict to have above average intelligence. What the addict doesn’t usually grasp is that he is the only person who can help himself. He can listen to “the melodic music of recovery” from others as well as the platitudes about what to do, offered by his counselor. The fact is that the addict seeking recovery must look in the mirror to find truth. “Who have I become and why do I do things that slowly destroy me while hurting those who love me.” Learning the truth about yourself is a precious strength and must be the beginning of lasting recovery. But it’s only words and action is now required. “You know what to do” I say and he nods his head. “So what will you do says I?”
He makes some practical suggestions for starters and I say “ok sounds good. Do it and record it in your daily record or journal. Come back in a few days and share with me what you’ve done, or if you like we can Skype.”
The addict in recovery needs recognition and support for solid daily accomplishments and I’ve found that a journal is a good idea. The Journal is visible evidence of accomplishment but should include all activities including relapse if that occurs.
Both counselor and client should be well aware of the long-term nature of the disease of addiction. Residential detox and treatment are often an essential starting point for the long-term recovery process. This will help the recovering person begin again, learning and practicing new habits and ways of positive thinking and living. However, we’re not done yet.
Most recovering people with their new drug free lifestyle need continued encouragement and coaching for several years following treatment.
The coaching should be done by those with experience and understanding and some of the best coaches will be long-term recovering people.
The close trusting professional relationship developed between coach and recovering person is critical and often the best relapse preventer.
The full article “Managing Addiction as a Chronic Condition”
can be found here.
David H. Kerr founded Newark, N.J-based Integrity House in the late 1960s. After retiring from Integrity House in 2012, Kerr went on to become the Founder and CEO at Recovery Advisory Group. He may be contacted at firstname.lastname@example.org