Therapists, counselors should recognize the signs and symptoms of substance use disorder

People trust their therapists or counselors with a variety of problems that arise in their lives. Typically, they share freely about these topics after establishing a supportive relationship with their therapist. However, a patient might also be struggling with a problem that they are less willing to talk about, which is their drug or alcohol use.

   It is important for counselors to be able to identify behaviors and symptoms that may point to the existence of a substance use disorder because these issues can be so damaging to a person’s life. Oftentimes, the problems that bring a person into therapy may be caused or worsened by their substance use and these issues cannot be fully resolved until the substance misuse is addressed.

   There are several reasons why a person may not be forthcoming about their drug or alcohol use. A person could simply be in denial or think they don’t have a problem. Sometimes a person will rationalize and compare themselves to others to justify their usage.  One might say, "well, I have a successful job and a loving family, so, I can't possibly have a drinking problem.” Or another may say, "I just use pills and I've never had an overdose, so, my usage isn't that bad.” 

   Another primary reason is that they fear the consequences of being honest about their usage. Consequences could include legal repercussions, the dissolution of their marriages or relationships, the removal of children from the home, or damage to their careers. In these cases, it is vital to review confidentiality laws with them to mitigate any fear that might be keeping them from being honest.

   Another reason that a person may conceal their drug and alcohol use is the stigma or “shame” of struggling with drug or alcohol use. Even though the medical community agrees that addiction is a disease and not a choice, a person going through addiction issues may still feel like they will face social judgment for getting help. One way to help a person work through this issue is to educate them about the disease concept of addiction and remind them that rehabs would not exist if people could address addiction problems on their own.

   So, what are some signs that therapists can look for in a person who may be struggling with substance use issues? Gateway Rehab uses a biopsychosocial assessment to identify impairments in functioning and to make substance use diagnoses. However, the most basic explanation is that substance use becomes a problem when it causes other problems in a person’s life. Other, subtler, indicators may include:

  • Changes in mood or persistent mood disturbance despite adherence to medication regimens
  • Loss of interest in activities or reliance on alcohol or drugs to be able to enjoy hobbies
  • Changes in performance at work or school
  • Cycles of illness that frequently include flu-like symptoms
  • Fear or anxiety when faced with the idea of “running out” of their drug of choice
  • Resistance to the suggestion of quitting the drug of choice

   Of course, this list is not all-inclusive and symptoms may be different for each type of substance. The reality is that substance use disorders fall along a spectrum of mild, moderate, and severe.  If a client meets only a few criteria for a substance use diagnosis, their usage is mild; their usage is moderate or severe if they meet additional criteria.  For example, a person who has multiple DUIs may have a mild substance use disorder.  On the other hand, a person who has a physical dependence on a substance, has lost jobs, is estranged from family, and/or has experienced overdoses, likely has a severe substance use disorder.

   Ultimately, what’s important is that counselors and therapists recognize the signs and symptoms of addiction so that they can assist their patients in getting the right type and/or level of treatment. If someone might have a substance use disorder, please encourage them to contact Gateway Rehab to schedule a complete drug and alcohol assessment.

 

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The role of medicine in early recovery

   Addiction is a chronic disease and, much like type I diabetes, hypertension and asthma, it is prone to relapse at staggering rates. In the past decade more than ever, addiction treatment centers and the field of medicine have been teaming up to develop the most effective ways to treat addiction and to prevent relapse. Following this trend, we have worked to incorporate medication-assisted treatment (MAT) into our well-established and evidence-based 12-step philosophy.

    In the midst of an opioid epidemic when many of our patients have been through numerous treatment centers, have tried 12-step recovery, residential treatment, and treatment programs offering only medication without success, we had to ask ourselves as treatment professionals, what can we do differently this time to improve the likelihood of our patients achieving long-lasting recovery.

    Our patients are unique individuals and are treated as such by an interdisciplinary team of professionals who understand their illness. Depending on the nature and course of each person’s disease, our team might suggest medication; however, medication is only a small piece of their suggested treatment plan. None of our patients are given medication unless as an adjunct to a holistic treatment plan that consists of therapy, group counseling, case management, and ongoing support. Medication is not and will never be a stand-alone treatment for the disease of addiction.

    We are aware there are varying opinions about MAT. Some believe a person is not “clean” when they are on medications, and others believe we are just trading one drug for another. One of our own therapists, named Joe, is a person in recovery himself and when he became a member of our MAT team he expressed some of these same thoughts and concerns. After five years working with us and seeing our process, Joe will tell you today that he understands our approach. He concedes that “the disease is getting worse and taking more lives than ever, and we have to use all the tools available to get people in treatment and help them stay there long enough to get better.”

    It is our belief that, regardless of medication type, a person will only get better if they engage in treatment and become active members in a 12-step program of recovery. Once a person develops enough positive support and has the skills needed to maintain long-term success and freedom in recovery, then they should no longer need the medication that only aided them to achieve that goal.

    While so much focus and debate can be placed on medications, it is our belief that the primary focus should be on the necessary changes a person must make in order to develop a healthy lifestyle of recovery. With or without medication, the same goal should hold true. Medication only serves to help those who need it to get through the toughest part of their recovery, the beginning, where so many people struggle.

    The path may need to be different for some, but the ultimate goal should be the same: to become free from active addiction and achieve health in body, mind and spirit.

 

Brandon D. Miller, LPCC-S, LICDC
MAT Program Specialist
Neil Kennedy Recovery Centers

Joseph P. Sitarik, D.O.
Medical Director
Neil Kennedy Recovery Centers

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The Roads to Recovery ... A Lifelong Process of Discovery Available to Us All

When first entering rehab, a lot of us think that we just have a drug or alcohol problem but we soon hear from others in recovery and realize that, “drugs or alcohol are only 10 percent of the problem, the rest is you.”

     Recovery from addiction involves the healing of all dimensions of ourselves, not only the physical but, also, the intellectual, emotional, social, vocational and spiritual dimensions of ourselves. Involving an improvement in self-awareness and self-image, we realize and accept gradually that recovery is a lifelong process of restoring ourselves to better health.

     But, while this may sound easy, recovery doesn’t happen overnight and for many of us, it is a tall order. As the Narcotics Anonymous Basic Text says: “This sounds like a big order and we can’t do it all at once. We didn’t become addicted in one day, so, remember, easy does it.”

     A simple comparison could be restoring one’s self to health to that of restoring an abandoned house to a livable condition, a process that definitely doesn’t happen overnight. It takes the right tools and resources. It takes time. It takes practice. It takes effort.

     Likewise, recovery takes patience, empathy, forgiveness and compassion. It takes honesty, open mindedness and willingness. It takes loving and accepting one’s self unconditionally. And, it takes dedication and perseverance – not giving up, no matter what, even if one stumbles and falls once, twice or even multiple times.

     Moreover, just like a house, which needs constant upkeep and maintenance, so does our recovery. Without constant attention, our recovery can stagnate and our foundation can crumble and collapse. In other words, “if you’re not working on your recovery, you’re working on a relapse.”

     But, while this process may seem daunting, we learn early in recovery that help and support are readily available.

     Our family and loved ones can be great supporters of our recovery, but sometimes they might not understand this lifelong process of recovery. So, in addition to family and loved ones, 12-step programs, such as Alcoholics Anonymous and Narcotics Anonymous, can provide a collective strength, encouragement and hope to those in recovery.

     By hearing and sharing life experiences with each other, recovering addicts and alcoholics can learn how to handle life on life’s terms without using. Additionally, 12-step programs provide the opportunity to build new and healthy relationships; to learn new and change behaviors through self-examination and the practice of guiding principles, and; to serve and help others in recovery.

     However, because we all came to a life of recovery differently, and all are unique in our own ways, recovery can never be quite the same for one another – no one way to recover is better than another. And, because it is lifelong requiring constant attention and maintenance, it’s not a race, nor do we ever graduate.

     Ultimately, recovery is a personal, lifelong journey of fulfillment and purpose – discovering a renewed sense of value, purpose and self-awareness. It is available to us all as long as we first have the humility and courage to ask for help, and then stay the course by being true to form – true to others and ourselves.

 

- Anonymous

 

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