January 4, 2013
‘What can you do if an addict isn’t ready to give up using drugs and alcohol?’
BILL: Dave, did you see that Scott Sterling, son of L.A. Clippers owner, Donald Sterling was found dead alone in his apartment right after New Years Eve?
DR. DAVE: I understand he had a history involving drugs. At any rate, the coroner’s office believes he died of an “apparent drug overdose.”
BILL: It wasn’t the first time I’ve read of someone OD-ing on Christmas, a birthday or like Scott Sterling, on New Years Eve. “Significant dates can indeed very difficult for addicts,” says Dr. Damon Raskin, Cliffside Malibu Treatment Center. “The addict will often use the day as an artificial marker to stop using. This is just a set up for failure and relapse since they haven’t done the necessary psychological work that is required to really quit for good.” Dave, how would you describe that “getting ready to quit” process?
DR. DAVE: In the early days of addiction treatment, the steps in the recovery process were “admitting you had a problem, Accepting the full therapy for recovery, and then Surrendering to the fact that it was a life long process; or the stages of Admission, Acceptance and Surrender.”
BILL: So, unless the addict admitted he had a problem, there was really no starting point for treatment?
DR. DAVE: Exactly the problem Bill. But, the addiction treatment process of the last 10 years has found another stage we can address to get the addict to admission–it is called the Contemplation Stage. If we can get the addict talking and thinking about his use, then we have a bridge to admission.
BILL: It seems to a non-professional like me that this whole “contemplation” process might be saying to my fellow addicts who are still using that “It’s not that bad, you can take your time deciding on whether to stop.” If you believe Amy Winehouse’s father, she was mixing Librium with her booze and died of an OD mixture of both while “contemplating” away.
DR. DAVE: If you are making the point that half-hearted efforts to quit can add to the fatal nature of the disease of addiction, you won’t get any argument with me. In fact, many credible relapse researchers believe there is something called the Abstinence Violation Effect–or A.V.E. for short. If an addict just lets her craving build and build, without reducing the emotional toxicity behind it, when the relapse occurs, the combination of guilt and craving can send the addict off into a binge of even more excessive use than before.
BILL: Another important idea, says Dr. Raskin is that “if an addict stops using for a week or two, and then goes back to using the same dose of drugs they were using before they stopped, they may have lost tolerance to the drug which makes it much easier to overdose.”
DR. DAVE: With all three of us having made the point that anything that delays the addict’s quitting will bring them closer to that fatal overdose, still, we desperately need additional research on how to turn the “contemplation stage” into a bridge to recovery….
BILL: ..including reminding our readers, along with Don Sterling and NFL coach Andy Reid who lost his son to overdose addiction in 2012, that one proven strategy to “cross the bridge” is to enlist a professional from this national list of Intervention Specialists. But Doc, I can’t help but be concerned about the many therapists and counselors who are not specialists but are trying to get their addicted patients who are in the Contemplation stage into addiction treatment.
DR. DAVE: I assume you mean the ones that have ethically confronted the addict, with compassion, and explained they need help and standard addiction treatment has been rejected? I have real ethical concerns about the health practitioners dispensing drugs that might hasten an OD, or the therapist who goes along with the addict’s pretense that addiction is simply a byproduct of depression or anxiety that should be treated INSTEAD of the drug use.
BILL: Of course! I know there has been a whole language game of therapy to avoid the elephant of addiction in the room…my personal favorite is someone tossing out the phrase they are doing “harm reduction” by addressing virtually any other problem than the addiction!
DR. DAVE: The one proven strategy, outside of Intervention, that has been shown to be effective in the Contemplation Stage is what is called Motivational Interviewing.
BILL: That’s what you were teaching the health personnel in the Scripps Emergency Rooms of San Diego County and the physicians dealing with drug using teens in Juneau Alaska?
DR. DAVE: Exactly, it’s a way of talking to addicts that move them farther out of denial and towards an internal motivation for admitting they need treatment. The National Institute of Health has actually taken the research and turned it into very readable strategies and methods that both family members and therapists have found useful. So many parents and spouses have found it helped them that I would recommend it to anyone working with or living with an untreated addict
