July 28, 2011
When Rehab Is a Revolving Door
The death of Amy Winehouse has left many people asking why she didn’t get more help for the fierce addictions that plagued her short and troubled life. She did in fact say “yes, yes, yes” to drug rehabilitation on numerous occasions. Unfortunately, rehab proved to be a revolving door that never led the 27-year-old singer to the right place.
Winehouse was certainly not alone in her high-profile on-again, off-again battle against long-term substance abuse. From Lindsay Lohan to Robert Downey, Jr., it seems that Hollywood types are constantly checking in and out of treatment centers. But requiring multiple attempts to beat an addiction is not just a star phenomenon — it happens to many ordinary addicts too.
Just How Common Is Addiction Relapse?
There are no reliable statistics on the average number of recovery attempts it takes to beat a drug or alcohol problem. Part of the problem with pinning down hard numbers on recovery is that many rehab programs don’t track their graduates after release, so they have no way of providing estimates. For example, Promises Treatment Centers in Malibu, Calif., which admits about 400 people a year at a cost of up to $55,000 a month out of pocket, says they have a recovery rate of nearly 70 percent. But the center has only recently begun following up with clients after they finish the program — and even then, only for about three months.
David Sack, MD, the chief executive officer of Promises, says that multiple trips to rehab are the norm. “About half of our patients have been through in-house treatment at least one or two times before, and many of our first timers have had a good deal of outpatient treatment before coming as well,” he says.
Joe Shrand, MD, medical director of the Castle Adolescent Rehabilitation Unit at the High Point Treatment Center in Brockton, Mass., estimates that at least 30 percent of his patients go through rehab more than once. Yet he’s quick to emphasize this doesn’t mean that rehab is a waste of time.
“The fact that relapse is more common than uncommon just shows how difficult it is to break addiction. Getting professional help is often your best hope of taking control despite the fact that it can take more than once to get it right,” Dr. Shrand says.
About 23.5 million Americans sought treatment for drug or alcohol abuse in 2009; of these, 11 percent (2.6 million) received it at special rehab facilities, according to a recent survey from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). According to SAMHSA, about 23 percent of those in publicly funded substance abuse programs sought treatment for alcohol abuse only; about 18 percent sought help for abuse of alcohol and other drugs; about 17 percent were trying to curtail pot smoking; about 40 percent wanted to kick another drug habit, including heroin, cocaine, and opiates, among others.
Why Is Addiction So Hard to Break?
Shrand points out that no one enters rehab intending to fail. “Everyone goes in hoping in their heart of hearts they can stop for good,” he says. “But addiction doesn’t happen in the heart. It happens in the brain.”
As Shrand describes it, a chemically dependent brain is like a deeply ingrained neurological super highway with few off ramps. Studies show that drugs and alcohol alter the brain’s normal chemistry, elevating activity in pleasure and reward centers, and reducing inhibition so that a person develops an overwhelming craving for their substance of choice. Drug use on a chronic, long-term basis can cause either permanent changes in the brain or alterations that may take hours, days, months, and even years, to reverse once a person stops using the drug.
And addicts face numerous other obstacles beyond brain chemistry. They often underestimate how challenging it is to stay clean, especially if it’s their first attempt to sober up. Many have alienated their friend and family support systems along the way and believe they have few places left to turn. Or, like Winehouse, they continue to expose themselves to an unhealthy environment and friends who may be enabling their old ways.
A new report from Columbia University’s National Center on Addiction and Substance Abuse (CASA) crystallizes just how challenging it is to break the bonds of addiction. If someone begins their journey into drug or alcohol dependency after the age of 21, they have a one in 25 chance of remaining addicted for life. Those whose addictions start before the age of 18 fare even worse: They have a staggering one in four chance of developing a lifelong dependency.
What It Takes to Get Clean For Good
Though the odds seem stacked against long-term sobriety, professionals who treat addiction say that with commitment and the right circumstances, it’s possible that even someone who seems to be far gone can achieve it.
“There’s some evidence that rehab is progressive. Treatment is certainly not a quick fix but it can make a real difference. Even if someone backslides several times and isn’t able to quit using completely there’s a good chance things won’t be as bad as they were before they’ve gone through rehab,” Dr. Sack notes.
Shrand adds that his years of experience treating addiction have shown him that the following seven basic guidelines can increase the chances for a successful recovery:
- Start safely. A period of detox is frequently the first step in many rehab approaches. Weaning off of substances like alcohol and opiates should be done in a medical setting because withdrawal symptoms can sometimes be life threatening.
- Seek lots of support. It’s important for a recovering addict to cultivate as many healthy, caring relationships as possible. If a loved one is trying to break an addiction, being there for them to lean on can considerably increase their success. Encourage a recovering addict to join a support group locally or online so he has plenty of people to lean on when the going gets rough.
- Choose right. Find a program that uses health professionals who are board certified to treat addiction. Psychiatrists, psychologists, physicians, and social workers can all be certified to work specifically with substance abusers.
- Address everything. According to Sack, up to 40 percent of addicts suffer from depression too. Also dealing with underlying mental health issues that can contribute to addiction — or that result from it — will go a long way toward preventing relapse.
- Avoid triggers. This is especially important for people fresh out of rehab who may not yet have the coping skills to resist temptation.
- Manage expectations. Shrand explains that recovery involves being humble and realistic about how much work is ahead of you. While it’s important to forgive yourself for all that has happened, it’s equally important to take responsibility for your actions.
- Be vigilant. Addicts must understand that recovery is a lifelong battle. By all accounts, the first year is the hardest, but many people struggle with cravings and temptation for the rest of their lives. Far from proving that rehab is a failure, this constant struggle underscores the potent power of addiction — and the importance of working hard to get and stay clean.
