Reporting on CORE Conference Summer 2016
I attended this conference on Amelia Island Florida in July. The membership goal is to improve accessibility to and the quality of addiction treatment and to promote recovery solutions.
The conference is “structured as a forum to increase the collective understanding of the addiction recovery processes.” Participants are eager, in general, to improve addiction treatment outcomes by better integrating abstinence-based practices and Twelve-Step principles into therapeutic initiatives.
Four themes emerged during the four day event.
More often, meds are being delivered in a physician’s office, administered in many cases by the physician’s assistant. Atlanta has seen this trend with Adderall. Used to be, a psychologist or psychiatrist would diagnose ADD or ADHD and submit the treatment plan with a prescription. Nowadays, people can get a prescription, without the rigorous assessment that was required formerly. In the case of opioid addiction, many physician’s assistants are writing the treatment plan. And many are not necessarily trained to develop it. Doctors’ offices are focused on harm reduction, which is good. But do they understand the cravings? Do they understand how medication could actually threaten authentic sobriety? These were the sorts of questions and issues that were explored.
Suboxone is used as a detox agent, and it represents a $1.5 Billion market. Doctors wrote 9 million prescriptions last year. One expert stated, “And guess what? It’s harder to kick than heroin.” Insurance companies encourage its use, allegedly, because users don’t need to go into detox, which costs insurance companies money. Many experts rejected claims of its benefits, because “it undermines the brain’s ability to present as one’s authentic self.”
Without “full surrender to abstinence, people cannot engage in recovery and 12-step (programs) as their own, real, authentic selves,” said the CEO of a recovery program. Otherwise, claimed many experts, people trying to recover can remain isolated and addicted.
“Full surrender” to medication-free recovery made a suboxone prescription sound sketchy, at best. But there is no question that some specific co-occurring disorders warrant medication.
4. Pornography addiction is a big ugly taboo problem. It is impacting a lot of folks, particularly 12-16 year olds who watch online. It has serious implications for brain receptors, in terms of the stimulation, even compared to what certain drugs do to the brain. I don’t know anything more, but will keep you posted.
The many dedicated professionals were on hand at CORE who are committed to helping people recover and lead full and happy lives – they were nothing short of inspiring. I am so glad I was able to attend and learn more about what they do, how they help others. Want to learn more about CORE?
The Substance Abuse and Mental Services Administration (SAMHSA) is a remarkable organization dedicated to helping Americans, particularly recovery professionals and people in crisis, to better navigate substance abuse issues with better tools and information. It also performs research on programs and tracks and reports outcomes. This checklist is beneficial to any parent who is trying to make a decision about what comes next for their teen in crisis. Whether a parent is alone in this journey or working with a therapist, law enforcement office, or school counselor, the list is a dependable guide to understand quickly what one must look for in terms of support services.
When you are looking for a recovery program for your teen, here is a list of services that you should feel are required.
Figuring out what program, what approach, is right for your teen or young adult — is no easy decision and is best evaluated with a professional substance abuse counselor. NIH National Institute on Drug Abuse states, “Research studies on addiction treatment typically have classified programs into several general types or modalities. Treatment approaches and individual programs continue to evolve and diversify, and many programs today do not fit neatly into traditional drug addiction treatment classifications.”
Most, however, start with detoxification and medically managed withdrawal, often considered the first stage of treatment. Detoxification, the process by which the body clears itself of drugs, is designed to manage the acute and potentially dangerous physiological effects of stopping drug use. As stated previously, detoxification alone does not address the psychological, social, and behavioral problems associated with addiction and therefore does not typically produce lasting behavioral changes necessary for recovery. Detoxification should thus be followed by a formal assessment and referral to drug addiction treatment.
Because it is often accompanied by unpleasant and potentially fatal side effects stemming from withdrawal, detoxification is often managed with medications administered by a physician in an inpatient or outpatient setting; therefore, it is referred to as “medically managed withdrawal.” Medications are available to assist in the withdrawal from opioids, benzodiazepines, alcohol, nicotine, barbiturates, and other sedatives.”
NOTE: If your child does not need to detox, he still might need intensive residential treatment. So first assess the extent of the problem. People who need to detox can die if they skip that step. Here are some programs. For detail, visit this NIH link about different types of programs.
Long-term Residential Treatment programs provide care 24 hours a day, generally in non-hospital settings. The best-known residential treatment model is the therapeutic community (TC), with planned lengths of stay of between 6 and 12 months.
These programs provide intensive but relatively brief treatment based on a modified 12-step approach. These programs were originally designed to treat alcohol problems, but during the cocaine epidemic of the mid-1980s, many began to treat other types of substance use disorders. They consisted of a 3- to 6-week hospital-based inpatient treatment phase, followed by extended outpatient therapy and participation in a self-help group, such as AA.
These programs vary in the types and intensity of services offered. Such treatment costs less than residential or inpatient treatment and often is more suitable for people with jobs, school commitments, or extensive social supports. It should be noted, however, that low-intensity programs may offer little more than drug education.
Group counseling capitalizes on the social reinforcement offered by peer discussion and to help promote drug-free lifestyles. Research has shown that when group therapy either is offered in conjunction with individualized drug counseling or is formatted to reflect the principles of cognitive-behavioral therapy or contingency management, positive outcomes are achieved.
These programs are exactly what they sound like. Wilderness programs use wilderness expeditions for the purpose of therapeutic intervention. A range of programing exists, and the philosophy behind it is to use “experiential” outdoor education to create positive outcomes in the areas of self-concept and self-esteem, along with improved social behaviors in areas such as trust and mutual support. Many therapists I have encountered believe this is an “efficient” approach for teen and young adult males, relative to other options.
Insurance providers in general offer limited or no coverage for these programs. Even court ordered programs usually require an out-of-pocket spend.
There has been an incident with your loved one involving substance abuse. Quick – what are the first 5 steps you should take immediately?
If your teen is on your phone plan, then start monitoring their call, text and internet activity. Start a record to track habits and calls. Start exploring the best course of action. Now.
Law enforcement or Student Conduct might dictate the next step, giving you no choice regarding what to do next. Unfortunately, depending on the community or school, some teens will be forced to attend mandatory, often inadequate DUI schools, which in many cases feel so punitive, that they hardly inspire sobriety or improved behaviors. What’s more, law enforcement might also impose community service, which could add fuel to feelings of humiliation, particularly if it is a service that does not necessarily fit the transgression or the behavior.
Intensive out-patient programs (IOP), which combine therapy, group therapy, counseling and medicine dispensation, along with other programs are available. Look for details forthcoming. Here is a start, in the meantime.
12-Step Programs are communities whose members come from all walks of life. They share a set of guiding principles outlining a course of action for tackling problems including alcoholism, drug addiction and compulsion. Per Wikipedia, a 12 step program was originally proposed by Alcoholics Anonymous as a method of recovery from alcohol. The original Twelve Steps were first published in 1939; then they were adapted and became the foundation of other 12-step programs.
American Psychological Association summarized following as hallmarks of 12-step programs:
Many 12-step and AA meetings will group people by age segment (any by sex, and by newcomers versus longstanding members). A young teen or adult will probably hear about a circumstance much like their own if they get in a group that is more a reflection of them, as opposed to a group with lots of adults.
Here are a few characteristics of the program, which probably need to coincide with other programs or support:
www.al-anon.alateen.org for teens
www.alanon.org for parents
Atlanta has a big drug problem. So many programs exist for substance abusers. Where to begin is tricky, because each person’s problem is unique and different from another’s. Let’s start chronologically by age, with programs from young teens to young adults.
Psychology Today Magazine has a website where you can comb through numerous options and get a sense of not only what you might need, but also what might sound like a fit, after you have received an assessment. But on the left column, you can refine your search, quickly.
Wilderness programs for teens and young adults tend to jump-start the recovery and results process. For the most part, a teen needs to commit to such a program for at least 30 days, and while these programs are lauded for having quicker outcomes, some teens and young adults might need to stay up to three months. What’s more, insurance rarely pays for them, claiming they are “camps”, which is unfortunate. They carry a heavy cost, but many of the programs have scholarships and payment installments available.
While we are not endorsing Aspen Wilderness programs, their site provides a good explanation of what makes Wilderness popular. Some are located in Georgia and North Carolina. It is a good starting place, Click Here to learn more.
Substance Abuse and Mental Health Services Association (SAMHSA) has a good overview of what you need to be considering and keeping in mind as you get close to a decision.
Metro Atlanta Recovery Residences: gender specific programs and sober living environments that enable young adults to continue school or work. Scholarships are available, as well as male mentoring.
Kennesaw State University Center for Young Adult Addiction and Recovery – Focus is on the college student. Criteria are pretty demanding. Students need to be clean and sober for at least six months, have a certain GPA, and be willing to live in a sober community. Young adults who want to stay in college in a supportive community can find it here. But they must earn the privilege of participation with extended sobriety.
Talbot Recovery Center: 3 locations in Georgia and a free one hour assessment available.
For mental health issues such as depression, bi-polar and borderline personality disorders. Skyland Trail has a new Atlanta campus for young adults, as well. And they offer thorough assessments; but clients need to be 18 or older.
Treatment for substance abuse disorders, like every medical condition, should be tailored to the needs of the client. Basically there are a few distinct treatment paths, and for many people a combination of treatments is necessary. Here is a representative list:
These are just some substance abuse treatment options. You can consider live-in or drop-in programs that include counseling and some medical treatment. Group counseling offers the support of others who share a similar problem. Often, one-on-one counseling with a therapist or social worker is combined. Twelve-step programs such as Alcoholics Anonymous and Narcotics Anonymous offer free support through the recovery process.
If a problem requires medical care and counseling as a teen withdraws, consider a live-in treatment center for about 30 days. The days-only program might lead to devoting longer than a month toward recovery.
National Institute of Health recommends programs with therapy that promote:
Try to find a person who’s been through this situation, or a school, church, or other guidance counselor who can get you started on the right path to a selection. Most people who know that you are in crisis will be discreet and respect your privacy.
Substance abuse relapse doesn’t mean drug rehab was a waste of time or money, or that a teenager is a failure. Rather, experts now view relapse as a valuable learning experience that brings an adolescent one step closer to lasting recovery.
Stress can translate into higher rates of relapse. “When teens feel that life is out of control, they tend to fall back on old behaviors and coping strategies,” says Eric Belsterling, an adolescent therapist at Phoenix Outdoor Wilderness Rehab.
“Teens are already balancing school and relationship stress, media influences, and pressures to fit in and succeed,” Belsterling notes. “When you add worries about getting jobs and affording college in a difficult economy, a number of teens begin self-medicating their stresses with drugs and alcohol.”
Parents can support their teen in early recovery by taking the following steps:
Although teens in early recovery may have a vulnerable moment, substance abuse relapse treatment helps them get back on track before they make a full return to their old drug-abusing lifestyle. This non-profit help site, was created by by Dr. Steven Melemis, MD, Phd, and offers additional insight and suggestions to avoid relapse.
I didn’t write this, but I found it a while back and am searching for the author. It has been helpful to a number of friends, with thanks to countless professionals who care so deeply about our teens.
Teens in early recovery are extremely vulnerable to relapse. It can be hard to understand why a teenager would work so hard to achieve sobriety only to fall back into drug use−but that’s the power of addiction.
Studies suggest that between 50 to 90 percent of addicts relapse at least once in the first four years of sobriety, and most relapse many times. Triggers for relapse can be as mundane as hearing a certain song on the radio or as significant as hanging out with friends from the old drug crowd.
Although relapse is considered normal and predictable, knowing the common triggers for relapse and having an action plan can help teens and their families guard against any slip-ups. Here are a few common relapse triggers to watch out for:
Unless teens remain on guard, their thoughts will likely turn back to old behavior patterns when they are around the people or places associated with their past drug use. Old friends who still use drugs will use peer pressure, teasing and subtle manipulation to get a teen in early recovery to return to their “fun” old self. These friends may not be ready to confront their own drug use and will not respond positively to someone who questions their habit or forces them to take a look at their own behavior.
Each adolescent has their own set of high-risk friends, places and situations that they must sacrifice for the sake of their sobriety. In drug rehab, teens can practice ways to cope with those triggers, make new friends who don’t use drugs and find sober activities they can enjoy.
After maintaining their sobriety for a time, many teens want to “test” their willpower by going back to certain places or social situations. This can be risky and seldom makes teens feel more secure in their recovery.
While it’s risky to stay in touch with old friends who use drugs, it’s equally risky to be socially isolated. Teens in early recovery need to closely follow the relapse prevention plan they created during drug rehab. This plan likely includes attending 12-Step meetings and therapy sessions to get support from other people in recovery and to have someone they can go to when the urge to use arises. Without this support system, teens start to feel alone in their struggles, which may make them want to start using again.
Being around drugs of any kind can trigger a craving to use. Even the sight, smell or sounds associated with a drug can bring back memories of the way drugs made the teen feel, as well as an overwhelming desire to use again. Most teens in early recovery will need to get rid of all paraphernalia, photos or any other item related to drugs or alcohol in order to avoid temptation.
A common pitfall for teens is thinking they can use drugs, as long as they avoid what used to be their drug of choice. So if they were hooked on painkillers, they figure it’s safe to drink alcohol. The reality is that addiction to one drug easily transfers to another drug (and even other compulsive behaviors like video game addiction, gambling and spending). If a teen has abused drugs before, they will likely need to abstain from all mood-altering substances for the rest of their life.
Many teens first start using drugs to cope with stress brought on by school, relationships or home life. Although adolescents learn new coping skills in drug rehab, it is common to revert back to old methods when life gets tough.
Before drug rehab, when conflicts arose, drugs or alcohol would allow the teen to escape the situation. Now, the teen must practice new ways of coping, such as taking a walk, calling a friend, journaling or some other form of healthy expression.
Establishing a daily routine, including getting up at a certain time or joining a club that meets regularly, may help teens maintain a sense of control in their lives. While predictability can help, teens will eventually have to learn to accept that they cannot control everything.
Self-confidence and an optimistic outlook are protective factors against relapse, but over-confidence is one of the most common reasons for relapse. The 12-Step principles remind teens that humility and an admission of powerlessness over addiction are essential for lasting recovery. But after staying sober for a period of time, some teens are so proud of their accomplishments that they don’t think they need to follow their relapse prevention plan anymore. They stop attending meetings and become less vigilant in monitoring their emotions and cravings.
A close cousin to over-confidence is complacency. Some teens in early recovery start to take their sobriety for granted. They become complacent, assuming if they’ve been able to maintain their sobriety for a certain amount of time, they no longer need to monitor their mental state, attend meetings or follow their relapse prevention plan with the commitment they started with.
In many cases, teens begin to wonder if they can use only occasionally or have just one drink without returning to their addiction. They want to prove to family and friends that they no longer have a problem. Unfortunately, complacency often leads to relapse.
Addiction frequently goes hand in hand with mental illnesses such as depression and anxiety. Something that aggravates an underlying mental illness can also trigger the desire to use drugs or alcohol. Teens with co-occurring disorders require dual diagnosis treatment that addresses both their substance abuse and psychiatric illness. After formal treatment ends, they also need to carefully monitor their state of mind through journaling, therapy and other forms of self-reflection.
Physical illness is also problematic, particularly if a doctor prescribes painkillers or other drugs as a form of pain management. Teens who self-medicate a mental or physical illness may find themselves becoming dependent on drugs of relief. For this reason, self-care is essential. A healthy diet, exercise and adequate sleep will help guard against exhaustion and physical illness.
Though it may seem counter-intuitive, positive life events and emotions can also trigger relapse. For example, getting straight A’s, falling in love or getting into a good college could be cause for celebration and reignite the desire to use drugs.
If an adolescent spends time thinking obsessively about how it felt to be high or telling “war stories” to friends about past drug use, this is an indication that relapse is imminent.
Without drugs, many teens in recovery don’t know what to do with their free time. A bored teen is a teen who is asking for trouble. Drugs are exciting; there are other activities and hobbies that are equally thrilling without the high level of risk. Teens can get involved in rock climbing, white water rafting, or some other adventure sport. They can also keep busy with school activities, clubs, sports, exercise or hanging out with sober friends.
We all want life to go out way, but even the most fortunate among us won’t always get what we want. Many teens fall into the trap of self-pity; feeling impatient that recovery isn’t happening fast enough, wondering why they have to deal with addiction and rehab, and questioning why other people can go out for a drink with friends and they can’t. They begin to feel entitled to have a drink or use drugs because they’ve been sober and worked so hard.
Though it isn’t fair, this is the reality of addiction. It’s better to accept the good and bad life deals rather than feeling like a victim.
So you have found a program. And you are aware that it is time to pile in the car and get to an intensive outpatient center (IOP) or inpatient program. It’s time to get real answers, for your unique, specific crisis. Understanding what different programs offer is critical to knowing that your child or loved one will get the help that they really need. Here are some questions that will help you differentiate programs, along with suggestions for what else you should expect before sending someone you care about to an IOP.
It’s OK. A lot of recovery centers are for-profit. A lot are not. Many do not offer outcomes reporting or track for them. But they should be able to provide family references to contact.
Detailed learning for parents can be found at The American Academy of Adolescent Psychiatry website.
This site also has another great resource of questions to ask a program or facility which can be found at this link.