Some people still say things like, “Addiction really isn’t a disease, because you guys don’t cure anybody!” Especially if the person is a healthcare professional, like a doctor or nurse, I reply to them with a question: “How many diabetics have you cured lately? How many patients with asthma have you cured recently? How many patients with high blood pressure have you cured recently?” The fact is that 90 percent of the work that doctors do involves the medical management of chronic illness. Diabetes is a chronic illness. High blood pressure is a chronic illness. Asthma is a chronic illness. For a lot of people, low back pain comes and goes and is a chronic illness. Headaches are a chronic illness. Arthritis is a chronic illness.
Most treatments in medicine today involve management of chronic illnesses. Sure, if somebody breaks his or her arm that’s an acute episode, and if somebody gets pneumonia he or she might require a hospital stay as well, so acute illnesses obviously occur. But the majority of what goes on in everyday medical practice is management of chronic illness.
I think diabetes is a wonderful model for addiction. Diabetes mellitus (sometimes called “sugar diabetes”) is a condition that occurs when the body can’t use glucose (a type of sugar) normally. Glucose is the main source of energy for the body’s cells. The levels of glucose in the blood are controlled by a hormone called insulin, which is made by the pancreas. Insulin helps glucose enter the cells as fuel, or food.
In diabetes, the pancreas does not make enough insulin (type 1 diabetes) or the body can’t respond normally to the insulin that is made (type 2 diabetes). This causes glucose levels in the blood to rise, leading to symptoms such as increased urination, extreme thirst, and unexplained weight loss. For people who don’t have enough insulin or can’t respond normally to insulin, the sugar in the blood stays very high because it can’t get into the cells to be metabolized (burned).
High blood sugar is toxic to many organs in the body. It’s toxic to the eyes and causes people to lose vision. It’s toxic to the blood vessels, people get heart disease, and can lose their feet to amputation because they don’t get proper blood circulation. They lose kidney function, they go into renal failure, and so on.
Type 2 diabetes is milder. People with this type may just have to take medication, increase their exercise, and adjust their diet. Type 1 is a more severe form of diabetes, which entails injecting insulin. But either way, if you have diabetes and take your insulin, take your medications, maintain your diet, do some modest to moderate exercise, and undergo what are termed “lifestyle changes,” you’ll probably go on to lead a normal, productive, and healthy life. If you don’t do those things and you remain in a state of denial and eat candy bars all day and rarely leave the couch, you’re at considerable risk of losing your vision, losing circulation to your feet, developing heart failure, and experiencing renal failure.
It’s the same with addiction. If you ignore your problem, maintain a state of denial, do not take your medications, and do not participate in treatment or support groups, you will progressively develop more and more serious adverse consequences, including a large number of medical complications, along with the potential for losing your life. On the other hand, if you acknowledge that you have a problem, take your prescribed medications, and make the necessary lifestyle changes, including support group participation, you stand a very good chance of living a normal, productive, and healthy life.
Here’s Dr. Solof’s “Two-step process,” framed for patients: Acknowledge you have a problem, and work with something outside yourself—professional resources, people, support programs, and a Higher Power, to help you do something about that problem. Of course it’s more complicated than that, but simply put, you have to stop using. You are no longer a person who can drink; you’re not a person who can use drugs. Sure, you’d like to go back to using alcohol or other drugs in some kind of controlled way, perhaps like some of your friends, but sorry, just like a diabetic would like to avoid the need for dietary restriction and insulin, this is no longer a viable option.
Some studies show that “just stopping” actually works for some people. There is a small subset of people who do just stop on their own. It’s called “spontaneous remission.” In most cases, however, it takes a “wake-up call”; often some sort of “spiritual event” to get them to stop using drugs. And by spiritual, I don’t necessarily mean a religious experience.
It could be that a person suddenly wakes up from an overdose or a car accident resulting from being impaired, with paramedics standing over him, while he’s on the gurney, and he’s close to death. Or she wakes up in the emergency room. Or his wife leaves, or she gets fired from her job, or something similarly traumatic. Something has thoroughly shaken them up. And that something is frequently enough to motivate people to rethink the course of their lives and look at their use of alcohol and other drugs more openly than perhaps they have ever been able to before.
Once people stop using, the challenge is to stay stopped, and for most that involves engaging in the process of recovery. Many people need a support or mutual-aid program to accomplish this. The most popular support groups for addiction are found in the various twelve-step programs. Twelve-step programs—Narcotics Anonymous (NA), Alcoholics Anonymous (AA), and others—are the longest-standing mutual-aid/support resources for people struggling with addiction, and represent a spiritual (as opposed to religious) approach that has helped millions of people achieve and maintain recovery.
However a spiritual approach to recovery doesn’t resonate for some people. Some people prefer Secular Organization for Sobriety (SOS), other people go to Self-Management and Recovery Training (SMART), while others go to LifeRing or Rational Recovery. Some women derive benefit from another group called Women for Sobriety (WFS). A number of support groups are available that help many people.
An important point to remember, if you yourself are in recovery, is that your role as a counselor is to help your client recover from addiction. Occasionally, counselors in their own recovery experience some confusion between their role as professionals and their personal recovery. There is the potential for these roles to bleed into each other, but it is critical to maintain the boundaries between them. Counseling is always about the client and his or her individual needs. Remember that everyone is different. Perhaps for you, abstinence-based treatment and twelve-step-oriented recovery has been a great fit, but for your client it may be different.
You have to work with your client as an individual. Certain clients may be better off with Suboxone or methadone maintenance, or maybe they are extremely uncomfortable with the central role of a Higher Power in twelve-step programs, and an SOS support group would be a better fit for them. There are a lot of treatment programs that are twelve-step-oriented, but you can’t tell clients that “it’s either twelve-step participation or nothing,” because it’s not the only answer—and if you think it is, you’re in the wrong profession.
You’re going to read a lot more about this later in the book but for now, keep in mind that if you are going to be an effective counselor or therapist in this field, you need to be aware of all treatment and recovery-support options: those that are twelve-step-oriented as well other support groups, in addition to all the new medications for addiction that are coming out every day.
Twelve-step programs began with Alcoholics Anonymous in 1935 and expanded with Narcotics Anonymous in 1953. Since then there has been a proliferation of other twelve-step programs that relate to various manifestations of addiction and to other areas, including but certainly not limited to Cocaine Anonymous, Crystal Meth Anonymous, Nicotine Anonymous, Gamblers Anonymous, Neurotics Anonymous, etc. There are also multiple subgroups within some twelve-step programs. For example, in AA there is a group for lawyers, called the Other Bar; a group for airline pilots called Birds of a Feather; one for physicians called Caduceus; and one for police officers called Peace Officers Fellowship.
There are many different potential