Guest blogger and long-time Council friend, Bob W. presents Part 64 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.
In the 1999
movie, The Matrix, a group of rebels are fighting a desperate
war against a machine that has enslaved humanity in a sophisticated virtual
reality system. Laurence Fishburne is Morpheus, the leader of the rebels,
and he has recruited Neo, played by Keanu Reeves and Trinity, played by
Carrie-Anne Moss as his archetypal warriors.
The operatives of The Matrix have been unbeatable, led by Agent Smith,
played by Hugo Weaving, such that most rebel warriors have little chance in
head-to-head battles with the machine.
But Neo and Trinity have developed and honed their skills. A
series of confrontations toward the end of the movie have Neo and Trinity
performing incredible athletic feats to avoiding being hit by a barrage of
bullets and simultaneously firing back in explosive bursts. In one scene, Neo contorts his body to
impossible extremes as the bullets fly by in slow motion.
A friend of mine, in a meeting one day, commented on this
scene as reminiscent, to him, of how, in our continuing growth in recovery, we
learn such adroitness, we develop evasive moves to avoid letting the pitfalls
of life destroy us as they once had.
What a spectacular vision it created for me. How often in our diseased states and even in
early sobriety did we let everyday mishaps and normal challenges penetrate our
fragile exterior and drive us to difficult ends.
Some of us, like me, may have reacted to minor mishaps with
near explosive rage. Maybe family
members pushed long-set psychic buttons with idle remarks; maybe a friend or
acquaintance made a snide comment that stirred some long forgotten pain; or
maybe some external unrelated event had a similar effect.
Our recovery demands that we learn to deal with these
events. As we work the program with
sponsors and with fellow recovering heroes we learn to let these events, these
triggers, to slide off or around us much as Neo dodged the Matrix’s
bullets. The image is powerful…we just
need to learn the intricate evasive moves for ourselves, using the tools we
hear over and over again from all our Fellows.
A road map to recovery options for those struggling with addiction
By Lori Fiester, Clinical Director for the Center for Recovering Families at The Council on Recovery
While the Council on Recovery is a known place to start when looking for help with alcohol or drug abuse, the average person who struggles with substance use issues does not know what is involved in treatment, much less recovery. It does not simply begin with the desire to do things differently…
Many people begin with decreasing their use of the identified substance, or stop completely. While some can be successful with either measure, most who have abused substances for a long period of time have withdrawal symptoms. Those who have heavily used or have a genetic predisposition need more assistance. Millions of people have a crossed the doorway to 12-step meetings, have a sponsor and have worked the steps and been successful. And then there are those who need more support.
When thinking about treatment, it’s important that the client be served in the least restrictive environment, but safety has to be the priority. The least restrictive measure involves individual therapy/counseling. This modality can work but it needs to be supplemented with regular 12-step group attendance, utilizing sponsorship and working the steps.
The next level of care is Intensive Outpatient Program (IOP). This type of program offers approximately 10 hours of treatment to the individual that includes individual and group therapy, psychoeducation, and skills group, spread out between three to four days a week. This allows the person to work and sleep at home, but a good portion of their time is dedicated to therapy. Most IOP’s last six to eight weeks.
Partial Hospitalization (PHP) is the next level in care. This option consists of being treated for up to five hours a day for five days, and then going home early evening. This service includes much of what IOP does, but is even more intense, adding five to ten hours per week, and can last several weeks.
Residential care is when the person enters a hospital-type setting in which they have about 20 hours of dedicated treatment services. They can stay there anywhere from 28 to 90 days. Many people who enter this type of care often need detoxification, which includes medical stabilization and a doctor to oversee the person’s withdrawal from the substance.
There are many avenues to consider when thinking about getting sober. The Council can help with an assessment that can diagnose and give recommendations of what to do next. The continuum of care has many opportunities for someone to stay sober. Research indicates that the longer a person is in treatment services, the less risk they have for relapse. If you or anyone you know is in need to start their journey to recovery today, start here – (713) 914-0556.
This guest post is written by Kierstin Collins, Clinical Manager of Children and Adolescent Services at The Council
Earlier this month, Sesame Workshop, the nonprofit educational organization behind Sesame Street, broadcast an initiative to support children and families affected by parental addiction. The newest Muppet to join the Sesame Street group, Karli, is featured in the initiative, whose mom is dealing with addiction. In the new content released, long time characters like Elmo and Abby Cadabby learn what Karli is experiencing and help support her. Resources released through the Sesame Street in Communities program, including videos, articles, and activities, broadcast the words children need to hear most: “You are not alone. You will be taken care of. Addiction is a sickness and, as with any sickness, people need help to get better.” And most importantly: “It’s not your fault.”
In a press release this month Sesame Workshop, shared the motivation behind their efforts saying, “In the United States, there are 5.7 million children under age 11, or one in eight children, living in households with a parent who has a substance abuse disorder—a number that doesn’t include the countless children not living with a parent due to separation or divorce, incarceration, or death as a result of their addiction. One in three of these children will enter foster care due to parental addiction, a number that has grown by more than 50% in the past decade. The trauma of parental addiction can have lasting impacts on a child’s health and wellbeing, but children can be incredibly resilient; the effects of traumatic experiences can be mitigated with the right support from caring adults like the parents, caregivers, and providers this initiative targets.”
The Council on Recovery recognizes that Houston is not immune
to these jarring statistics and aims to meet the needs of this special
population. The Council has a long history of educating the community about the
disease of addiction to break down the stigma and misunderstanding around this
complicated family problem.
With the understanding that addiction is a family disease,
The Council addresses all those who are touched by addiction, including youth
who are at high risk of developing a substance use problem. Children from
families of addiction are more likely to use and use problematically at a young
age due to both genetic and environmental factors. To address this cycle of
addiction, The Council provides services tailored to the developmental needs of
youth. In the Kids Camp at The Council program, kids age 7 to 12 participate in
three days of games, activities, and group work to gain education, prevention,
and support. Kids in the program learn through their experience that addiction
is not their fault, they are not alone, their job is to be a kid, and how to
take care of themselves. Parents work alongside children to learn
age-appropriate language around addiction and how to communicate about hard
feelings, problems, and secrets.
As the rate of substance abuse grows in our community, the population of children who are impacted grows alongside it. You know a child who needs us. To interrupt the cycle of addiction and provide hope in the face of addiction, call 713-914-0556 or visit us online at councilonrecovery.org where you can learn more about Kids Camp and other youth services offered at The Council.
This guest post is written and graciously shared by Janel, a grateful client who found recovery through The Council
Seven years ago I was trapped living a nightmare with no way out. My addiction took me to the darkest place imaginable. I was literally battling for my soul. I could not stop using. I eventually gave up and tried to take my own life. It was the only way I thought I could find peace. Waking up in Ben Taub’s ICU after my liver shut down, I realized that God had another plan for me. I had been given a second chance at life.
Forced to seek help, The Council on Recovery started me on
my new journey. They found me a bed at a treatment center where I spent almost
3 months coming out of my fog of addiction. While there I met one of The
Council’s recovery coaches who told me about a longer term treatment program,
where I spent fifteen additional months. During that time, I learned so much
about myself and how to overcome my addiction. I learned how to be a lady and
live life with a purpose. I would not be where I am today if it hadn’t been for
The Council guiding me in the right direction. Their resources are what saved
my life. The work they do in the recovery community is vital. Most addicts
don’t know how to stop. They do not know how to get help. That’s what The
Council is for.
Last year I found a way to give back and help The Council. I
used my story and my first-ever marathon to help raise more than $3,000 for
this powerful organization. The marathon was about pushing myself to do
something I once saw as impossible. It was meant to inspire others and – of
course – bring as much attention to The Council as possible.
People need to know there is a solution. They need to know where to reach out when they are ready. I am living proof that recovery is possible. Today, I am 7 years clean and sober and I am a productive member of society. I have put myself through school, received my Bachelors degree in Human Services, and now manage a successful staffing agency. I have run a marathon and am now training for my first Ironman. Seven years ago my addiction almost killed me, but today I live free with no limits to be and do whatever I want to. And it all began at The Council. They showed me how to break the chains that bound me. They gave me hope.
The following article was recently published on the research page of the Recovery Research Institute website. It reports that abstinence from alcohol and other drugs is commonly perceived as a defining feature of recovery and has been widely used as a marker by which to evaluate the success of substance use disorder (SUD) treatment. Efforts have been made to define recovery more broadly by incorporating indices of functioning and well-being, but even within such broader definitions, achieving abstinence (as opposed to drinking at low-risk levels) is noted as an important milestone. This research presents three-year outcomes of persons who participated in outpatient treatment for alcohol use disorder, where treatment outcomes are defined in terms of both alcohol use and functioning.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
A focus on abstinence in defining recovery from an alcohol or other substance use problem has a long history in the field of addiction. More recently, however, efforts have been made to broaden the definition of recovery so as to align more closely with the variety of actions one can take toward health and wellness for those with substance use disorder. This broadening of the definition has largely focused on incorporating indices of functioning and well-being, which, of course, are of great relevance to individuals with SUD, both inside and outside the treatment context. When it comes to substance use, however, most definitions of recovery continue to focus on abstinence rather than also considering drinking patterns that do not result in a re-occurrence of substance use disorder symptoms or other harms. Clinically as well, patients are often advised to choose abstinence as their treatment goal. Increasingly, however, it is being questioned if abstinence is a necessary treatment goal for all persons with substance use disorder. To shed further light on this issue, Witkiewitz and colleagues looked at the outcomes of 806 alcohol use disorder outpatients over the course of three years after they started alcohol use disorder outpatient treatment.
HOW WAS THIS STUDY CONDUCTED?
This study was a secondary data analysis of the well-characterized and frequently analyzed dataset stemming from Project MATCH, a multi-site project conducted in the 1990s in the United States. This analysis used a subsample of these study participants who were followed for up to three years following the initial Project MATCH treatments. In this subsample, 952 individuals with alcohol use disorder were randomized to receive one of three individually-delivered outpatient treatments (i.e., cognitive behavioral therapy, motivational enhancement therapy, or Twelve-Step facilitation). Of these, 806 (85%) provided data on their drinking during the three years following treatment and were included in analyses. Assessments were conducted prior to treatment, during the 12 weeks of treatment, immediately following treatment, and 6, 12, and 36 months after treatment end. In addition to reporting on their drinking and negative consequences they experienced due to their drinking, participants also provided information on their experiences during the past 30 days, using four yes/no items (“employed,” experienced “serious depression,” “trouble understanding, concentrating, or remembering,” “serious anxiety or tension”), and completed several items measuring to what degree they engaged in problematic social behaviors and to what degree they felt satisfaction with their life.
Witkiewitz and colleagues then conducted two types of analyses. First, they simply defined three groups of participants in terms of their drinking based on cut-off values of public health interest and described their outcomes over time. The three groups they defined were abstainers, low-risk drinkers (i.e. non-abstinent individuals with no heavy drinking days) and heavy drinkers. A heavy drinking day was defined using nationally-defined standards as consuming four or more drinks in a day for women, or five or more drinks in a day for men. Then, they used an exploratory technique called “latent profile analysis” to identify groups of patients based on their reports of alcohol consumption and life functioning (i.e., as described above) over the three years following entry into outpatient treatment.
In defining groups that emerged by considering participants’ data over time, Witkiewitz and colleagues identified four profiles:
Figure 1. Four drinking categories identified by researchers.
By far the largest group is ‘high-functioning infrequent non-heavy drinking’ (51.2%), which is good news in and of itself. Among these, only 49% were completely abstinent from alcohol, demonstrating that both abstainers and individuals who experienced at least some low-level re-exposure to alcohol were able to achieve high-functioning. Of note, all of these patients were able to refrain from heavy drinking.
For the remaining three groups, whether or not someone remained abstinent was also not a very informative datapoint: a third of these participants were high–functioning despite at least some heavy drinking. Note also that achieving infrequent drinking or abstinence did not guarantee higher functioning: roughly 25% of those achieving infrequent drinking had very poor functioning (i.e., the ‘low-functioning infrequent heavy drinking’ group, which comprises 25% of all participants who were able to refrain from occasional or frequent heavy drinking). Of note, this group also seemed to be worse off at the beginning of the study, as they reported higher levels of depression, tension, and difficulties concentrating at the onset of the study, suggesting that this group was struggling to overcome greater psychosocial challenges than the other groups.
More generally, the study also made observations about how baseline characteristics of patients related to outcomes three years later:
Higher functioning: Patients who at baseline were found to have better mental health, greater purpose in life, and social support from family and friends were more likely to be high–functioning three years after treatment.
More frequent heavy drinking: Patients who at baseline had more high-risk social networks that actually supported continuing to consume alcohol were more likely to engage in frequent heavy drinking three years after treatment.
Achieving high-functioning heavy drinking: Patients who had lower alcohol dependence severity at baseline were more likely to achieve high-functioning despite at least some heavy drinking. Note that high-functioning patients who engaged in occasional heavy drinking were more likely to be White, and at study entry drank fewer drinks per drinking day and experienced fewer consequences due to their drinking than those high-functioning patients who engaged in infrequent non-heavy drinking.
WHAT ARE THE IMPLICATIONS OF THE STUDY FINDINGS?
The findings from this secondary data analysis project of a large, multi-site trial delivering outpatient treatment (in the 1990s) to more than 800 alcohol use disorder outpatients lend further weight to recent calls reconsider how the effectiveness of SUD treatments ought best to be measured. It builds on a previous report from the same research group that has highlighted the shortcoming of existing Food and Drug Administration guidance to use heavy drinking as indicative of treatment “failure,” as it fails to acknowledge substantial psychosocial improvements made by individuals who continue to occasionally drink heavily post-treatment. As Witkiewitz and colleagues argue, patient variability (i.e., heterogeneity) has long been acknowledged as an important factor to consider; it may now also be time to acknowledge that there is considerable variability in how some individuals may function following treatment for alcohol use disorder. That said, whereas it is becoming clearer that abstinence is a relatively uninformative indicator of treatment success, engaging in heavy drinking in and of itself confers harm, given that alcohol is a known Group 1 carcinogen – it has the potential to cause cancer. It is also a major cause of liver disease. Thus, while it is possible to engage in heavy drinking occasionally and still function at a high level, such toxicity–related risks need also to be considered. For this reason, perhaps other characterizations of alcohol consumption may be more informative, such as staying within national “low-risk” drinking guidelines. Drinking guidelines, such as those of the American Cancer Society, seek to prevent not only alcohol use disorder, but also the harms posed by both toxicity from alcohol, and recommend that women and men should drink no more than one and two drinks per day respectively, to limit harm due to alcohol’s toxicity-related effects. Beyond broadening our perspective of how alcohol consumption should be considered in terms of defining treatment “success,” the results of this study raise additional intriguing questions surrounding the broad definition of “recovery” that most agree should encompass both indices of functioning and a range of alcohol use indices.
Also of note, roughly half of those who are low-functioning after outpatient treatment show vulnerability to intermittent alcohol exposure, and continue to struggle psychosocially, underscoring the importance of continuing care that can help address these challenges over the longer term. LIMITATIONS
This new analysis of a large, multi-site trial with more than 800 alcohol use disorder outpatients showed that some individuals who engage in at least some occasional heavy drinking following treatment may function as well as those who are mostly abstinent with respect to psychosocial functioning, employment, life satisfaction, and mental health. Such individuals tend to have lower addiction severity and fewer alcohol-related consequences prior to treatment, suggesting a more favorable prognosis overall.
For individuals and families seeking recovery: An incidental finding of this study, but good news that deserves highlighting nevertheless, is the finding that more than half of the alcohol use disorder outpatients examined in this study had a positive outcome for at least 3 years following treatment, both in terms of drinking (i.e., no heavy drinking days) and functioning (i.e., low probability of reporting problematic social behaviors, unemployment, other drug use, or life dissatisfaction). This positive finding is in line with other recent findings highlighting that roughly half of the people seeking to recover from a substance use problem need only two recovery attempts.
For treatment professionals and treatment systems: This paper provides further empirical support to move beyond a reliance on abstinence as the ultimate indicator of treatment success, and instead to move towards a broader range of drinking as well as psychosocial functioning. See our previous Bulletin article on broader definitions of recovery. Patients with higher addiction severity at treatment entry are less likely to achieve high-functioning with occasional heavy drinking. Moving beyond abstinence as the indicator of treatment success may help decrease barriers to treatment–seeking amongst those who do not wish to abstain from alcohol entirely but may otherwise welcome support in achieving low-risk drinking and higher functioning.
For scientists: The present study, as well as similar reports, are based on older datasets, and thus replication in more modern-day datasets would help clarify if observed findings generalize to present day alcohol use disorder treatment contexts and recovery supports. Note also that “functioning” may be defined in a number of ways, but in the present study was limited to the indices used in Project MATCH. As Witkiewitz and colleagues highlight, further research should examine the role and impact of heretofore understudied correlates in this context, such as cognitive functioning/executive control, medical health and chronic pain, and misuse of prescription drugs.
For policy makers: An increasing body of research points to the downfalls of relying on abstinence as a marker of alcohol use disorder treatment success. Far beyond being a simple matter of treatment goal preference of a substantial number of treatment seekers, current evidence, including this paper, suggests that alcohol consumption by itself does not necessarily equate to “treatment failure.” Guidance used to evaluate alcohol use disorder treatment, including FDA regulations, may need to be updated in light of this emerging evidence, with perhaps measures of diagnostic remission status and/or drinking within the national low-risk drinking guidelines being the optimal outcomes.