What If My Child Isn’t Motivated to Get Treatment for Addiction?
Suggesting Treatment to a Loved One
Intervention – a Starting Point
Drug Use, Stigma, and the Proactive Contagions to Reduce Both
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March 2021
The names sound similar, but these are two different approaches to recovery.
Not too long ago, getting treatment for drug and alcohol addiction mostly meant walking into a 12-step meeting and relying on will-power, camaraderie, and a higher power to make a change. Today, there are more treatment options available than ever before. That’s great — it allows individuals to find the path to recovery that is right for them. However, it also means that there’s pressure to understand the treatment options and choose between them.
One common source of confusion is between medically-assisted detox, and medication-assisted treatment. Both of these treatment approaches can be helpful for people with opioid addiction or dependence. Although the names sound similar, the approaches are actually quite different. Medically-assisted detox helps people get off opioids entirely, whereas medication-assisted treatment helps people manage their substance use disorder by taking prescription opioids in a responsible and controlled way.
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How does ASAT support recovery?
People get to a point where they think, okay so I stopped the coping behavior, now what? If just stopping substance use or stopping something that was causing negative effects in my life was adequate, I wouldn’t be thinking about what my New Year’s resolutions were going to be this year. So once you’ve gone through withdrawal management, you’re stabilized, you’re no longer using a substance in a negative way, what does your recovery look like? And that’s where abstinence supported environments come in. You have this period of life where you can practice recovery-based skills and competencies and get the basic life skills of growing up.
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Self-Medicating - Simon Pegg’s experience with self-medication is likely familiar to many other recovering addicts. It absolutely reflects my own life story. Like Pegg, I was diagnosed with depression as a teenager, and started “treating” it with alcohol from an early age. Alcohol made me feel better in the moment, while doing nothing whatsoever to address the underlying issue. In fact, by the time I eventually got sober at age 29, my depression had grown worse than ever before. This falls exactly in line with a warning from the CDC that excessive alcohol use may increase anxiety, depression, and other mental health issues.
Simon Pegg drew on his experiences with addiction when co-writing The World’s End with Edgar Wright. The movie is a science-fiction comedy about a group of friends trying to complete a pub crawl which ends at a bar called “The World’s End.”Fittingly, as they progress through the bars, aliens invade, putting the characters in the wake of a potential literal “world’s end.” It’s a funny movie, but it’s also a parable about alcoholism. As everything goes to hell around them, Pegg’s character remains obsessed with finishing the pub crawl.
Pegg told Jonze “that’s what addiction is like. It’s like you have grown a second head and all it wants to do is destroy itself, and it puts that ahead of everything else — your marriage, children, your job.”
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To protect my sobriety, I had to stop doing these three things.
- Being Around Alcohol
- Debating Myself
- Not Asking for Help.
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In opioid use disorder treatment, there’s been a persistent (though not always acknowledged) tension between what’s good for public health and what individuals and their families want from treatment. I’ve written about it before. For public health, there’s plenty of evidence that MAT (medication assisted treatment) reduces illicit drug use, improves health and reduces crude mortality rates.
Meeting people with opiate use disorder who were in long term abstinent recovery from illicit and prescribed drugs changed my mind about what was possible. I suppose I have met hundreds of such people over the years. That’s a game changer. I worry that some prescribers don’t spend enough time with people in recovery.
Although there are substantial benefits to MAT, there are also problems: non-engagement with those who would benefit and timely access for instance. Then there are other issues too: stigmatisation of those on methadone, poor retention in treatment and how MAT fits in with the management of problem polysubstance use, including alcohol.
So, does MAT help patients achieve their wider goals – those person-important outcomes?
We don’t really know is the short answer. A systematic review published in 2017[1], found that health related quality of life measures are rarely used as outcomes in MAT research. When looked at from a recovery perspective, we have more evidence on the negatives that go than on the positives that arrive. There are studies showing improved quality of life, but we need more on whether people reach their goals and get improvements in the things that matter to them.
A small in-depth Norwegian study[2] involving 7 women and 18 men on MAT found evidence of them being ‘stuck in limbo’ in terms of not moving on despite national guidance that the patient’s own goals ‘should be the basis of treatment’. These drug users were still engaged in illicit drug scenes. The researchers found four themes:
- Loss of hope
- Trapped in MAT
- Substitution treatment is not enough
- Stigmatisation of identity
- Re-tasking the Judicial Educator to Rehabilitate Not Incarcerate
- “It’s not that difficult to overcome these seemingly ghastly problems [drug addiction]… what’s hard is to decide to do it.” Robert Downey Jnr (2004)
- The long-term effect of the NSW Drug Court on recidivism
- Helping an Alcoholic Loved One