Inpatient Addiction Treatment: A Journey

111 days ago I said the most important words an addict can say; “I need help”. What followed was the most rewarding 93 days of my life. I began giving birth to the person I was meant to be and like any birth, the experience was beautiful and painful. What follows is a synopsis of the inpatient treatment process compiled of not only my experience, but the experiences of others that I shared the journey with. I hope our experiences may help others to make healing choices for their lives and the lives of their loved ones.

Detox and Withdrawal. If an individual is still physically under the influence of chemicals (drugs or alcohol) withdrawal symptoms are to be expected. The types and severity of symptoms will vary according to what was used, how much, and for how long. Some chemicals most commonly requiring medical monitoring during “detox” are alcohol, benzodiazepines, and opiates due to the potential severity of withdrawal symptoms. Withdrawal from chronic alcohol use is safest in a hospital setting. Symptoms include dehydration, heart palpitations, hallucinations, psychosis, and convulsions. Up to 5% of patients in acute alcohol withdrawal die. In extreme cases, alcohol withdrawal is managed with an induced coma lasting up to two weeks. In most cases however, withdrawals are managed with intravenous fluids, and medications to manage pain, anxiety, depression, hypertension, and obsessive cravings. The acute period for alcohol withdrawal is two to seventy-two hours. Benzodiazepines (benzos) are a family of drugs prescribed most commonly for anxiety/depression, seizure disorders, and insomnia. They are extremely addictive and have risen in popularity as a “street drug”. Many addiction specialists call benzodiazepines such as Xanax, Valium, Ativan, and Klonopin “alcohol in pill form”. Acute withdrawal symptoms (eighteen hours to six days) commonly include seizures, convulsions, suicidal ideation, violence, insomnia, panic attacks, psychosis, hallucinations, and confusion. Medical management includes low doses of sedatives, observation, and in rare cases restraint. Opiate withdrawal symptoms are not life-threatening, but extremely uncomfortable. Being “dope sick” can include preoccupation & cravings, pain in bones, muscles, and joints, diarrhea, fatigue, restless leg syndrome, persistent chills, sweating, nausea, anxiety, depression, confusion, and paranoia. Acute opiate withdrawal typically occurs in a 12-hour to 6-day window. Medical management may include anti-anxiety drugs, pain medications, and concentrated nutrition as well as opiate substitutes to lessen cravings. Stimulants such as cocaine, crack cocaine, methamphetamine, and “club drugs” are not characterized with physically severe withdrawal symptoms. The most common withdrawal symptoms in early stimulant recovery are persistent cravings, depression, fatigue, restlessness, and increased appetite due to malnutrition. I detoxed for six days in a hospital from sustained benzodiazepine and alcohol use. The seizures and hallucinations subsided after two weeks, while depression, panic attacks, sleeplessness, and confusion persisted for two more months.

Residential Inpatient Facility; Primary Treatment. The first twenty-eight to thirty days of inpatient treatment are about getting chemical-free, discovering the problem of addiction in our lives, learning to ask for help, letting go of stigma and shame, and starting to physically recover. My “care team” consisted of a medical doctor, two nurses, a psychiatrist, two psychologists, a spiritual care advisor, two wellness specialists, a dietician, a fitness coach, a student intern, and two addiction counselors. During treatment programs based on Twelve-Step Recovery (statistically the most effective long-term addiction treatment process) patients are introduced to the Twelve Steps of Alcoholics Anonymous and/or Narcotics Anonymous. Gender separation is typical and unity within the peer group is encouraged. Our days consisted of a morning meeting/meditation, chores, meals designed to meet the needs of addicts in early recovery (weight gain is very common), individual and group therapy, spiritual consultations, medical monitoring, lectures and seminars, stress-reduction and wellness activities, exercise, visitations, AA/NA meetings outside the facility, unity-building ceremonies such as initiations, addiction histories, and graduations, homework and presentation of written assignments, addiction education, and more therapy. Lots of therapy. By the end of Primary Treatment, most patients are not only aware that they are truly addicted, but have come to accept themselves as “good people with a bad disease” rather than “bad people”. This attitude does NOT get us “off the hook”, but quite the opposite. When we get out from under the shroud of shame, we can begin to recover as the people we know we want to be; people who take responsibility for their actions and stop inflicting harm on ourselves and others through our addictions.

Residential Inpatient Facility; Extended Care. A few situations will warrant a longer stay in residential treatment; a history of multiple inpatient treatments, a long using history, multiple relapses, and a drug-of-choice with a high potential for fatality in relapse (intravenous heroine). Extended care is about learning to cope with our afflictions and addictions. The number of group therapy sessions doubles in frequency and gets deeper in intensity. Individual therapy is less about recent drug use and more about exposing hidden pain and unresolved conflict. Specialized treatments for depression, anxiety, phobias, and PTSD are explored. Written essays and specialized readings are frequent. In my facility, art therapy was utilized. Spiritual care expands to include defining how “a power greater than ourselves could restore us to sanity” in more than a theological practice. We learn to ask one another for support through the beautiful agony of enlightenment. Many of us begin to experience thoughts and emotions that we either could not fully comprehend in our active addiction, or used chemicals to suppress. We learned to honestly work through fear, frustration, sadness, and loneliness without using chemicals or other addictive behaviors. Men held onto crying men. Roommates woke each other up in the wee hours to “talk it out”. The Twelve Steps were explored further and we began “practicing these principles in all our affairs”. After thirty to ninety days in extended care, the care team will suggest what comes next for the recovering addict.

My “after-care” recommendations were typical for someone with long-term addiction and a history of relapse; three to nine months in a sober group-home, six weeks of intensive outpatient treatment (twelve hrs/week) followed by three to nine months of extended outpatient treatment (six hrs/week), continued medical monitoring, and weekly psychotherapy sessions. I was also instructed to get an AA/NA Sponsor, attend at least three Twelve-Step meetings per week, and engage in low-stress work/school/volunteering for no less than thirty, and no more than forty hours/week. If I follow all these suggestions, my statistics for sobriety after eighteen months abstinent are 58%. They’re 83% if I choose to recover from nicotine addiction as well.

The objective of this time in my life is to learn how to live as the man I want to be, not the man my addiction created. Was treatment inconvenient? Yes…but not as inconvenient as dying. Was treatment intrusive? Yes…but not as intrusive as prison. Was treatment the end of a journey, or the beginning? Both.

Peace

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