Addiction Treatment, Why Detox-Rehab Cycles Fail
Written by: Richard Gracer, M.D., San Ramon, California
Posted by: Ron Kennedy, M.D., Santa Rosa, California
John was addicted to Norco (a pain pill that contains hydrocodone the same opiate pain killer found in Vicodin), taking up to 30 daily. He started drinking heavily to cope with the feelings he would get when he could not get enough Norco. Things finally collapsed when the police stopped him while driving intoxicated. He was sent to a hospital for three days to “detox” off his pills and alcohol and then referred to “rehab” for a 2 week stay. While there he participated in groups, ate well, and bided his time until he could leave. He had to admit that he was an addict. He continued to have withdrawal symptoms throughout his stay. He scored drugs on the way home from the rehab center and was careful to go to all the meetings and group sessions that were required by the courts. When a urine test showed him to still be using, he was sent through detox and rehab again, with similar results, although this time he really tried to stay clean and was successful for 6 months before relapsing.
Patricia is a 30 year old woman who started using methamphetamine in her last year in college. She found that it gave her “an edge” in studying and on tests. The problem was that she soon found that if she did not have any “meth”, she couldn’t function at all. She tried many times to shake the habit, and even went through “rehab” three times. However, after a while no matter what she tried, the depression and lethargy was too much to take and she would relapse. She weighed 80 pounds, was unemployed, and her health was failing. She finally moved in with her parents and sought help and support.
These stories describe the lives of many addicted persons in our society. They are not “Bowery Bums”, but middle class folks, who suffer from a deadly condition that is resistant to treatment. In fact, about 15% of the population suffers from some type of substance dependency or abuse (not counting smoking). This problem does not discriminate between classes and social status. The typical detox/rehab system that John and Patricia experienced has a success rate of less than 15%, yet the response to failure is to put people through the same process again and again. Repeating something over and over, and expecting a different outcome has been described as a form of insanity.
What’s wrong with the Detox/Rehab Cycle?
Addiction is a medical disease, as well as a social, and indeed a societal problem. The current predominant system of treatment stresses the social aspects of this all-encompassing problem. The usual treatment is to “go to “rehab”. While this is differs from place to place and program to program, what usually happens is that after medical “detox”, the affected person is sent to a residential program of varying length and luxury, depending upon monetary factors, or is sent home to a relatively brief outpatient program. After this, the person is released to their previous life (and lifestyle) to be supported by local lay 12 step programs, like Alcoholics or Narcotics Anonymous (AA and NA). The stress is on abstinence from all drugs (an obvious and laudable goal).
The treatment is for “Substance Abuse” and everyone gets basically the same treatment regimen. The person must admit that they are an addict and submit to the program’s mandates, even if they do not buy into the process. Many folks do what John in the story above did; He “shined it on” until he could get out. Others check out early and return to using very quickly. Also, most programs do not evaluate and treat psychiatric disorders, underlying nutritional problems, and the real underlying problem that causes treatment failure, THE BRAIN DISEASE!
So what is the problem?
After an addicted person gets through the first few weeks off their drug most of us assume that they eventually return to normal. This is a fallacy. The withdrawal symptoms, such as depression, anxiety, fatigue, and muscle aches, and can go on and on, sometimes indefinitely. (This is a HUGE problem with methamphetamine use). This condition is called the Post Acute Withdrawal Syndrome (PAW). In addition, there are psychologic triggers for cravings that can themselves cause the return of these physical symptoms. Eventually, almost all of these people succumb and restart using.
The recent spate of celebrity substance abuse treatment failures underscores the need for comprehensive long term treatment that emphasizes treating the brain disease caused by these substances, as well as the psychosocial factors that are main part of most treatment programs. These brain alterations are the cause of the ongoing cravings and emotional disturbances that fuel most relapses. Abstinence based programs that keep a patient in residence for a specific period and then have them go back to their prior life style are doomed to fail. One of the main predictors of treatment failure is the return to the previous life style. The best way to increase success rates would be for the public and press to ignore the famous drug users and for the courts to deal with them the same way as anyone else. It’s hard to believe that one recent female young and famous drug user was allowed to leave rehab for shopping and a beach party. When she was released back to her normal life, she used again very quickly, which allowed her life to spin totally out of control.
In my book, A New Prescription for Addiction, I outline a better way to treat these problems. We stress the need to decrease cravings using treatments such as buprenorphine (Suboxone) for opiates and prescription drug abuse, as well as the Prometa protocol for treating the cravings and brain disease associated with alcohol, cocaine, and methamphetamine use. Alone, these too are not enough. Careful evaluation and treatment of psychiatric problems, such as depression, anxiety, and bipolar disorder are critical for success. Nutritional factors should also be treated. We believe that patients need to be in treatment for at least one year. We call this the Recovery Maintenance Model. Patients who participate in the program for a year have about a 2/3 chance of success.
In summary, the current Detox/Rehab cycle almost always fails because of:
Read another article by Dr. Gracer: Revolutionary New Treatments for Drug Addiction
You can order Dr. Gracer’s new book from: A New Prescription for Addiction