Changing the Face of Addiction Treatment

Let's save lives and families by reducing addiction relapse

The Face of Addiction

When I wrote this a few years ago there were 46.3 million addicts in the United States, costing the taxpayer $600 billion every year and growing.  A recent study showed addiction is growing faster than at any time in history and drug overdoses have surpassed auto deaths.  Our prison system is overwhelmed, 16% of people in state prison and 18% of people in federal prison reported committing their crimes to obtain money for drugs. 

www.drugwarfacts.org/cms/Prisons_and_Drugs#sthash.20NHEuRC.dpuf

We have all heard about the war on drugs and billions have been spent along the way.  This money has been spent with the intent of wiping out the source of the drugs by crushing the cartels, destroying the poppy fields in Afghanistan, and arresting those who distribute and sell drugs.  They have produced ad campaigns and created slogans, such as “Just say no” and “eggs abuse is life abuse”.  You may have also seen the TV ads, such as the one showing the egg frying in a pan, where they say “This is your brain on drugs”.  Since 1971 when the war on drugs was declared by President Nixon we have spent over $2 trillion.   All we have to show for it is 2.3 million behind bars for violation of drug laws.  

Now here is what is concerning, according to data from several sources, for 2022 107,081 Fentynal overdose deaths of those 68% of Fentynal contained Xylazine a muscle relaxant for horses and cattle, which is a non-opioid sedative not approved for human use.  What does this mean?  Narcan (Naloxone) does not work to revive them and there is no known antidote.

Where are the drugs coming from?  Well let's say there is more than one way to destroy a nation, one is to flood the border with illegals and the other is to flood the country with drugs.  Well, both are happening, ninety-nine percent of the Fentanyl is coming from China, and then it’s manufactured by two cartels, the Jalisco and Sinaloa Cartels, and they’re the ones that are bringing it across the border, In 2022  according to the Drug Enforcement Administration they seized over 50.6 million fentanyl-laced, fake prescription pills and more than 10,000 pounds of fentanyl. They estimate that these seizures represent more than 379 million potentially deadly doses of fentanyl.

Now that we know where the drugs are coming from and how dangerous they are, what happens when they get into the hands of a dealer and then into the hands of a user…..  Now what happens when someone overdoses, and they are revived and survive in the hospital?  Here is the problem, when someone overdoses and is revived in the hospital, they are immediately angry because you just ruined their high.   Now they are having withdrawals, and now they want to get high again because you made them dope sick.   If we took them to the next step instead of releasing them we would have a chance of getting them well, instead, we pat them on the but and send them down the road.  Chances are they will use it again within hours.  So what was accomplished? 

The Courts along with Parole and Probation are overwhelmed and often treat everyone the same.  I have seen cases where probationers have become productive and even got full-time jobs only to lose the job because of demands from a parole officer or court-appointed counselor.  

All of this money and effort spent on the war on drugs has had little to no effect on drug use in the US or the world for that matter.  In all categories, the use has steadily climbed every year since the war on drugs was declared.

A Pew study says it costs the U.S. an average of $30,000 a year to incarcerate an inmate.  http://www.pewtrusts.org/~/media/legacy/uploadedfiles/pcs_assets/2010/collateralcosts1pdf.pdf

What if that $2 trillion was spent on treatment?  Let’s look at it from a pure business model of supply and demand.  By treating those using you cut down the demand and you reduce the supply.  

Most current treatment plans consist of twenty-one to ninety-day inpatient treatment, followed by a few months of outpatient treatment.  What we are doing clearly is not working, since statistics show 80% of those coming out of rehab fail in the first year. Some fail or relapse five or six times before they stay clean or die.  Then we must realize that 89% of those who need treatment, never get treatment.  //www.drugabuse.gov/publications/drugfacts/treatment-statistics

The Failure of Current Treatment

The problem with most treatment programs is they are too short and clients are isolated during treatment, far from the real world. Then they are sent right back to their old world, where they got into trouble in the first place. In the real world they are confronted by the same triggers and circumstances they thought they left behind.   Some are put on disability or other entitlement programs enabling them to continue to be idle and dependent. They don’t have a chance.

Many people I see are so heavily medicated by a physician that they can’t even function, they are in a fog and numb so they are incapable of experiencing true emotion, such as joy.  The problem with many of the medications used to treat depression and anxiety is they impact all of the senses.  It’s like pruning the whole tree because of one bad branch.  Then we see those who are on Suboxone or Methadone and how they become chained to these drugs because of the fear of withdrawals.  These medications should not become replacements or a crutch and should be used selectively, for a short time in conjunction with counseling.

A life of addiction, pain, and struggles cannot be rebuilt quickly and addiction treatment is not a quick fix or one-and-done.  It takes years for treatment to be effective.    Addiction is part of deep-rooted pain, and struggles, which were created over a lifetime and cannot be replaced in three months or six months.  To solve these issues, we must look at the cause of their addiction and the source of their pain; otherwise known as the “why”.  It is important to address the “why” they started using for to self-medicate, why they needed to feel better, to not feel pain.  

Jail and prison are not the answer either; I have heard many say “they can do time standing on their head” or that “it is easier inside than out”.  Jail and prison can create more issues and harden them, adding the label of felon.  For teens it’s even worse, twelve-year-olds are housed with seventeen-year-olds who have already become hardened criminals.  For many of these young teens when they are released from prison they end up back in jail or prison because home life is worse than prison.

Some prison systems have “retained jurisdiction” or “Riders”, which are programs to help rehabilitate inmates during their prison stay and incorporate some of the thinking outlined below.  The problem is these tools are often “hung on the gate on the way out”.   We need to make sure they can retain and use these tools in everyday life.

What Should Treatment Look Like      

Treatment should look more like how we treat chronic illnesses, such as cancer or diabetes.  Just like these diseases, if not properly treated addiction can be deadly.  Forcing anyone into treatment rarely works, the client must want to get well.  When working with an addict they must want something more than the drugs, alcohol, or food they have been using.  They need some desire, motivation, and hope. This could be anything, a paycheck, their health, family, and friends.  The trick is to help them keep hope alive and keep the scales weighted in the right direction. 

The Role of Inpatient Treatment

The Inpatient treatment center plays a big role in getting the client started on this journey and is the first big step for the client.  Whatever their motivation, this first step shows the desire to heal.  We need to get their head clear and get them off ALL drugs and alcohol for them to have a fighting chance.  When they are clean from ALL mind-altering substances for 60 days we have a clean slate to work with, and the real treatment can begin.  Why 60 days?  This is when the "pink cloud" begins to fade; the pink cloud is that great feeling during early sobriety, the feeling of “I got this”.  It can take weeks to taper off SSRIs get out of the client’s system and have serotonin return to the client's normal level. Now they are starting to see the real world and feel the real world.   http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants

Some treatment centers and doctors want to automatically put clients on medication to reduce cravings, depression, and anxiety. A clear head is important because many times mental illness is developed as part or as a result of long-term addiction.  We need to know what we are dealing with.   Some clients need it, but most don't, they need to see who they are and learn to deal with their feelings and issues that have been buried for years.  They need to be taught the skills to identify these issues and manage them.  If you just medicate the client you may cover up the real issue and you won’t get to the “why” they started.

The Role of Outpatient Treatment

This is a very important step in the process.  No matter if the client chooses a 12-step program, clinical program or private coaching, or a combination, the key is consistency and longevity.   The doctors and counselors should have a clear head to work with now so they can create a long-term treatment plan customized to the client.  A plan with small steps is preferable, with obtainable goals so they don't feel overwhelmed. The motto should be, one bite at a time, one achievement at a time, over two to three years. If you tell them treatment may be two to three years, they may run in the other direction. 

With a clear head, we need to get a new baseline to build on so we are treating the person, not the effects of medication.  The problem is there are no blood tests or X-rays to determine where to start or how to treat an addicted client.  All we have to go on are the answers the client gives us and the behaviors we observe. We need to be able to chart their progress and that is difficult since the client doesn’t always understand what they are feeling when we ask the question and they don't always tell us what they are really struggling with. Look at traditional medicine, when you are being treated by a medical doctor, at every visit, they check blood pressure, temperature, and pulse, so they can eliminate anything new from the baseline.  With addiction, it is tough to establish a baseline and then identify what are new issues, and be able to compare them throughout the course of treatment. 

Changing Behavior Through the Use of Technology

A big part of the treatment plan should include changing the behaviors and triggers. To put it in simple terms, this involves changing the brain and the thinking process, replacing old habits and triggers.  We need to reroute the pathways in the brain (retrain the brain) so that when a trigger happens it automatically goes to the new reaction and not the old reaction. This will begin to reverse the damage caused by the past, but to do this we need a way to monitor and change these 24/7. 

We have known for years there is an area of the brain, called the Limbic System, which is responsible for addictive behaviors. One of the areas within the Limbic System is the caudate nucleus, and this area is partly responsible for voluntary movement, learning, memory, sleep, and social behavior.  As part of the treatment of addiction and mental illness, we need to focus on the voluntary responses in the brain and rewire them, get them back on track.  This can be done with the right tools.  This is not a new treatment method, over the past twenty years, behavior therapy has been shown to be extremely effective in treating obsessive-compulsive disorder (OCD). There are multiple studies showing the effectiveness of a combination of counseling and self-treatment, used at UCLA for the past 25 years, which they call this approach "cognitive-bio-behavioral self-treatment." (proven by PET/CT scans) Dr. Gorbis, an Assistant Clinical Professor at UCLA, used this method to achieve an eighty percent success rate with minimal relapse rates, which is much higher than other methods.  This falls into the category of Neuroplasticity, which was first theorized by Dr. Hebb in 1949, and proven by Dr. Schwartz, Dr. Doidge, Dr. Lewis, and Dr. Mc Gonigal among many others.

A form of Cognitive-bio-behavioral self-treatment should be part of addiction and mental illness treatment and the best method is to use technology, and put it into the hands of the client.  This enables them to self-report and modify behavior when issues come up, no matter the time of day or night.  Then these issues can be identified and monitored in real-time instead of reported once or twice a month.  These tools can monitor moods, track progress, identify triggers, and help the client see the issues and change their reactions. This is not much different than how we retrain the brain after a stroke or trauma. We have known for years about Neuroplasticity and circuit retraining, now we can use this knowledge to retrain the addicted brain.  This is especially important since we know most addictions have suffered from abuse, neglect, and trauma.

Who is developing this technology?

I developed this technology to modify behavior by monitoring and managing the progress, behaviors, and triggers 24/7.  I believe this will work for those struggling with addiction, and mental illness and to modify criminal behavior for those on Parole and Probation.  It is a form of Cognitive-bio-behavioral self-treatment and should be part of any treatment program.  By using technology, we can put more effective treatment in the hands of every client, so they can self-report and modify behavior no matter the time of day or night.  These tools will monitor moods, track progress, and identify triggers to help the client change their reactions. By using the app these issues can be identified and monitored in real-time instead of reported once or twice a week. These reports can be used by professionals to watch for changes and receive alerts for particular signs and then take the necessary action. 

This is especially important because of the growing number of people suffering from depression, mental illness, eating disorders or drug addiction as a result of neglect, abuse, and/or trauma. 

I use the smartphone, a perfect vehicle to deliver technology because of its ease of use, and most people, these days, don’t leave home without it.  We have all become comfortable using smartphone apps to pour out our hearts; proved by looking at social media and texting. 

My technology works with most addictions and mental illnesses as well as modifying criminal behavior.  

Educating the Client and Family

Treatment should include interviewing education and involvement of family and close friends.  The family and friends need to understand addiction and how to support the recovery without enabling old behaviors.  Stop the blame, begin to understand the role the family and friends played in the addiction and to role they play in the recovery and healing. We are not just dealing with addiction, in most cases, we are dealing with abuse, trauma, or neglect.  Now we may be dealing with criminal behavior and the shame of failure. 

Treatment Plan Should Include the Beginning

Where to begin? Start with the family, and look at the family history of addiction, abuse, neglect, and trauma.  Stop the cycle. If addiction starts at a young age it can halt their emotional maturity and must begin here.  Some have spent too much time in jail or prison and most have never held a job.  This should be part of the pictures and used to create the basis for a successful treatment protocol.   The doctors and counselors should now have enough detailed information to be able to customize a treatment plan for the client, without assuming anything or using a cookie cutter. The primary goal should be tailored to get them back on their feet, heal their pain and the pain of others, and give them their life without getting overwhelmed. 

The client needs to be able to live, survive and pay for treatment but free entitlement programs are not usually the best option.  I am not in favor of giving clients a false or premature diagnosis so we can bill insurance or be put on SSI, so they can receive yet another label. Many centers are now dual diagnosis to provide treatment for co-occurring or co-morbidity, which is important if the client really needs it, we must remember we are dealing with a person.  When you give a diagnosis of anxiety, mania, depression, or even Schizophrenia before the addiction is under control, you may be treating them unnecessarily.  It’s the old chicken and the egg; did the addiction cause the mental illness or vice-versa?  I am not saying no one ever needs medication, many do, but medicating should be the last resort, not the first step.  http://www.drugabuse.gov/publications/comorbidity-addiction-other-mental-illnesses/why-do-drug-use-disorders-often-co-occur-other-mental-illnesses

The best thing is to get the client working and busy.   This can solve the big problem and the need to support the client financially during their treatment. In most cases, we don’t want the family supporting the addict as this creates, dependency, tension, and resentment.  This can lead to many clients on welfare or disability. This only furthers their dependence on the system and does nothing to rebuild them. 

I would rather we create work programs so they are not sitting on the couch playing video games between treatment sessions.  Sitting on the couch with others in their situation is a recipe for disaster.  If they don't have marketable skills, we need to train them, until then there are many public works projects we can put them to work on to help them build a work ethic and pride.  We all have seen the workers along the freeway cleaning up, these are from our local jails getting some fresh air.  There are many public projects that the taxpayers already pay for, which do not require a lot of training, such as painting, street sweeping, snow removal, etc.  

Teach and Treat the Whole Person

This isn’t just about learning to stay clean and sober, it’s about rebuilding years of damage so it doesn’t repeat with the next generation.  Treatment needs to include a complete education; job skills, how to keep a job, coping skills, character building, and conflict resolution. We need to teach them how to survive in the real world and the workplace. If you just toss them back into situations where they will use the same skills they have always used, they will fail.  There are great examples of how to do this; Union Gospel Mission https://www.uniongospelmission.org/, Steps Reentry http://stepsreentry.org/index.html, Inland Northwest Fuller Center for Housing - www.INFullerCenter.org and Defy Ventures. http://defyventures.org/ The Last Mile https://thelastmile.org/. These are examples of private organizations that have taken the broken and rebuilt them.   We can also look at Mental Health Court for habitual offenders, these programs contain some of the elements required to make a difference. http://www.kcgov.us/departments/districtcourt/trialcourt/mentalhealth.asp

Now many will need housing and again there are many solutions available but the big limitation is usually local governments who have the attitude of " not in my backyard”.  What they don't realize or want to admit, it is already in their backyard.  Loss of productivity, criminal behavior, medical treatment, and death.  Every time an addict is released from jail or relapses they sleep on couches of friends and family until they wear out their welcome and end up homeless.  Now they turn to crime.

The Cost

There is no need to raise taxes, what we need to do is free up the money spent on the war on drugs and other failed government programs to fund this.  No new taxpayer money needs to be spent.  The best estimates are that for every $1 spent on drug treatment returns $4-7 in cost savings to society. http://archives.drugabuse.gov/Published_Articles/Solutions.html