I’m Still Here: Treatment for Long Term Sobriety

I often talk about changes on this blog. Changes that are happening, and changes that need to happen. There is an endless list of things wrong in the sphere of addiction. From the problems with the way the police and justice system deal with addicts, to the stigma we deal with in the general population, and even on the front lines in the treatment world.

There are many different kinds of treatment out there. There is a lot of treatment available to someone who is in the very beginning stages of sobriety. We have the highest levels of care in detoxes, which then typically lead to an inpatient or Partial Hospitalization Program (referred to as PHPs). The level of care after that is generally Intensive Outpatient Programs (referred to as IOPs). There are no rules to the order in which someone engages in treatment, except that most programs do require someone who is actively using to have completed a supervised medical detox before enrolling them in treatment. Some people jump right into an IOP without having gone through an inpatient program.

The problem with any kind of outpatient treatment is that is allows the client to still engage in addict behavior while enrolled in treatment. Whether it is actively using, or other shady behaviors, it can be challenging to break those habits and that lifestyle while only engaged in treatment a few hours a week.

This is a problem that not only outpatient treatment programs deal with, but that is common in the rooms of twelve step programs as well. Everyone who has ever been in treatment or in the rooms has been told to “stick with the winners”, meaning that you shouldn’t hang around with people who are struggling to live a clean and sober life.

This philosophy can be difficult to adhere to, however, when those with good clean time are mixed into a group session at the treatment center with those who are still struggling to stay clean.

This issue basically stems from the major problem with treatment in general, which is that there is little treatment available for those in long term sobriety.

Once you have over a year of good clean time, your life generally changes in very significant ways. For most of us, our legal problems have been resolved. We are no longer on probation, and if we are on a long term probation that has extended multiple years, we are no longer worried about violating our probation in our daily lives. We don’t worry about giving dirty urines. We don’t have open cases with DCF and we don’t worry about losing custody of our children. If we have lost custody in the past, we have regained it or are in the process of regaining it. We don’t associate with people who are actively using, even if it’s only occasional slipping. We no longer frequent places like pawn shops, or spend time hanging out in the streets. We have realized major changes in the three areas I talk about that indicate true recovery: Behavior, Mindset, and Intent.

For these reasons, I generally avoid attending groups or twelve step meetings. I don’t want to spend time talking about those early recovery issues, because for me personally, it puts me in a negative mindset.

It is extremely triggering for me, personally, to be put back into a room full of people who have a totally different set of behaviors, a completely different mindset, and a dangerous intent.

Keep in mind, AS ALWAYS, we are all unique in our experience. For some people, they call it “keeping it green”, which means being reminded of those bad times so that they remember not to fall back into those old routines. For those people who find that kind of group experience to be beneficial, they should continue to utilize it as part of their program of recovery. However, for myself and many others, we prefer to stay moving forwards.

Yesterday I made the mistake of attending a group at my treatment center. I typically only attend one group, which is an aftercare group for those of us who have completed IOP and are succeeding in recovery. There is only one of these groups available, and all the rest are open to everyone, regardless of their level of recovery. Don’t get me wrong, these people need groups, and they should be welcome to attend them. The problem for someone like me, with multiple years, is that we need a different level of group care.

This group was completely out of control from the minute it started, which was ten minutes late. The topics of discussion were all things that are typical problems for people who are still using. Custody issues, probation violations, arrests from pawning stolen items, you name it. The individuals who were talking dominated the entire group, and became agitated every time the counselor tried to reign them in. The topic of the group was supposed to be “Coping Skills”, which is something we all need to work on. No one on this earth has perfect coping skills. However, there is a big difference between coping with the early days of sobriety and coping with the problems that arise for us later on.

The treatment industry needs to take steps to address the needs of those who are living in recovery long term. I am proud that my treatment center does offer the one aftercare group that I truly benefit from, but we need more. We need to make it a common practice in treatment centers to offer groups to those who have a history of clean urines and whose counselors can approve them to attend based on their time in recovery and what they have accomplished during that time.

The problems that generally arise stem from trying to ascertain what qualifies someone to attend what we might call an “advanced” group. For me it always comes down to the three qualifiers of Behavior, Mindset, and Intent. Is this person engaging in any negative behavior? Is their mindset focused on living life in recovery? What are their intentions in their daily life? These are observations that a counselor should be able to make regarding each of their clients, and determine who has come to a point in their recovery where their daily challenges have changed from those faced by someone who has less progress.

My daily challenges have drastically changed from the ones I dealt with three years ago, or even one year ago. This is why I struggle to sit through a group with people who are still navigating those early struggles.

We need to break down the recovery process further than simply clean vs. dirty.

Progressive treatment centers need to find ways to cater to clients in every stage of recovery. Someone who has been in recovery for ten years probably has much different challenges from someone who has been clean for three years. Someone who has been clean for six months is in a totally different place for someone who is still counting their first thirty days.

Everyone who desires a life in recovery deserves to have their unique needs addressed by their treatment center. When we talk about opiate withdrawal, the Post Acute Withdrawal process can last up to two years, but the average treatment center provides no more than eight weeks of care to clients enrolled in an IOP. What happens after that? Where is the follow up care? We need to do a better job with the follow through process when it comes to continued care.

A diabetic doesn’t get prescribed insulin, spend a few weeks getting monitored, and then get sent on their way. They continue to report to their doctor and talk about what is working and what is not working for as long as necessary to keep their condition under control. A cancer patient doesn’t go into remission and then never see their doctor again. They go back for testing for years to ensure that the cancer doesn’t return, and if it does, it is caught early BECAUSE of the continued regular monitoring.

Addiction is an all consuming disease that totally alters every single facet of our lives, and it typically goes on for months or years. When we talk about weight loss, we always hear that it took so long to put the weight on, so it’s going to take just as long to lose it. We need to treat addiction and recovery the same way. Changing your behavior, mindset, and intent amounts to changing your entire perspective on life. These changes cannot be made overnight. We spent years building these negative habits, and it can take years to fully break them and replace them with our new way of life.

This is just one of many changes we need to see moving forward in the treatment of addiction. The list of steps towards progress is endless, and it’s going to take time to implement new strategies of care as we change the way we look at and treat this deadly disease. The good news is that there ARE progressive treatment centers who are looking beyond the twelve step model to see what else is out there and what other ways people can get into and stay in recovery. What changes would you like to see in the treatment of addiction? Let me know in the comments!

©Copyright 2017 In Angel’s Arms and Lauren Goodkin

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