Notes to Help the Vulnerable
Everyone deals with addictions differently. I try to tell people to think about the stuff they’re not obsessed with from 5-10 years ago and try to apply it to habits that need to stop now. This method has honestly helped me although I’ve never used substances. We all had to give up bad habits (and still do) and once you overcome them, use these tools with others who are struggling to help them out, starting with the basics:
- Encourage the whole family to abstain: humans are a product of the environment and dealing with substance abuse, I also target the whole family to not engage in these activities in the first place or at least limit the partying/smoking/drinking/drug habits. Patients assume it’s okay to be around others if they haven’t been to rehab but that’s not the point, we want the patient to be in a clean environment if possible, not around enablers that probably need to go to rehab. Continue to encourage everyone (friends, parents, peers, inner circle, partners, etc.) to give up these habits to reduce relapsing.
- It’s a group effort. Anyone dealing with addictions needs to have a support team (hence, the family/environment needs to be sober). However, many of these patients burned bridges due to substance abuse, lost money/employment, did prison time, or whatever. Continue to give the patient hope. They are many anonymous meetings, non-profit organizations, programs, sponsors, etc. who are also in the same boat that can help build a supportive team. I tell the patients, you have to constantly replace the bad people/things, with something good.
- Discourage self-pity. I frequently reiterate to my patients do NOT beat yourself up! Self-pity will make you relapse. Examples include woe is me, no one cares/understands/loves me, I’m worthless, I destroyed everything… What do these thoughts and attitudes also usually leads to?? RELAPSES, SI, or other self-harm behaviors. So I counterattack this almost all the time, in the intake, even if they don’t say these things….keep fighting against this mentality until the addiction is no longer an issue because it’s one of the reasons why relapsing can easily occur.
- RETRAIN the brain. This is where CBT (cognitive behavioral therapy) is supposed to work but honestly, it’s hard to find good therapists. Many times they actually enable the behaviors by not challenging toxic thought patterns and poor attitudes. Yes, replace the regular CBT meaning to CHALLENGE the behaviors and thoughts. The addiction population is rough, with tons of manipulation, and easily irritable, but it all goes back to the thoughts (retraining the brain). Therefore, go back to the basics: work on coping skills, conflict resolution, adult functioning, and stability. Sometimes I’ll use the follow-ups to help with job/school applications, resumes, driving license paperwork…etc., which will lead to my last point:
- Promote independence and stress management. You want to build those coping skills and behaviors so the person can live a functional adult life. Many people have kids, jobs, and families and although we have to retrain the brain, we don’t want to handicap them from their responsibilities. This is why we also need stress management because the STRESS and this pressure will cause a relapse. People normally use substances as a form of coping or when they’re bored (or from not tending to their responsibilities). Quick side-note: if the patient absolutely has nothing plan, no job, family, then use the meeting to work on a plan. I will literally write out step one; work on a license, step 2- create a resume…etc. And used meetings to help with their resume or refer them to someone to help with social security paperwork for example i.e. case management.
This is all in addition to medication management etc. The point I’m trying to make in all of this is DO NOT just focus on the addiction. Another way I look at treating substance abuse is to keep providing the patient with a purpose/responsibility, but also in case, a person relapses. The world doesn’t just stop revolving because a person went on a coke binge. Whenever the person calms down and comes back to their senses, we still need them to go back to being a functional adult…
Therefore, don’t get discouraged if a patient relapse. It’s like a child learning how to ride a bike, it may take several whacks before a person realize what’s good, helpful, and reliable versus what’s not. They’re finally working on trying to be a good person and in today’s world that’s NOT easy, especially if the person spent years/decades in an addiction.
Lastly
NO ONE gets it right on the first try. So in conclusion providers, don’t take it personally if the patient relapse multiple times, takes years to get clean, or even if it gets fatal. The above key points should help and there are millions of resources out there, but ultimately it’s up to the PERSON to make the decision to remain sober. I don’t work harder than the patients, since they have to prioritize their recovery and be independent but I do work hard in getting them on the right track. Thankfully, I didn’t have any incidents but some of my co-workers did so I’ll just throw in this final quick note, use the med reviews to mainly:
- Maintain protocols such as regular Rx screens, screening tools, and boundaries, especially with benzos and stimulants. Target sleep and mood, address ADHD, anxiety, or other conditions that can lead to relapsing. Be mindful of clinical considerations i.e. heart, kidney, liver problems, diabetes, HTN, etc. Please TARGET cravings (PRN medications if necessary). Also, be mindful that all of this may require follow-up <2-4 weeks if needed…
