Life After Detoxification (Detox)

What will life be like after detox?

First let Recovery 2-Day® (R2D) define detoxification: a medically supervised removal of toxins or toxin, from a person's body, and brain and possibly where initial medical or non-medical evaluations are determined. Obviously the medical opinion will be better than an untrained or poorly trained clinician making the assessment, but untrained opinions happen quite often in the world of "recovery or treatment". Mark L. Willenbring, M.D. The director for the National Institute of Alcohol Abuse and Alcoholism NIAAA, stated:

THE PAST AND FUTURE OF RESEARCH ON TREATMENT OF ALCOHOL DEPENDENCE

Mark L. Willenbring, M.D.

"In addition to addressing these scientific challenges, there is a pressing need to create a new system of providing risk reduction and treatment for heavy drinkers and people with alcohol dependence. The current treatment system model, the Minnesota Model, was developed by professionals at a State hospital in Minnesota and promulgated most famously by the Johnson Institute and the Hazelden Foundation. Based on what was known at the time (primarily through the folk wisdom of Alcoholics Anonymous [AA]), the Minnesota Model combined the first five steps of AA with lectures on the disease concept of alcoholism and some practical supportive psychotherapy. Central to its concept was the use of staff members who themselves were in recovery from alcohol dependence, along with others (Anderson et al. 1999).

Unfortunately, because this model of care was developed without the benefit of a scientific basis, it was not configured in such a way as to rapidly change in response to scientific advances. Currently, more than 90 percent of community treatment programs in the United States offer lectures, group counseling, and referral to AA, and nothing else (McLellan and Meyers 2004). It is common that treatment staff members are poorly trained and supervised, are paid little, and frequently do not stay long (McLellan et al. 2004). In fact, the "counseling" that is provided often consists of casual talk rather than sophisticated psychotherapy (Carroll et al. 2008). To assert this is not to disparage the dedicated professionals who devote their lives to helping others with addiction. However, most addiction counselors have relatively little education and almost no supervision, which is in stark contrast to the counselors who provide behavioral treatment in efficacy trials (Anton et al. 2006; McLellan and Meyers 2004). In addition, very few treatment programs use integrated teams with other professionals such as physicians, psychologists, nurses, and social workers (McLellan and Meyers 2004). As a result, there is a disconnect between what has been discovered through research and what is actually implemented in everyday practice, or, for that matter, what can be implemented given the state of the treatment system."

What this states should shock you!!

This is the director of the National Institute reporting to the current state of affairs on the current treatment models which is technically "after detox". His statement should shock you.

Did you notice the director of NIAAA in his opening statement said "There is need to create a new system." And Recovery 2-Day is a new system that will rise to that call.

By returning to the original question, what is life like after detox?  That depends on the individual. If a person is medically diagnosed "addicted" physically, that is called substance dependence. In the upcoming APA DSM V, it may move to Substance Use Disorder or SUD. Blurring the lines between misuse and dependence, so heavy "use" is not considered dependence and that line needs to remain clear. There is a difference between "misuse" and physical dependence.   The question after detox, is once the toxin that a person was dependent upon, are they going to need "treatment" to remain toxin free? In the same report issued by Dr. Willenbring states:

"About three-quarters of people with alcohol dependence reduce or stop drinking without any kind of professional treatment or even interaction with a community support group such as AA (Dawson et al. 2005)"

What Problems Besides Substance Problems Need To Be addressed?

What help, if any, is required to remain toxin free, is typically called recovery. Now where we go next is complicated. With the World Health Organization reporting that thirty to ninety percent of people with substance problems have what is considered Co-Occurring Disorders called COD. We then have to look at what is a Co-Occurring Disorder? Can it be depression, chronic depression, or a mania, or personality disorder, remains to be seen.

This means we are dealing with clusters or constellations of issues.  And the problems start to intertwine to a degree of difficulty that drives the intervention in many directions. How severe is the depression, could determine how it is treated, with talk therapy or psychotropic drugs.   Which "problem" needs to be treated first? Does it make sense that on a daily basis,  flare ups of depression, could drive a person back to that substance currently detoxed from, which they may have used to treat their depression with? The chicken and egg equation in recovery is a daily dilemma. With many symptoms looking similar, which one is more serious in nature than the other? Studies have shown the connection of depression to suicide, and we know depression is a withdrawal symptom from substance dependence. Should we treat the depression more seriously than the substance problem, or is it simply a withdrawal symptom that will pass, in time, untreated as the levels of dopamine or other chemical reactions in a person's body starts to or returns to  normal level, post substance. The at risk, of course remains the person trying to live substance free, dealing with their issues, life after detox.

When people think of recovery the normal association turns to the after care market of recovery systems, historically "going to meetings." The largest being the Minnesota model, and free self-help. Since the Minnesota model teaches the first five steps of Alcoholics Anonymous (AA). The natural created the treatment affiliation with Alcoholics Anonymous, "where do you send your clients?" if you teach one method?  Sending their clients to the self-help group, called AA meetings seemed like the right action to them. The problem with this model was described by Dr. Willenbring. The focus of AA is on complete abstinence for what Alcoholics Anonymous called "a real alcoholic." "If you are satisfied that he is a real alcoholic" —pg 92 Original manuscript 1939 circa.

The main focus in self-help or mutual help groups is the substance, not the co-occurring disorders since in self-help or mutual help groups they are not run by doctors, therapists or psychiatrists. But life after detox if a person is sent to these self-help groups or mutual help groups is the standard form of "after" detox, which can be called the after care market run by untrained personal, it is after all completely "self-help".

What Is The Role of Aftercare?

Technically the term "after care" was the role of the treatment centers their clients attended, after a detox was preformed. Some are monitored by licensed therapists; many remain untrained or poorly trained volunteers. Once again repeating the facts stated by Dr. Willenbring.

As you can see, the life after detox is just not that simple. While many suffer from the "thought" that folk wisdom is doing a good job, the industry as a whole suffers from urban legends of days long gone.

There is good news in the recovery industry, in Dr. Willenbring same news letter, he clearly stated Dr Dawson's research, about seventy to seventy-five percent of diagnosed with dependence problems, or heavy users,  do quit, or reduce their intake,  without any needed assistance, neither inpatient or aftercare. The recovery industry calls this "harms reduction." Harms reduction is either, or, reducing amounts of substance consumed, reducing the "time spans" between substance use, and abstinence, which is simply time spans between uses. Since there is not a single recovery system that produces 100% guaranteed "recovery" forever, unless you consider death or lock down in prison recovery. Human nature is to test any boundary and remain subject to their own thoughts and actions.

What Dr. Willenbring did bring to light, was the fact that new recovery systems must be created. Life after detox will depend on the individual always and treatment is good.

The question remains, what do you think, life after detox will entail? And the truth is, whatever works, works, and whatever works for you, may not work for the next person. The other truth is now you have a choice, that was not available seventy years ago, called www.recovery2day.org