Expert: Peter L. - 1/16/2011

Question
QUESTION: 2 years ago our son (Now 21 yrs old) was arrested for possessing OXY. He had been doing pot since high school and oxy for a bout 6 months.  He agreed to go to inpatient rehab for 30 days. Came out, was put on probation, lived at home, got a job, appeared clean, did UA's etc, met with drug counselors and therapist. All seemed good.  A year ago while still on probation for durg offense, he got a DUI.  Several months later he got another DUI.  Probation was revoked and he was sentenced to 6 months in a county residential Therapeutic facility for drug and alcohol offenders, where he had to live and stay and could not leave. Pretty good program where they offered classes, counselors, etc, to help people with addictions and prepare them to to re-enter the social environment.  He had one month left and due to not following some simple rules, the center sent him back to jail. Nothing bad or violent or harmful to anyone but little things like talking in meetings, having food in his room etc.  The judge did not see him as a serious problem/offender so he sentenced him to the section of the residential center where he could go out seek employment but had to stay at the residential center every night.   He found a job but after about 5 weeks there, (about a month ago) he managed to seek out and find oxy and heroin and relapsed. He will finish his jail sentence in about a month.  We, his parents are trying to figure out what we do now.  We have the financial means to help him get further treatment.  He has been diagnosed as dual-diagnosis with addiction, depression, anxiety, panic attacks etc. he gives us no trouble at home, is not violent.  With his background and dual-diagnosis, what would be your recommendations for further treatment at an inpatient facility here in the U.S. that really specializes and focuses on treating dual-diagnosis? The local programs here in our region don't specialize in treating for dual-diagnosis, and outpatient treatment is probably not an option for us at this time for fear of him relapsing again.   His mom says if he doesn't go to treament soon as he gets out of jail, he cannot live at home anymore.  Our son, at this point, is saying he doesn't need more treatment but I know that's the addict in him talking and we really haven't determined what our last ditch treatment option is yet.  Once we figure that out then we can talk with him and say here's the options.  Your thoughts???  Thanks

ANSWER: Hi Steve,

I apologize for my late reply as I've had some catching up to do.  The story of your son parallels the experience of many of my opioid addicted clients.  This is an exceedingly difficult addiction to break, and my clients struggle to maintain abstinence.

Almost everyone with opioid dependence is put on some kind of opioid maintenance therapy.  Most common are Suboxone and Methadone.  I would recommend he be treated with one of these drugs, as his chances of success will be very limited without them.  Opioid addiction is very disregulating to the mind and body, resulting in very long term ups and downs in mood and physical well-being.  

It's my belief, and the belief of many other professionals, that most addicts and alcoholics have some sort of co-occurring disorder, i.e., a mental health problem.  Either these mental health problems precede addiction and increase risk of same, or substance abuse impacts mental health negatively.  Most experts believe both scenarios are true.

Your son will need long-term treatment, starting hopefully with an inpatient stay, and then moving on to an intensive outpatient program that meets 3 or 4 days per week.  Following that, there should be relapse prevention counseling in groups or individually.  

The Brattleboro Retreat in Brattleboro, VT is a facility that treats addiction and co-occurring disorders.  I suspect you don't live near Vermont, as you'd already know of that program.  

There are other programs scattered throughout the US, the problem is whether they will accept his insurance, or how you can get him there.  Plus, follow-up becomes difficult when he is discharged from far away.  

If you give me your geographic location, I can possibly assist you in finding a program.

Peter

---------- FOLLOW-UP ----------

QUESTION: Thank you Peter, Vermont is a long ways from us.  The distance or cost is not a concern for us but good call when you mention follow-up is difficult when far away.  Perhaps we should rethink what to do.  I can tell you, our son was initially at a facility with several locations in Kansas when he first went in for detox and residential rehab/treatment two years ago. He was there for a month.  I don't think they are much on treating dual diganosis. They seem to be more of just group meetings, 12 step program kind of place like so many programs everywhere that have the average success rate.  With his depression, anxiety, panic attacks and his drug addiction, we really hope to find someplace that reaches deep into the mind to find what, in his life, is causing these emotions to swell to the point of triggering his need to do the drugs.  (I failed to mention before, he had also been diagnosed with ADD back in High School)  Before he was sent back to jail recently, he was going to be prescribed Naltrexone by his drug Counselor/Therapist.  You did not mention that medication in your response.  Any thoughts on that?  Unfortuantely, the jail does allow Naltrexone so he has not taken it yet. In fact the jail doesn't allow him to take his ADD meds either. One more question.  What is you experience on treating addiction by looking at it from a neuroscience approach of healing the damage done to the brain from alcohol and drugs to rebalance the neurological system to assure successful recovery. Thanks again.

Answer
Hi Steve,

Dual diagnosis conditions are not fully recognized when it comes to mental health or addiction treatment, as you have alluded to.  As bad as the addiction field may be in offering advanced dual disorders treatment, the mental health field is considerably worse.  That is because many individuals who present for treatment of anxiety, depression, or other mental health concerns do not mention that they have a substance abuse problem.  There is much stigma attached to substance abuse conditions, even though 2/3 of Americans have some contact with addiction in some way.

Mental health clinicians are notoriously slow to discover these co-occurring substance abuse addictions, and even then will often have the erroneous belief that their treatment of the mental health condition will ameliorate the substance abuse condition. A hopeful scenario at best.

As you can see, we have a lot to do.  Unfortunately the substance abuse field is bogged down by traditional methodology, i.e., the very narrow 12-step perspective dominating the field.  It is almost irretrievably locked down by 12 step methodology, and only now is the iceberg starting to melt, and we're getting some integrated or holistic treatment interest.

That is my current area of interest, and I'm presenting workshops on that very topic.  I feel it is the only way we'll advance and get to more people like your son.

Here is a DVD (Addiction: Getting the Addiction Monkey off your Back) that does a good job covering many non-traditional methods in addiction treatment, and may possibly answer the last of your questions.

http://www.burtongoldberg.com/catalog/addiction-59/

I was made aware of this compendium of approaches by a former boss who knew of my interest.

The problem has been that treatment programs and clients have been slow to embrace holistic methods.  We're doing better in medical circles, with more physicians interested or at least accepting of integrated medicine.  A new doctor I see has a sub-specialty in integrative medicine, for which I was very impressed.  She and I "spoke the same language."

A book I'm currently reading is End Your Addiction Now. The writer is one of the presenters in Goldman's DVD.  It seems to explain the neuroscience very well with some nutritional recommendations for rebalancing the system.

http://www.amazon.com/End-Your-Addiction-Now-Nutritional/dp/0757003133

I think this is the wave of the future, but change will come slowly.  It is up to individuals and concerned others to pursue these alternatives.  

A program I'm thinking of in Connecticut is integrative.  It's called Mountainside Treatment Center.  While not possibly a resource for your son, it might educate on how an addiction treatment program incorporates integrative thinking.

Hope all this is helpful to you.

Peter