Precept #6: Drug abusers and addicts can do more than get off drugs; they can achieve mental health.

She’s the goad, the instigator, the person at Muskingum Behavioral Health who gets those recovering from addiction into group discussions, out for road trips, and onto the gymnasium floor for healthy exercise. She publishes F.R.O.G. News each month (F.R.O.G. stands for Fun Recovery Organized Gatherings), and she is the energetic impetus that makes participating in those events attractive, fun, and realistic. She is a voice of hope—You CAN do it!—in a difficult and challenging enterprise.

She is Stephanie Hinds, and she knows what she’s talking about.

“I drank and drugged for over twenty years,” says Hinds. “I had to completely lose everything in order to want treatment.”

One of the things Hinds lost, while using, was day-to-day life with her children.

“I decided to get treatment because I was sick and tired of living the way I was. I knew I needed help. I missed my kids and I missed myself. I didn’t even recognize the person I had become. I used to live and I lived to use…I was also on felony papers and I didn’t want to go to prison. I wanted a new life.”

Addiction had changed Hinds physically, as it changes all of those who fall prey to the disease. “It is well documented by research that the brain is changed by opiates, alcohol, and other addictive substances,” writes Dr. Vicki Whitacre, medical director of the Muskingum County Health Department. “Addiction becomes a chronic relapsing disease with the brain not able to make normal decisions and respond in the way it did before the addicting substance(s) took over.”

Stephanie Hinds demonstrates the truth of Dr. Whitacre’s words. Her brain HAD changed—her goal, while addicted, was solely to obtain more drugs to use. And even after deciding to get treatment, the road was hard.

“I successfully completed outpatient treatment [only] after multiple attempts,” she says now. 

Once successfully in recovery, Hinds set herself a challenging road. She enrolled at Zane State College in the Social Work Assisting program. She wanted to get credentialed so she could help others in recovery achieve the success she enjoys. Her life in recovery is, she says, completely different than her life while addicted.

“I graduated from Zane State College with my associate’s in Social Work. I also hold my credentials as a Chemical Dependency Counselor Assistant, an Ohio Certified Prevention Specialist Assistant, and my favorite, my Ohio Peer Recovery Support certification. I work at Muskingum Behavioral Health. I help clients in any way I can.”

“Stephanie has made a lasting impression on so many people.  She was the student in class who was not afraid to challenge a grade, analyze the reason for an assignment, or explain that the real world is different from the information presented in a textbook,” says Social Work Assisting program director Stacie Curtis. “Stephanie balanced school, work, family life, and the Social Work Club while she was a student at Zane State College. 

“Stephanie was one of the first to volunteer her time to assist others in need.  She was, and is, a mentor to her peers with her bold and gregarious personality.  Stephanie encourages others to obtain an education, and she personally accompanies students to the campus to ensure the potential student obtains the information he or she needs and meets the faculty. 

“She is not afraid to push others to complete tasks that are difficult, and she is a glowing example of how hard work pays off.  I am proud of Stephanie and the sacrifices she has made, the challenges she has overcome, and the support she has become to so many in recovery!”

Steve Carrel, CEO of Muskingum Behavioral Health--MBH,--agrees. “While she was a student at Zane State, Stephanie was in a class I taught,” he says. “She was an excellent student, very inquisitive, always providing input and stories.  She told me at that time she would be working at MBH in the near future.”

MBH hired Hinds once she earned her associate’s degree. “She is doing an excellent job – coordinating recovery events, participating on the local Citizens Circle for people returning from prison, helping with the Friends and Family group, and basically anything else we ask of her,” Carrel says now.  “She is a real advocate for recovery!!!”

In fact, Carrel says, MBH works to extend Hinds’ sphere of influence. “We have been working to get Stephanie into Marysville Prison to work on re-entry for women there who will be returning to Muskingum County.   Unable to make the connection, Stephanie attended a meeting with Gary Mohr, Director of Ohio Department of Rehabilitation and Corrections. Stephanie, not one to miss an opportunity to promote recovery, approached the Director, explained what she wanted to do at Marysville, and had a call from the prison to schedule times for her to go there.  Stephanie,” says Carrel, “is a loud, proud person in recovery.”

She is proof, too, that recovery is possible…and that people in recovery can go on to be physically and mentally healthy, to lead worthwhile lives, and to make a positive difference to their families, their friends, and their communities. It isn’t easy, Hinds says, but it can be done.

“For others seeking recovery, I would recommend finding whatever treatment works for them. There are many pathways to recovery.” And it’s not over once the program is completed, says Stephanie Hinds. “I live recovery every day. I not only work with the 12 steps, I live by them. I am very active in the local AA and NA. I have a sponsor, and I sponsor others.”

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For information on treatment, please contact Steve Carrel (scarrel@mbhealth.org; 740-454-1266) or the Mental Health and Recovery Services Board (http://www.mhrs.org/; 740-454-8557) for information and referral. You can reach the Crisis Hotline at 1-800-344-5818. Find out about Genesis Healthcare’s substance abuse recovery programs at 740-454-5927 or 800-322-4762, extension 5927.

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Recovery is Beautiful image from http://www.recoveryisbeautiful.org/

  

Precept #5: As with any other illness, the prevention strategies and treatments most likely to work aren't based on tradition, wishful thinking, or faith, but science.

If a person does not know they have a disease, they are obviously not going to seek medical care.  Instead, they seek “help” in ways that are proven to be ineffective.

  --Dr. Bryan Borland

.    How do you respond to precept #5?

This precept attempts to clarify that alcoholism and drug addiction are chronic medical diseases that require medical treatment for the person to get better.  If a person does not know they have a disease, they are obviously not going to seek medical care.  Instead, they seek “help” in ways that are proven to be ineffective.  Science has given us the ability to perform research so that we can confidently say what works and what doesn’t.  Sadly, most (>80%) addicts and alcoholics will never be given an opportunity to receive the treatment that has been proven to work. 

We have excellent data that shows there are two factors that influence how likely a person is to become an alcoholic/addict.  These factors are genetics (family history of addiction) and the age that a person begins to use alcohol/drugs.  We can’t alter a person’s genetics, but we can certainly educate children (especially those with an alcoholic/addict parent) on the risks of using drugs/alcohol at an early age. 

      What does our best understanding/current science tell us about effective treatment of addiction?

This question is one I like to simplify because each alcoholic/addict requires an individualized treatment plan that considers a multitude of factors.  I feel secure in simplifying my answer because we (the medical community) are doing such a horrible job that we need to start with the basics.  I will also specifically address and clarify several misconceptions that currently exist in regards to treatment. 

Many alcoholics and addicts require detoxification in a controlled medical setting.  When an alcoholic/addict is no longer permitted to use alcohol or drugs, they experience the symptoms of withdrawal.  The symptoms can be dangerous and extremely uncomfortable.  Therefore, medications are given to help the patient safely and comfortably stop using alcohol or drugs.  Detox is not a treatment for alcoholism or drug addiction.  Without further alcoholism or addiction treatment, detox is essentially useless and in no way increases the likelihood that a person will remain sober.

The Basics of Effective Treatment:

- treatment at a treatment center (rehab), aftercare, and drug screen monitoring

- consideration of a medication to assist treatment

- ongoing long term social support (counseling, AA, NA)

Individually, rehab is the only modality proven to significantly increase the likelihood of achieving long term sobriety (~40%).  Medications and social support alone are not effective.  Patients that participate in all three treatment modalities simultaneously have an excellent chance--more than a 60% likelihood--of achieving long term sobriety.  As an example: physicians, attorneys and airline pilots must participate in all three basics of treatment.  Because of this, these groups have recovery rates greater than 80% at five years. 

Why then does it seem like most alcoholics and addicts never get better?  Well, most alcoholics and addicts are never given the opportunity to obtain the treatment we know to be effective.  Why is this?  Let's explore some of these reasons.

Medical providers have little knowledge in the field of addiction.  Here we have a disease, and patients who are seeking treatment, but the treatment providers do not know how to effectively treat the disease.  Only 11% of patients discharged after a hospital admission for opioid use disorder were provided with at least two of the above listed treatment recommendations. 

Many communities have no access to a quality treatment center.  How can alcoholics and addicts get treatment if there is no treatment facility?

Treatment is expensive and most patients require more than 90 days of treatment.  I understand how inconvenient it is (I spent a ton of money and over 100 days in inpatient treatment… twice), yet patients diagnosed with cancer will readily spend whatever it takes and accept treatments that are beyond horrible.  If they can do it, we can too.

Everyone has commitments in life that can be used to justify why now is not the right time to get treatment – but this is simply not true.  What can possibly be more important than your health and for many, your life?  In reality, if people think you need to go to treatment, you are probably the last person you would choose to be in charge of important things in your life.  There’s a saying in AA: Anything you put before your recovery will be the first thing you lose.  I have personally seen this to be true in my own life, as well as countless others.  That wife will leave, your children will be taken, you will be fired from that CEO position, your money will run out, and your poor health will become permanent.  You can get treatment now, or you can let your life continue to get worse.  It’s your choice – you hit your bottom when YOU decide to stop digging.

Alcoholism and drug addiction are diseases that affect the brain – the brain is what we use to make rational decisions – thus, alcoholics and addicts do not make rational decisions.  This concept is so crucial to understanding the seemingly insane behavior of alcoholics and addicts.  Successful treatment requires the alcoholic and addict to understand that their brain is dependent on drugs and alcohol and will do everything in its power to get them to continue using.  Every decision and thought has a hidden ulterior motive that will ultimately lead us back to using.  Our brain tells us lies, and we believe it.  Why wouldn’t we?  Our brains would certainly never do us any harm – right?  Wrong.  I am sure everyone has watched someone they love nearly die or lose everything in life, only to immediately go back to using.  The brain needs its chemical first and doesn’t care about your life or anything else in it.   

 

      Does personality determine what treatment is effective? If so, can you elaborate?

Not really.  Research shows that people who are forced into treatment do just as well as those who willingly go.  Effective treatment must follow the basics we discussed in Question 2.  A combination of rehab, consideration of a medication to assist treatment, long term aftercare with urine drug screening (normally one-year duration) and social support (counseling, AA, NA).  We know that if a patient completes that treatment sequence, they are very likely to get well – regardless of personality. 

There are certain personality disorders that can complicate treatment.  These disorders are generally screened for while the patient is receiving treatment.  If identified, the patient’s treatment then relies on simultaneous treatment of the personality disorder and their substance use disorder.  This is also true for mental health (depression, bipolar, anxiety), gambling, and eating disorders. 

      Many people would be upset at the thought that faith, attitude, etc., are ineffective in treatment. Does faith play a role? Is there value in the power of positive thinking in addiction recovery?

When I first began lecturing on addiction I would tense up and feel my heart racing as I stumbled to answer this question.  It’s actually quite simple now.  I don’t care what you do as long as it is in addition to – and does NOT replace - the treatment we know works.  You want to go to Church? Absolutely you can, but you are still going to attend aftercare and AA meetings.  Does faith in God, an unquenchable desire to get well, and a positive outlook help?  Probably, but these are not requirements by any means. 

Do we tell diabetics to skip the insulin and just pray for their blood sugars to be lower?  Maybe that kid having an asthma attack just needs to “man up.”  These diseases have nothing to do with faith, strength, or will power.  Substance abuse falls into the same category.  The brain is dependent on the substance – it MUST have it.  To tell an addict to “not use” is like telling a non-addict to “not breathe”. 

      What can families, loved ones, friends, etc., do to identify the science that will help their addicted loved one?

Great question.  First and foremost: Do not try to get your family member sober!  Yes, that’s really what I meant to type.  This is incredibly hard to hear because we want to help the ones we love, but most of the time we aren’t helping.  If a family member is in a car accident, I would hope you would call the Emergency Squad; if they have cancer you would take them to a cancer specialist.  Substance Abuse is no different; they need to go to a treatment center and see an addictionologist. Let the addictionologist treat their addiction – that’s their job and they are good at it.  I’ll make a bold statement here that may seem harsh and uncomfortable: Any attempt to do anything other than get them to treatment is actually doing them harm.

Can a person get sober without treatment?  Yes, RARELY: there's a less than 5% chance.  I can’t accept those odds, so I encourage treatment for everyone. 

 

      What else needs to be said about this precept?

We are fighting a war on drugs and losing.  We know how to treat this disease and yet no one is getting treatment.  How do we get people into treatment?  All I hear is we can’t (insurance, distance, money, they won’t go, they never get well, they all relapse). 

Bear with me as I make this lengthy hypothetical point:

I grew up in Thornville, Ohio.  Imagine if today a man goes into the Thornville community bank and robs it.  The police come and a shootout takes place.  A police officer is killed and the robber is critically shot in the chest.  The emergency squad comes and a young EMT relays the information.  A penetrating chest wound is a Level 1 trauma and thus requires immediate treatment at a Level 1 Trauma Center.  A helicopter is sent out to Thornville carrying a highly trained medical professional (Doctor, Nurse Practitioner, or Medic).  The robber is loaded into the helicopter and they take off.  Now, en route to downtown Columbus, no one checks the robber’s insurance, nor do they ask him for any money.  They arrive at the Level 1 Trauma Center where the man is greeted by no less than two, and probably three, physicians, several nurses, a pharmacist, a chaplain, hospital administrators, registration clerks, x-ray technicians, residents, interns, students, and a social worker.  They still haven’t checked his insurance or asked for payment.  The robber has multiple surgeries and spends two weeks in the trauma ICU.  The next month he is on the trauma step down floor, and finally he is discharged to a Correctional Facility.  He will likely pay nothing for this treatment. (He was robbing a bank so I doubt he has much cash lying around.)

If this is possible, why can’t drug addicts get treatment?  Maybe we need to try harder.  Where are the Level 1 Addiction Treatment Centers?  If this is a WAR on drugs, we are losing.  One in seven Americans will be diagnosed with Substance Use Disorder.  I don’t want to tell patients that I can’t give them the lifesaving treatment they need. 

We have sick patients and we know how to help them – Let’s get to work.

*******

Dr. Bryan Borland graduated from the Ohio University School of Osteopathic Medicine in 2011, and completed three years of his residency in emergency medicine at the Ohio Health Doctors Hospital. He was named the Outstanding Student Leader of the Class of 2011, and was twice nominated for the Doctors Hospital Spirit of Caring award. Dr. Borland, a drug addict and alcoholic himself, was fortunate to receive the high quality treatment proven to get people sober.  He is determined to make this treatment available to anyone struggling with addiction.  

Precept #4: This Disease is Treatable (A Mother's View)

---by Lorraine (Rainy) Oliver

“Everything is connected…no one thing can change by itself.” – Paul Hawken (1946-?)

My son was a curious, bright, mischievous, active, sensitive, and loving child growing up. He was 7 years old and an amazing big brother when his baby sister was born. Unfortunately, shortly thereafter his father and I divorced and had joint custody. My son struggled with going back and forth every other week from one parent to the other. His adolescence was quite challenging to say the least, as his anger and aggressive behaviors became directed toward me and were upsetting to his younger sister. After careful thought and consulting with peers and friends, I let my son go live with his father full-time when he was 15 years old, which is what he wanted to do. That was one of the most heart-wrenching decisions that I have ever had to make in my life. I oftentimes ask myself if things would have been different if I hadn’t done so, but as parents we do the best we can with what we know at the time. I rarely saw my son after that other than at holidays, on special occasions, or when I attended his sporting events.

From what little I know, my son started using pain pills in high school while playing football. As both an offensive and defensive lineman, he sustained several injuries but was encouraged to “suck it up” by others and continue playing. I can only assume that he was originally prescribed pain pills but later started getting them from other people. He told me once that the mother of one of his teammates gave him one of her pain pills just prior to a game because of an injury he had sustained. Of course, he wouldn’t tell me the name of the parent, and at that point in time, I didn’t realize where he was headed with his addiction or he would have heard a lot more than my motherly lecture on why that was inappropriate. During this period in time, I was more worried about my son’s alcohol abuse. He had been cautioned that alcoholism runs on both sides of the family but like most teenagers, he had the attitude of, “It won’t happen to me.” He had totaled two or three vehicles before the age of 21 from what I have been told, and they were all alcohol-related accidents. One accident resulted in him being pinned under his truck for several hours until someone called 911. I had not been informed until the next day when he showed up at my house with bumps and bruises. I was grateful that he was alive and thought this might be a “wake up call” for him. It wasn’t.

A couple of years after he graduated high school, when I did see my son, he was either very “up” or could barely keep his eyes open. His opiate addiction was quite evident and most of the family knew about it. Efforts to communicate with his father were a one-way street. Then one day my son called me and informed me that he was “shooting up” with heroin. That image of my baby boy using a syringe to inject himself with this deadly drug devastated me! No, not my son! Not my baby! I felt like I had been kicked in the stomach with a steel-toed work boot! I could barely breathe. This is when the nightmare truly began for our family. Instead of sharing all the gory details let’s just say it involved physical aggression, threats of sexual harm to my daughter reportedly by “two guys (traffickers) from New York,” my son carrying a 9mm tucked in the back of his jeans, my personal purchase of a 9mm for self-protection, extortion, meeting with the FBI,  coerced urine samples, hearing my son’s name on the radio repeatedly, and seeing his “mug shot” on the front page of the local paper several times. It was like a never-ending episode on the Investigation Discovery (I.D.) Channel and unbelievably terrifying to me as a mother. Over the years my son had multiple arrests for various charges, incarceration at the county jail numerous times, and a couple of short-term inpatient treatment admissions, and none of it seemed to make a difference. I tried to mentally prepare myself that he was either going to die from an unintentional overdose or spend his life in prison.

Fast forward to today. My son has been clean and sober for over a year. He is working full-time and is in a healthy relationship. He is engaged to be married next spring and is already being a great father figure for his soon-to-be four- year-old stepson. He is also wanting to further his education and is looking into doing something part time to help others overcome their addictions. He now calls me at least a couple of times a week and texts almost daily. He is trying very hard to rebuild the relationships that were strained and badly damaged during the years of his addiction. This will take time. For some, it will take more time than others due to the distrust, heartache, humiliation, and fear experienced by everyone in the family.

So how did my son finally get on the path leading to recovery? He recently told me that he doesn’t even know. My response seems simplistic but it is truly more complicated than it sounds. He was ready. He was ready to change and the supports were in place when he needed them to start his journey to recovery. As a mental health professional, I often refer to the Stages of Change with my clientele. The stages include Pre-contemplation (more commonly referred to as “denial”); Contemplation; Preparation; Action; Maintenance & Relapse Prevention. The other critical piece that I previously mentioned was that the supports were in place when he was ready. Although the county jail isn’t the best place to go through de-tox, that is where it occurred this time for my son.  He also developed a rapport with a great counselor and had the support of wonderful staff at Alcohol and Drug Services of Guernsey County. He participated in individual and intensive out-patient group counseling there as well. They saw my son as a person and not just as an addict or a criminal. They advocated for him to get the Vivitrol injection which probably saved his life. I had obtained a Naloxone kit through Project D.A.W.N. (Deaths Avoided With Naloxone) from the local health department in case he ever showed up at my house and accidentally overdosed if he had relapsed. He developed additional support from peers at the Celebrate Recovery meetings at Christ United Methodist Church in Cambridge. He was held accountable by his probation officer with random drug testing. He had family and friends that were supportive and non-judgmental without “enabling” him. Most importantly, he was READY!

As families and communities fighting this plague on our great nation, we need to be prepared with resources readily available when those struggling with addiction are ready to receive those desperately needed services at the time they are ready…. not 30 days later; not depending on what kind of insurance they have (if any); and not when their names come to the top of the “Waiting List”! These services and resources need to include easy and rapid access to de-tox units, inpatient treatment, intensive out-patient services, medication-assisted treatment, sober living facilities, peer recovery supports – whatever it takes! After spending almost a decade living in fear as the mother of a child with life threatening addiction, I realize that my son spent just as long, if not longer, living a life in hell that he would not have chosen for himself. Given everything that I’ve shared in this blog, I hope others realize this too. Given all that he’s done in the past and all that we have endured as a family, and then… to see him now – happy, healthy, loving, generous, working -  I can honestly attest to the fact that addiction IS a disease and recovery IS possible! I have my son back! Treatment works! Recovery IS beautiful!

Lorraine “Rainy” Oliver has a Master’s degree in Education with emphasis on Community Counseling and is a Licensed Professional Clinical Counselor – Supervisor. She has worn many hats while employed by Allwell Behavioral Health Services (formerly Six County, Inc.) for the past 26 years. Currently she is the Director of Allwell - Guernsey County and the clinical supervisor of the Day Treatment and CORE Vocational Rehabilitation Programs. Ms. Oliver is an active member of the Guernsey County anti-drug coalition, Project: C.H.O.I.C.E.S (Community-Hope-Opportunity-Independence-Change-Empowerment-Success) and a proponent of Integrated Dual Disorder Treatment. First and foremost, she is a mom.