Substance Use Disorders: What to Expect in Treatment

Today, let us focus our attention on the topic of addiction and substance use disorders.

This brief blog entry is not an exhaustive treatise on this highly complex area, nor is it a substitute for treatment or a consultation.

It is an overview of how some clinicians may work to help clients who present for help with such concerns.

Substance use (alcohol, cannabis, cocaine, meth, heroin, ecstasy, benzos, fentanyl, etc.) is very serious and deserves proper diagnosis, management, care, and treatment.

Left untreated, addiction progresses. In its course, it impacts the client's life in extremely adverse ways. In this blog, the spotlight is on substance use disorders - not on behavioral addictions.

In my work with clients who present with substance use issues, I witness addiction wreaking havoc on the whole person: on their health, finances, legal status, employment, relationships, mental health, and housing, among other areas. Substances harm clients' daily functioning across many domains of daily life!

Another dimension of addiction to highlight is the area of anosognosia - a lack of insight, a lack of awareness into the very existence of a problem. For instance, this may be evidenced when a client goes through the experience of several and consecutive DUIs without acknowledging the underlying issue, or when a client is cut off from the family system due to a problematic substance use pattern that creates anger and conflict on an ongoing basis without seeing this dynamic for what is is.

Anosognosia progresses along with the addiction itself: the more damage a substance causes, the harder it becomes to see its pernicious impact from the perspective of the affected client. In cases where conditions, such as alcohol use disorder, are severe enough to bring on organic brain deficits, it is yet harder to reckon with the high costs wrought on by the substance.

Multiple bodily systems take a "hit", as it becomes harder and harder to fight the chronic decease that is addiction.

Clinicians fight for the clients' lives when it comes to substances.

We seek to work in accordance with the gold standard of care. However, due to the chronic nature of the conditions, substance use frequently takes a deadly toll on the clients.

During my career, I have indeed witnessed loss of life due to substances. I have indeed received phone calls from grieving relatives advising me and my practice colleagues of untimely and often accidental passing of our clients. It is overwhelmingly sad to receive such news!

During Covid-19 lockdowns, all existing societal problems have exacerbated, and, not surprisingly, addiction has been "front and center".

Access to behavioral care became harder to obtain, with longer wait times, as clients' daily stressors went through the roof, and their coping repertoire became insufficient.

Substance abuse is a type of silent pandemic that is raging behind the scenes of the Covid-19 pandemic that is on everyone's mind, day and night.

The problem with the "silent" part of the substance abuse pandemic is that this silence kills.

For instance, in case of fentanyl and other opioids, the deadliness factor is off the charts.

A single-time use, which could very well be someone's first and only lifetime use of any opioid, can be deadly, as overdoses are not always addressed in time.

Drug dealers cutting and mixing opioids intended for street sale are not chemists and do not guarantee safety with use. Playing the proverbial roulette this way is extremely deadly.

Cheap opioids flooding our streets is a terrible mark of our times. We simply do not have the resources to keep up with the ever-growing need for substance abuse care. Nor do we see enough prevention and information disseminated to the population to help understand the opioid addiction or enough beds and outpatient providers to help fight this ill.

Treatment should take place at every stage of addiction. It is a treatable condition! Your therapist will work to integrate your therapy in with consultations and services of psychiatrists, addictionologists, primary care providers, specialists, 12-step support group providers, and a recommendation to obtain a so-called sponsor (a 12-step recovery program veteran who can help you work the recovery steps and support you in your recovery journey with customized goals).

Once you decide to avail yourself of the full spectrum of treatment services, having embraced the unmanageable nature of the addiction as something you are powerless against on your own, we have encouraging news for you by way of the available care that you can pursue.

We have the world's leading system of care to help stabilize your substance use disorder. Depending on your needs and circumstances, you may utilize the following resources: withdrawal management (also known as detox), residential rehab, partial hospitalization, intensive outpatient treatment, and routine outpatient treatment. You have the ability to choose inpatient versus outpatient care, depending on your attending team's recommendations.

If you carry an insurance policy, chances are you have coverage for these levels of care, but you should always verify this by calling your insurance company ahead of time (perhaps your provider offers to do so on your behalf). If you have Medi-Cal/Medicaid, then you are also able to access services by calling your county information line for linkages.

It is important to persist and persevere in this journey, to stay the course of treatment, to set meaningful treatment goals, and to trust the process, as hard as it may be.

Healing and recovery become lifelong goals. They enrich you. You discover new ways of coping; you discover your strength.

Nowadays, you will be delighted to learn, your doctors will have a number of pharmacological tools to help address any ongoing cravings for alcohol and opioids, those vestiges of old behaviors that may hang around and persist long after you have stabilized your overall status with regard to substances.

In coordination with your overall system of care, your therapist will work alongside the above-mentioned specialists and providers by addressing your old traumas, depression, anxiety, mood swings, self-sabotage, loss of motivation, relational problems at work and at home, etc.

You are not alone in this journey. Please reach out for help today!