FAQ :: Frequently Asked Questions and Answers about Recovery and Addiction Treatment from Dr. Harry
APRIL 7, 2015
I’ve been in recovery for 25 years. For the first time in my life, I’m watching movies and television shows about recovery on almost every channel. Have you noticed a shift in attitudes about recovery?
Absolutely. There are more television shows, documentaries, mini-series, and movies made about addiction and recovery than ever before. So many, in fact, that it would be impossible to list all of them in the space allowed for this article. Addiction and recovery, once fairly taboo and serious topics, are now not only mainstream but include some award-winning shows. And the media isn’t limited to on-screen performances. Plays and even bands where every member is in recovery and not afraid to write and perform songs about their new lifestyle are growing in number.
While there are dozens of shows and movies that portray addiction and all the drama that goes with it, what’s more interesting to me are those that (as you say) portray people in recovery. This, I believe, is happening for many, many reasons—first and foremost being that times are changing.
First, the Twelve Step program, which owes some of its growth and strength to ensuring that members remain anonymous, now contains a large number of people who admit to being “friends of Bill.” They don’t harbor shame about their disease and willingly opt to put a face on recovery. I’m referring not only to headliner personalities but to everyday people.
This willingness to speak out didn’t happen overnight. A couple of generations of kids have been raised to disregard the long-standing stigma associated with addiction. And the fact that addiction is proven to be a brain disease helps to take this stigma away as well—it’s not a moral defect. Almost everyone knows an alcoholic or an addict. With the ongoing growth of treatment programs and Twelve Step programs, more and more people know someone in recovery.
Active addiction usually involves some amount of drama, so portraying the life experiences of an addict or alcoholic has entertainment value. But the media are now seeing recovery as a life experience and sharing it with the world. This in all likelihood is because Hollywood is no stranger to addiction and recovery. A growing number of producers, directors, writers, and actors embrace their recovery—and aren’t afraid to admit to the world that alcohol and other drugs were problematic for them and, in fact, ruined their lives.
They yearn to share the types of miracles recovery brought into their lives.
What’s beautiful is that the shows aren’t sugar coated. Recovery can be hard, especially early on when cravings and old thinking (“stinking thinking”) dominate. Recovery doesn’t end conflicts but shows us how to get through them. Recovery doesn’t instantly instill trust but shows us how we earn it back. Recovery doesn’t give us a perfect personality but helps us identify where and when we’re falling short—where and when we could do better, be better.
The media has never entirely shied away from portraying people in recovery (think Cary Grant in the Philadelphia Story) but until recently, the person in recovery had a “guest” role on a sitcom or recovery itself was not the major theme. In Cheers, for instance, everyone drank except bartender Sam Malone, a recovering alcoholic, but recovery was most definitely not the focus of that show.
The overarching impact from my point of view is that, if media is a reflection of society, then recovery is now being seen as “normal” and “cool.” It’s cooler to show up and function and engage than it is to harm self and others. Imagine that. Now imagine what might happen in generations to come. Drinking as a rite of passage might go by the way of sacrifices and blood-letting. So I applaud these producers and directors and actors. Recovery is cool. The world just doesn’t know it yet.
APRIL 18, 2016
What’s being done to address the painkiller epidemic? Why are so many people overdosing and so few getting help?
You are right—the nonmedical use of painkillers has become an epidemic in the United States and a very serious one. Before I answer your question, let’s look briefly at how the use of painkillers spiraled so quickly out of control.
In the late 1990s, the medical community began monitoring pain as a fifth vital sign (in addition to temperature, heartbeat, breathing rate, and blood pressure). The idea was that pain had for years been undertreated—which was true. Patients would come into the office with chronic conditions that could be excruciating—nerve or back pain, for instance—but as doctors our hands were tied. We couldn’t ethically prescribe refillable prescriptions for highly addictive narcotics, regardless how much pain our patients endured. The fear was that these patients would find themselves addicted to the drugs meant to help them, creating yet another issue. So, we advised them to take an over-the-counter aspirin or anti-inflammatory.
Toward the end of the last century, a study showed that only a small percentage of people with chronic pain actually became addicted to narcotics when used long term. Advocates for chronic pain patients lobbied that, given this information, not treating chronic pain patients was unethical. And so the medical community began asking patients to identify their pain level on a scale of 1 to 10. If a patient’s pain level was 6 or above, the doctor was obligated to prescribe a painkiller.
Chronic pain patients were now being cared for, but the efforts backfired—and quickly.
Narcotics, like other mood-altering drugs, create what we in the addiction field call “tolerance.” The body adjusts to the effects of the drug so that taking it no longer produces a high. Instead, we feel normal. But without the drug, we are anxious, uncomfortable, feverish—in other words, we’re in withdrawal. So we take the drug to avoid withdrawal and to feel normal. In the case of chronic pain patients, the prescribed dosage no longer conceals the chronic pain it was meant to treat. Many patients find themselves taking three times the prescribed dosage and still suffering from pain.
Now we’ve got two issues: chronic pain and addiction. The narcotic is no longer serving its intended purpose—the patient is in pain, again. And, addiction has taken over, so that the narcotic is now necessary so the patient can feel “normal.”
In response to the urging of their patients, some doctors agree to up the dose or to fill an extra prescription if they feel it’s necessary. But those who can no longer manage to get their drugs via prescription turn to the street, where dealers have these pills readily available, as well as very pure heroin—which is stronger and often cheaper than pills—creating an epidemic of frequently fatal overdoses across the country.
Since 2002, use of prescription painkillers has doubled. From 1998 to 2008, the number of people being treated for opioid abuse increased 400 percent. Opioid-addicted patients tend to have a higher than usual treatment drop-out rate and have been more likely to overdose during a relapse. But this is changing.
The federal and state governments, along with alcohol and drug treatment centers, educators, and advocacy groups have spearheaded several initiatives to help combat the epidemic from many angles, including prevention, monitoring programs, law enforcement, and enhanced treatment models.
Educational programs in schools and communities are now widespread, informing students, parents, and health care workers of the potential danger. Drug-monitoring programs and overdose education are meant to help those currently on painkillers. Law enforcement has been more aggressive in dealing with “doctor shopping” and “pill mills,” which is how some addicted patients get more of their drug of choice.
On the treatment end, patients now have greater access to medication-assisted treatment (MAT). With MAT, clinicians can administer drugs that reduce cravings during withdrawal and throughout the course of treatment and even into early recovery. This has the effect of keeping patient in treatment longer, which is proven essential. In some states, MAT has reduced opioid-related deaths by nearly 30 percent. MAT has been shown to reduce positive opioid drug tests in up to 80 percent of treatment patients. This is significant.
It’s likely that chronic pain patients will still receive prescriptions for narcotics, at least until the medical community comes up with a better solution. The development of nonaddictive painkiller medication is underway, which may have a big impact on future patients.
It’s important to know that there are many alternative methods to treating chronic pain. Ask your doctor or seek help elsewhere. Meditation, acupuncture, tai chi—these completely natural methods work. I’ve seen it day in and day out at the Betty Ford Center. Patients come in wheelchairs with 15 prescription medications, including painkillers, go through our pain management program, and leave on their own two feet. Do your research, though. Avoid pain management clinics that keep you addicted. Look for alternative, drug-free solutions. They work.
April 25, 2016
How do you know when it’s time to get help for a drinking problem?
This is an excellent question because most people believe the myth—that alcoholics and addicts have to lose everything before they’re ready to accept help. The truth is that addiction, regardless of what stage it’s at, is a treatable disease. And people can get help before their world falls completely apart.
First off, let me explain that addiction is defined in part as a loss of control around use. It doesn’t matter how much control you’ve lost. What matters is that the disease has control.
For example, Penelope has never been much of a drinker. She splits a beer with her husband on occasion and that is enough. When her husband dies suddenly of a massive heart attack, Penelope is consumed with grief and loneliness. She opens an old whiskey bottle she finds in the cupboard and begins sipping on it to forget her pain. She drinks a shot every night. One evening, she decides to take a shot before going to her granddaughter’s recital. Her granddaughter tells Penelope that she smells funny. The next day, Penelope takes an online drinking assessment in begins an outpatient treatment program.
Joe goes to the bar with a friend knowing he has to deliver a big presentation at work tomorrow. He swears he will have no more than two drinks and call it an early night, but he ends up closing the bar. He does this not once in a blue moon but enough to make him wonder why he can’t stick to his plan. Although Joe has a bad headache, his presentation goes fine. His boss doesn’t know he’s been drinking a lot, although he notices that Joe seems tired lately. His wife works evenings, so she doesn’t complain about Joe being gone all the time.
Joe’s life is basically intact, but he’s lost control of his ability to decide whether to have a drink. Fast forward six months, when Joe gets pulled over for driving under the influence. Now he’s got a legal problem related to his drinking—a major consequence. His license is suspended and his wife, after working late every night, has to wake up early to drive him to the office. She’s now more alert to his drinking habits because it’s beginning to affect her directly. Joe and his wife have a heart to heart conversation about how much alcohol he’s been drinking. Joe agrees to go in for an assessment to appease his wife.
On the other hand, Angela has been a hard drinker all her life. She lost her nursing license when she showed up intoxicated for work one day and refused to get help. Jobless, she couldn’t pay her mortgage and lost her home. Her siblings, tired of loaning her money, have stopped returning her calls. Angela never had control—her first drink at age nine convinced her that alcohol was what she needed to feel whole. She made it through high school and nursing school and held a job for ten years before getting fired. Angela is a regular at the corner bar. She’s also homeless. She has no desire to seek help. Alcohol is more important to her than life itself.
Penelope, Joe, and Angela have the same disease. They’ve each lost control over their drinking to one degree or another. But each of them has a different “rock bottom.” For Penelope, the thought of disappointing her granddaughter was unbearable. For Joe, the thought of losing his wife catapulted him to get help. Angela does not care about her rock bottom. She doesn’t feel she’s reached it. Angela’s rock bottom could have been death, but when she wound up in jail after assaulting an officer, she was sent to detox and then enrolled in a treatment program.
I see people at Twelve Step meetings sometimes compare themselves to other alcoholics in the room. When the Angelas of the world tell their story at a meeting, the Penelopes of the world sometimes feel diminished—maybe they don’t truly have a problem. After all, they didn’t lost their home or end up in prison. But Penelope did have the disease of addiction. She didn’t need to lose everything to understand that she needed help.
Everyone has a different rock bottom. If you’re questioning whether you need help, there’s a good chance that you do. There’s no need to wait until all is lost. If you or a loved one has lost control, get help. Millions of others have walked the same road before you. Treatment works. The Twelve Steps work. No one will judge you, so do not judge yourself.
May 23, 2016
I’m scheduled to have surgery next month. However, when I met with the surgeon, he seemed “out of it.” I’ve been reading about the number of health care professionals who have an addiction. While this surgeon is supposed to be the best in his field, I couldn’t help thinking that he might be using drugs. Is this something I should be concerned about when I visit my physician?
In the addiction field, we like to say that addiction is an “equal opportunity destroyer.” It affects people regardless of education level, profession, race, age or gender. Some of the most brilliant minds in the world have succumbed to addiction to alcohol and other drugs—including doctors. If you suspect that your doctor was “high” during a consultation—and fear he might be under the influence while you’re in surgery—by all means you should be concerned.
The vast majority of physicians do not have problems with drugs or alcohol. But at the same time, health care professionals are not immune to addiction. In fact, an estimated 10 percent of health care workers are addicted to alcohol or other drugs, and they are just as likely as the rest of the population to suffer from addiction.
Most health care workers are in the field because they want to help people. Yet the reality is they work long hours under stressful conditions. It’s not unheard of for some of these professionals to turn to alcohol or readily available prescription drugs in order to combat stress and fatigue. And even stealing drugs from a clinical setting or directly from patients—called “drug diversion”—happens more often than you might think.
When doctors, nurses, techs and other health care professionals are addicted, the consequences can be very serious. Instead of helping patients, these workers become a health threat. Health care workers who divert drugs from patients put patients at risk. Those who are under the influence of substances are likely to perform poorly and make mistakes, also putting patients at risk.
We don’t want to jump to conclusions about anyone because in most cases, our health care providers are highly professional and healthy themselves. If you confront your surgeon about drug use and you’re wrong, you’ve just insulted the integrity of the very person you’re counting on to save your life. So keep in mind that sometimes we may meet our doctors on a day when they are overly tired from lack of sleep, which makes their eyes look glazed over or make them seem less articulate than usual—all signs that might mimic someone who is on mood-altering substances.
However, if you have a strong indication that a health care professional charged with your care is under the influence at work, there are steps you can take to protect yourself. First, you can bring it up with another health care professional in their office. Another option is to make an anonymous call to the medical board and report your concerns or suspicions. The board will take immediate and direct action. Clinics and hospitals are also now highly tuned into employee drug diversion and drug use on the job, and many of them now have employee education programs about drug use, as well as policies on how to handle employees suspected of having a substance use disorder. These policies help doctors and nurses get the help they need.
At the Betty Ford Center, our Health Care Professionals Program helps physicians and other health care professionals recover from addiction. With holistic and individualized treatment, using evidence-based practices and a Twelve Step approach, health care professionals benefit from specifically designed individual and group counseling, educational presentations, weekly group sessions and peer support.
The good news is that most doctors and other health care professionals do well in treatment and long-term recovery. While this may be due to their personal commitment to maintain sobriety or their desire to continue working in the health care profession, it is also due, in part, to adhering to the strict guidelines of the medical board and monitoring programs in order to regain their licensure.
August 29, 2016
My 72-year-old wife recently got out of addiction treatment. She’s been attending AA meetings, and I’ve been attending Al-Anon. This is my first exposure to a Twelve Step Program. I have to say that, the more I experience the program, the more impressed I am. What makes the Twelve Steps so effective? Can you share some of the history of the Steps?
The Twelve Steps are brilliant. And you don’t need to take my word for it. Just ask the millions of people who have found peace and serenity and joy by going through them. Knowing their history makes them even more intriguing.
Lots of books have been published about the history of Alcoholics Anonymous (AA) and cofounders Bill W. and Dr. Bob. Most of them mention how Bill W., who suffered for years from severe alcoholism, suddenly—miraculously—found sobriety in 1934 while in a hospital “drying out.” Utterly disgusted with his life and himself, Bill got down on his knees, asked God for help, saw a white light, felt an overwhelming sense of peace and well-being, and then drank no more. Thereafter, his life was filled with a passion to help other alcoholics (the first one being Dr. Bob). It was as simple and as fast as that.
Those of us in the Twelve Step Program call Bill W.’s experience a spiritual awakening—and a powerful one at that. This helps to explain why the Steps are spiritual in nature. Bill W. sketched them out shortly afterward in 1938, while writing chapter 5 of Alcoholics Anonymous (the Big Book), a book he intended for people who could not make it to AA meetings—and one that is now in its fourth edition and used by everyone in the program. As a basis, he used tenants of the Oxford Group, a spiritual organization popular in the twenties and thirties and one which Bill had joined just prior to getting sober. Other influences included Dr. Silkworth, his physician at the hospital, who insisted alcoholism was an illness, and a book by William James entitled Varieties of Religious Experiences, which covered the gamut of routes for finding spirituality.
How is it that one man could create such powerful tenants based on just a few influences? Bill later wrote that he crafted the Steps in as little as 30 minutes, after asking for guidance from his “Higher Power.” Silkworth was key in adding what Bill called the “missing link”: to get sober, an alcoholic needs to talk to someone who’s been there. Dr. Silkworth could talk to alcoholics until he was blue in the face without results, but alcoholics would listen to an alcoholic who’d sobered up. James’s work was key in ensuring AA would be a spiritual program but never a religious one.
So what makes the Steps so brilliant? They take anyone—regardless of age, income, gender, race, and so forth—who’s willing through a process that helps to destroy the powerful illusion, created by the ego, that says we are separate from and more powerful than our Higher Power (God, the Universe, etc.). This illusion has us believe we can control anything, including our drinking or drug use. It also tells us we are not good enough to be close to our Higher Power, working with our HP in love and joy. The Steps help us see self-destructive thoughts and actions for what they are.
Their brilliance also lies in the fact that anyone, from any religious background, regardless of whether they believe in God or are angry with God, can employ them in their life and see a 180 degree difference in their world. Peace and gratitude replace discontentedness and “self-will run riot.”
There are different routes to sobriety. Most treatment centers use the Twelve Step Program along with a more clinical modality (such as cognitive-behavioral therapy) to approach patients holistically—provide them with spiritual, mental, emotional, and physical recourse. It works.
I applaud you and your wife. Stick with it. The miracles will continue.
For those of you who do not know the Twelve Steps, here’s a link to Alcoholics Anonymous website. Here, you can read more about AA and the Twelve Steps.