Chapter 4

ADDICTED?
NOW WHAT?

Know That You Are Not Alone

Written by Dr. Dina Macaluso, Psy.D, L.M.H.C., Alan Boyd, & Sharon Therien

Addicted? Now What?

You have gone through the stages of addiction discussed in the third part of this guide, so now you are in addiction’s hold (or someone you know is at this point).

This is probably not what you expected for your life, but you find yourself here nonetheless.

The next question is: Now what?

When you find yourself addicted to a substance, you are basically at a fork in the road with one path taking you to recovery and the other bringing you on a downward spiral of addiction.

You might:

  • Hide or manage your addiction

  • Try to battle it yourself

  • Reach out for help

  • Have people in your life intervene and try to get you into treatment

Another possibility is that addiction beats you, causing you to lose parts of your life or your actual life.

It’s up to you if you will continue on the path of addiction, whether it’s what you choose to do or some of the many roadblocks to recovery are standing in your way. Or you could seek treatment for your addiction, even if it requires overcoming certain barriers.

Staying on the Path of Addiction

If you are not getting help for your addiction, you are not alone. The National Survey on Drug Use and Health of 2013 found that 22.7 million Americans of the age of 12 or older required treatment, yet only 2.5 million people got the help they needed in the last year.

So 20.2 million Americans needed treatment for substances but did not receive it.

Why is it that addicted people do not get treatment, and what can happen when they don’t?

First, let’s discuss the potential consequences of sticking with addiction, and then we’ll
cover barriers that could be keeping you from treatment, as well as paths to recovery.

It’s possible for some people to continue with addiction, managing its symptoms and effects on their lives. On this path, the addiction will cause problems for you, but you might be able to deal with them and continue with this way of life. Your ability to manage substances will vary and be affected by the type and quantity of the drug you use. Nonetheless, continuing on this path is likely to decline your health more and more over time, similarly to many kinds of chronic diseases.

One of the possible and probable outcomes of sticking with addiction is that you will lose the battle in some way. Your downward spiral could include disease and a lot of loss, including loss of:

Loved ones

Your home

Your job

Your hobbies

Essentially, yourself

Your addiction could be all you have left in your life if you stay on this path.

Continuing with addiction can and will deteriorate your health immediately and over time. The National Institute on Drug Abuse lists many consequences of addiction on your mind and body, which include:

  • Hepatitis

  • HIV/AIDS

  • Cancer

  • Heart Disease

  • Lung Disease

  • Kidney and liver damage

  • Stroke

  • Prenatal problems

  • Mental disorders

  • More

And whether by an overdose or by the slow progression of a chronic health condition caused by the addiction, substance use can ultimately lead to death.

But treatment is available, and it can work even if it hasn’t helped you in the past. It’s worth trying different types of treatment and continuing despite setbacks to help you keep your life, your health, your family, your career and your interests.

Barriers to Seeking Treatment

Many people decide to stick with addiction or find themselves unable to continue with treatment because of various barriers that stand in the way of treatment and recovery.

All sorts of barriers exist that can cause you to stay with addiction instead of trying to jump over that hurdle or ram your car through that roadblock. If you can figure out what your barriers are, maybe the realization can help you with your treatment process.

Here are many of the barriers that affect addicted people:

Not Thinking You Need Treatment

As you would imagine, it’s a barrier to recovery if you don’t think you need help. Of the 20.2 million Americans who did not get the treatment they needed in the past year, 95.5 percent gave the reason that they didn’t think they required treatment for their substance use, according to the 2013 National Survey on Drug Use and Health.

If you fall into this group, maybe you think you could stop any time you want and you don’t realize the problems the substance is causing in your life. In this case, the drug could have control of your decision-making processes and your reality. It might take some self-assessment or discussions with people close to you to figure out if you do have a problem.

Another scenario is that you feel as though you like or need the substance. Maybe you believe you enjoy addiction and that the substance is making you feel good. Or maybe you think it helps you in some way, such as with pain or with handling social situations.

If this sounds like you, you might want to think about whether the consequences of your addiction are outweighing the benefits you feel like it’s giving you. Ask yourself:

  • Is addiction causing problems with my loved ones?

  • Am I having trouble with work because of my addiction?

  • Is my life centered around the substance?

Social Stigma

It’s easy to experience feelings of shame, fear of judgment and embarrassment centered around addiction. Despite a lot of forward progress in the addiction field, many people still feel that addicted people have a lack of willpower or loose morals. There is still stigma around addiction, which makes many people afraid to admit they have an addiction and equally afraid to seek help for it.

You might be hesitant to tell your boss you need time off for treatment or to let your family know you are looking for help. You might even hesitate to take advantage of employee health programs for treating addiction.

Further, you might feel the need to keep your addiction a secret from friends and acquaintances, nervous about what they would think of you if they knew. Even when many people have gone through treatment, they still fear that their previous addiction will get in the way of new relationships and new opportunities, such as jobs and financing.

The main problem is that people still believe stereotypes about people with drug problems. Journalist Leo Barasi points out that “suspicion, fear and distrust of people struggling with drug problems are widespread.”

This problem can make it much harder for you to get the treatment you need for an addiction. It’s easy to keep the addiction a secret and avoid treatment rather than face the social stigma from those you know. And the lack of social support can make it much harder to recover.

Plus, if people are denied opportunities, such as work or housing, because of drug problems, their hardships can perpetuate the problem.

Many people also face stigma from health professionals. “Some find it impossible to convince doctors or nurses that they need help, even when they are in agonising pain or suffering from long-term conditions,” says Barasi.

And the stigma tends to continue even after they have gone through treatment and are no longer using substances.

“[People with drug problems] are seen as bearing a stigma, an enduring mark that defines them and which cannot be removed by their stopping using street drugs.” It can make it harder for some people to get help when they feel as though they’ll always be labeled as an addict no matter what they do.

Barasi notes that it could be possible to change this stigma within popular culture by reframing media stories and facing the problem head-on. Attitudes have been changing over time with new information on drug addiction that paints a different picture than an immoral junkie. Also, the more people are open about addiction instead of hiding it, the more popular culture can change.

Insufficient Resources

Another common roadblock to addiction treatment is insufficient resources. You might not have the extra money needed to enter a treatment program. And if you enter an inpatient facility, you might need to take time away from work, which could take away from your resources.

Also, your insurance plan might cover a portion of your care, but you’ll more than likely need to pay for some of it. Or you may not have insurance to help with the costs, or your insurance plan doesn’t cover the specific type of care you require.

Insufficient resources could also mean that you don’t have the information you need to get help.

A lack of resources is a common barrier to treatment. Of the group of people in the National Survey on Drug Use and Health of 2013 who did not get the help they needed but did want treatment, the majority said not being able to pay for treatment and not having insurance coverage were the reasons.

To jump over this hurdle, keep in mind that different types of treatment programs exist at varying price points. You might not be able to afford a resort treatment center, but you might be able to find a low- or no-cost outpatient program. And some programs, such as 12-step meetings, are free.

In addition, health insurance under the Affordable Care Act is required to cover substance use and mental health treatment, and cannot deny you coverage because of your substance use, explains Michael Dahr.

The Affordable Care Act also helped many states expand Medicaid, which could help if you are unable to afford an insurance plan.

If information is what you’re lacking, look to websites that provide resources and/or seek help from health professionals.

Ongoing Relapses

Some people really try to seek treatment and overcome addiction, but the relapses that result after treatment stand in their way of full recovery. You might end up feeling like professional help doesn’t work for you, but sometimes, it can take numerous times in treatment before it finally works.

But each time, you learn new techniques and can progress toward recovery. Also, there are different kinds of treatment and different viewpoints on addiction, which you can read more about in the first part of this guide. It’s possible that one type of treatment won’t work for you, but that another type might.

For example, perhaps you would benefit from a wilderness program or from
cognitive-behavioral therapy instead of a 12-step program. You also might need a combination approach, such as medical detox along with therapy.

Do you continue to try the same approach each time? It might be time for a change.

If relapse is a problem for you, it might help to work on coping strategies and cues, which a professional can help you with. Alternative coping strategies to substances could help you stay away from substances during times of stress.

And you might need to retrain your brain through cognitive-behavioral therapy to stop associating certain cues with your substance of choice, which is most likely one of the main factors bringing you back to addiction each time.

You might also need to break free from people that you used substances with. And everyone is different. Some people are able to enjoy a little alcohol or a cigarette, while others need to stay away from all substances to prevent a relapse of their specific substance.

Susie Shea, owner of a drug treatment center in California, explains that it helps prevent relapse when you work on some of your own personal barriers to recovery, which could include:

  • Uncertainty of what your life will be like if you do recover

  • Overconfidence about your ability to stay away from substances

  • Being closed to different perspectives on ways to live and strategies for overcoming addiction

She also mentions that a mental health concern could get in your way, so it could help to be evaluated for a co-occurring mental disorder and be treated for that if needed.

Trying to Beat Addiction Alone

Maybe you hold the belief that you will be able to beat your addiction on your own or that you should do it on your own. This method can and does work for some people, and certain tools might help, such as:

Faith

Yoga

Lifestyle changes

A change in environment

But everybody is different, and trying to do it on your own won’t always work. If you
haven’t succeeded with personal attempts at sobriety, that doesn’t mean you have failed. Instead, it probably means that you could benefit from some outside help and another perspective.

Professionals can offer their expertise in addiction, helping you figure out your risk factors and the best way for you to fight the addiction. There are different types of treatments, so you might need to seek help from a professional trained in a certain specialty that you don’t have the expertise in.

Plus, detoxing from certain substances, especially alcohol, opiates and benzodiazepines, requires professionals for your health and safety. You might need a medical detox to survive the withdrawal symptoms from these substances.

Continue reading for more on treatment.

Barriers Specific to Certain Populations

Certain populations can have specific barriers to treatment as well. For example, certain races, cultures and genders could have their own roadblocks. This list is not complete, but will give Asian-American Pacific Islanders and women as two examples.

  •   Asian-American Pacific Islanders

    In a study published in the Psychiatry journal in 2007, Timothy W. Fong, MD, and John Tsuang, MD, MS, discuss that there is an idea that treatment doesn’t work for Asian American Pacific Islanders, but that in reality “AAPI substance dependent patients are less likely to enter substance abuse treatment as compared to non-AAPI substance dependent patients.”

    The reasons for this include:

    • 1. A lack of access to proper healthcare for this group because of language, no insurance and other reasons.

    • 2. A lack of substance use professionals who are specifically trained and aware of the needs of this group and able to customize services to them.

    In addition, Fong and Tsuang explain that this group has a tendency to try to solve problems, including an addiction, within the family instead of facing the shame of asking for help outside the family. The family will act as though everything is fine, even though they need help.

    Further, this group is hesitant about treatment because of “AAPI past experience with addiction treatments in their native countries whereupon such treatments are often equated with incarceration, banishment, or long-term institutionalization.”

    The authors of this study think that treatment programs need to be understanding of this culture’s beliefs and practices to provide services in a manner that will work for them. If you have trouble seeking treatment because of your culture, try to find a health professional or treatment program that speaks your native language if needed and that is sensitive to your cultural needs.

  •   Women

    In the case of gender, “Women are more likely than men to face multiple barriers to accessing substance abuse treatment and are less likely to seek treatment,” says Carla A. Green, Ph.D., M.P.H.

    Women tend to have trouble leaving their home responsibilities; including taking care of children, cooking and cleaning, and possibly caring for aging parents; to enter treatment.

    Further, women seem to be able to hide their use better than men, as Green shows that health providers, child protective services and employers are less likely to notice a problem in women than men.

    Green notes that women often have more difficulty paying for treatment, and they are often discouraged from treatment by family members and even physicians.

    To get around these barriers, Green explains that it can help to go after programs with child care services and gender-specific programs.

    In addition, women tend to look for help from their primary care providers and mental health providers, but you are more likely to succeed with treatment if you go to a specialty setting for substance use.

    Also, try to get the people in your life to recognize that you and the whole family will be better if you are able to dedicate some time to your recovery, and try to find a support system that can help with your responsibilities while you are in treatment.

Fear of Withdrawals

Once you are addicted to a substance, you will experience some symptoms of withdrawal when you try to quickly stop using the substance. Having gone through the pain and suffering of these withdrawals before, or knowing and imagining what they’ll be like, is enough to make many people avoid treatment.

Going off any substance will generally create some common withdrawal experiences. The National Council on Alcoholism and Drug Dependence lists these as some of the symptoms of withdrawal:

Sweating

Shakiness

Anxiety

Irritability

Vomiting

Nonetheless, the withdrawal symptoms will vary depending on the type of
substance you are using, explains Mount Sinai Hospital. For example:

  • Withdrawal from marijuana can take away your appetite and give you chills, among other symptoms.

  • Withdrawing from cocaine can make you feel depressed, anxious and tired.

  • Going off alcohol can give you hallucinations, shakes, seizures and more.

So expect to experience differing withdrawal symptoms based on your particular substance. The withdrawal for higher amounts of substances or from certain kinds of substances, such as opiates, alcohol or benzodiazepines, can make withdrawal dangerous to your life. That’s why a medical detox is needed in some cases.

But one of the worst parts, according to Dr. Marc Myer of the Hazelden Betty Ford Foundation in Minnesota, is “a severe depression and feeling that you’re never going to pull out of that state.” Because of that, he notes that, “It’s pretty well known among [treatment] providers that, because of that feeling of hopelessness, the anticipation of the withdrawal is oftentimes worse than the actual thing.”

You have to stick with recovery even when it seems hopeless, and a strong support system and effective treatment program can help you do that.

“Recovery may not happen immediately. A person may not feel all the way better immediately or on their timeline, but it does happen. It always happens,” says Myer.

Treatment can help with your withdrawal period so you can have better success with recovery. A medical detox can monitor the state of your body and possibly help with symptoms through medication. In addition, treatment can provide features that can help you get through withdrawal and stick with sobriety, including:

  • Support groups

  • Various types of therapy, including cognitive-behavioral therapy

  • More

Seeking Treatment Toward Recovery

Don’t give up on recovery. It’s something that is possible for you to achieve. If you are able to recover from an addiction, you could improve your health and your life overall.

To achieve this goal, work on overcoming the barriers that are holding you back from recovery, and consider whether addiction is helping or harming your life and the lives of those around you.

Treatment for addiction can be different for everyone. That’s why it can be difficult for treatment to work, but it helps for you to figure out what will help you and seek out that kind of treatment. Don’t be afraid to lean on help from a personal support system and from qualified addiction treatment professionals. If people in your life are holding you back from treatment, go after a new support system of people who will understand what you’re going through.

Lea Winerman explains that a large part of the problem in finding effective treatment is the gap between what is available and what is actually being practiced. She elaborates, “Over the past decades, researchers have developed effective pharmaceutical and behavioral treatments for addiction. Yet in residential and community treatment programs around the country, these evidenced-based treatments are relatively scarce.” She explains that many programs are not run by qualified professionals and rely on outdated views and information on addiction.

Winerman explains that the health care system needs to change to further treatment.
But in the meantime, there are effective, evidence-based treatments you can find, including:

  • Cognitive-behavioral therapy, which retrains you to react differently to triggers

  • Medications, which help withdrawal symptoms

  • Contingency management, which provides positive reinforcement through incentives

  • Motivational interviewing, which helps you identify your motivations for becoming sober

You might be able to overcome an addiction on your own, but it’s important to recognize that substances can take hold of your body and mind. Qualified addiction professionals have many tactics that might help you overcome addiction once and for all — you just might need to search to find the right program for you.

In the end, the key to beating addiction is finding the method that works best for you and your life.

Continue reading our guide to learn more about treatment and recovery, so you can create a new life that is not controlled by substance use.

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