Relapse: A Monster In The Recovery Machine

November 23, 2013

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By Terence T. Gorski
In sobriety, relapse can sneak up behind us like a phantom in the dark.
There are many warning signs that can lead to relapse. No one thing brings us into recovery and no one thing leads us back into addiction. Recovery is the process of making and then remaking the decision not only to STOP drinking and drugging – but also to start and then maintain a way of life that provides meaning and purpose to us in sobriety. We also need ongoing support for recovery and a willingness to learn new ways of thinking and being. Solutions? Yes! Simple solutions? Don’t I wish!

Relapse is a process that begins long before the first use of alcohol or other drugs. Like an avalanche, the first signs are small and seem insignificant. If ignored the problems leading to relapse keep crashing down hill and growing in strength.

Being alert for the subtle warning signs that lead to relapse is, in my opinion, a critical recovery skill. These relapse warning signs start, not with thoughts or urges to use alcohol or other drugs, but with simple problems and subtle ways of irrational thinking that cause unnecessary pain and problems in recovery. When the pain is severe and the problems overwhelming, addiction sneaks up behind us like a phantom in the dark. The addiction whispers in our ear. It tells us over and over again that the only thing that can stop the pain and solve our problems is using our drug of choice. Then, and only then, comes the addictive thinking and the craving. At that moment, before putting our drug of choice in our bodies, we are in a crisis of sobriety. We are standing hypnotized by the approaching avalanche of addiction. If we don’t awake from the trance in time, we will be crushed.

Simplistic answers to the problem of relapse, in my experience, are comforting but not helpful. We must do the work of learning what this “cunning, baffling, and powerful” disease is doing to us in our sobriety. Once we are sure we have it beat forever, the disease has already won! It is only a matter of time. This is why in my understanding of the 12-Steps, we must work a daily program of rigorous honesty and correct problems as soon as we are aware of them. This early identification and solution of problems is a critical survival skill for those of us who are addicted.

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Addiction Treatment and the Affordable Care Act (ACA)

November 22, 2013

By Celia Vimont
February 26, 2013

An Introduction
By Terence T. Gorski

The following article by By Celia Vimont summarizes the predictions made by Thomas McLellan, PhD, who reported at the 2013 annual meeting of the New York Society of Addiction Medicine that he believes that the Affordable Care Act (ACA) will revolutionize the field of substance abuse treatment.

I am not as optimistic as as Dr. McLellan about the positive impacts of the ACA on overall recovery rates for addiction clients. Here’s why;

1. When addiction services are merged into medical services the addiction tends not be diagnosed and initial referrals are made to individual doctors most who use medication management.

2. Residential Rehabilitation will not be considered an essential services.

3. Brief screening and early intervention will be attempted but relapse rates tend to be high.

4. Stigma and poly-drug abuse that mixes legal and illegal drugs will both deter early voluntary intervention.

Here is the article reporting on Dr. McLellan’s projections, which are far more optimistic than mine.
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The ACA Could Provide Substance Abuse Treatment to Millions of New Patients”

“It will have more far-reaching positive consequences for substance abuse treatment than anything in my lifetime, including the discovery of methadone,” he said at the recent annual meeting of the New York Society of Addiction Medicine.

“It will integrate substance abuse treatment into the rest of health care.”

Currently, just 2.3 million Americans receive any type of substance abuse treatment, which is less than one percent of the total population of people who are affected by the most serious of the substance use disorders—addiction, said Dr. McLellan, who is a former Deputy Director of the White House Office of National Drug Control Policy.

Most who receive treatment are severely affected, he said.
“If diabetes were treated like substance abuse, only people in the most advanced stages of illness would be covered, such as those who had already lost their vision or had severe kidney damage,” he said.

A. Thomas McLellan, PhD
Dr. McLellan reported that 23 million American adults suffer from substance abuse or dependence—about the same number of adults who have diabetes.

An additional 60 million people engage in “medically harmful” substance use, such as a woman whose two daily glasses of wine fuels growth of her breast cancer. The new law will allow millions more people to receive treatment, including those whose substance abuse is just emerging.

Under the ACA, substance abuse treatment will also become part of primary care, and will be focused more on prevention.

Substance abuse treatment will also be considered an “essential service,” meaning health plans are required to provide it. They must treat the full spectrum of the disorder, including people who are in the early stages of substance abuse. “There will be more prevention, early intervention and treatment options,” he said. “The result will be better, and less expensive, outcomes.”

By the end of 2014, under the ACA, coverage of substance use disorders is likely to be comparable to that of other chronic illnesses, such as hypertension, asthma and diabetes. Government insurers (Medicare and Medicaid) will cover physician visits (including screening, brief intervention, assessment, evaluation and medication), clinic visits, home health visits, family counseling, alcohol and drug testing, four maintenance and anti-craving medications, monitoring tests and smoking cessation.

Currently, federal benefits, such as Medicaid and Medicare, focus on inpatient services, like detox programs, but do not cover office visits for substance abuse treatments. In contrast, Medicaid covers 100 percent of diabetes-related physician visits, clinic visits and home health visits, as well as glucose tests, monitors and supplies, insulin and four other diabetes medications, foot and eye exams, and smoking cessation for diabetics.

“These are all primary care prevention and management services, which are the most effective and cheapest way of managing illness,” he said.

The impact of these new rules will be quite substantial, since an estimated 65 percent of insured Americans are covered by Medicaid or Medicare, and the rest are covered by insurance companies that base their benefits structure on federal benefits, said Dr. McLellan.

As addiction becomes treated as a chronic illness, pharmaceutical companies will be much more interested in developing new medications, he added.

“Immense markets are being created,” he said. “Until now, there have been about 13,000 treatment providers for substance use disorders, and less than half of those are doctors. Now, 550,000 primary care doctors, in addition to nurses who can prescribe medications, will be caring for these patients.”

ON THE INTERNET: http://www.drugfree.org/join-together/addiction/affordable-care-act-to-provide-substance-abuse-treatment-to-millions-of-new-patients

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