I am by no means an expert in recovery, but is anyone truly? After yesterday’s blog, I felt a little bit more like an ass than I usually do. Then I thought about it and decided that I was essentially correct.
I will not say that traditional recovery programs don’t have that respectable goal of getting someone to stop using a substance. The problem is that getting someone to stop is only 25% of the battle and the reason I say it’s only 25% is because 75% of why someone is using a substance (probably more than 75% but I’m just making up percentages anyway) is not the fact that they like using substance.
I’ll quote a patient I had a while back, who said to me one day, “I’d like to stop drinking, but every time I turn around, I find myself with a drink in my hand.” I asked him why, and he never really could provide me with a good answer. Other than, “it’s the only thing I know.” In and of itself that’s a pretty powerful statement because it says this is the norm of my life. I am not sure what else to do so I drink. It speaks a lot to what I talked about yesterday where there is an underlying problem that is being self-medicated. He never stopped drinking, and it led to his death. He is one I wish I could have given him better tools, but I was too naive to know how to help him find those things he needed, besides to sober up because it was killing him.
Now before I go any further any intoxicating substance with physical addiction such as alcohol, opiates, and amphetamines do require some care in detoxification. You can’t just quit alcohol one day after drinking a gallon of vodka a day for a year (yes, I know people who drink this much from work well not from work but as patients. See above); and all of a sudden decide I’m going to quit and not have consequences. The body adapts to your routine, as much as it can, and the removal can cause some profound withdrawal symptoms that can border on a medical emergency. In the old days we use to lock them in a room until they were sober, we found after a while this can be deadly. In the hospital setting, we use a gentler approach such as; opiate replacements for opiates and benzodiazepines for alcohol. It slows the withdrawal to a manageable stage to help someone to cease using the substance.
Working in a hospital setting, usually, this is where we end. Most of the time, this is the patient’s choosing. “I’m sober I’ll be fine now,” and checks out. No, I frequently see these patients month after month after month because the sobriety is only 25% of the problem like I talked about before. In a rush to get someone sober we must focus on getting them sober and then instead of working on the underlayment, the underlying cause of why they are using a substance, we focus on not touching that substance. From my perspective, it appears that it is more about not drinking than focusing on those things in your life that make you want to drink. Now we all joke about, “I could use a drink,” but this is much more like I have “x” going on and I’m going to drown it with alcohol. Heavier drinking begins with, I have “x” going on, I have a drink, and it feels better, and soon the adage happens, “one is good a lot must be amazing.” Before long “x” happens, we drink, wash rinse repeat.
I am not saying that recovery does not touch on the underlying problem. It does, however, and yet primary care is so often not involved in this process. We have a focus seems to be centered on sobriety and sobriety isn’t the issue.
I also don’t think being sober is the answer. Without removing “x,” it’s very easy to fall into the trap of unhealthy use. I am not an absolutist on sobriety. If you’re sober, which I bet you’re not, and it works for you great. I can bet that about 99% of us are not sober. We all use one or another substance in our lives that we pass because it’s not an intoxicant. Well, it as sugar, caffeine, nicotine, alcohol, opiates, or any other substance that alters your perception then it’s an intoxicant to some degree. I attended an AA meeting as a student and was amazed to hear people talk about addiction to alcohol while they lit their 3rd cigarette in less than 30 minutes. Who are we kidding?
There was an experiment that highlighted in the video I posted that talks about how when given alternatives to the water with a substance in it, that the rats (cage type) chose the alternatives and drank untainted water. It is possible, and there are alternatives.
After all this rambling I’m sure many of you are going Nursie poo what is your point here? My point is the same as yesterday’s point. Primary care needs to be a part of the process of helping the patient find their way. We cannot help them with substance use any easier than we can help them with diabetes if they are not the driving force. We cannot, nor should not force people to any plan of care, since that never works. We must help the patient find what they need to be doing instead of substance use. We must help them look for those things in their day-to-day living that lead to the use of the substance. It allows us to help them not only improve mental health but to drive their emotional health as well.
A very basic example of this is I wake up in the morning I am tired as hell. I stumble into the kitchen and grab myself a cup of coffee and a cigarette before beginning anything with my day. So right off the bat, I begin stimulating myself or overstimulating myself to “get myself moving.” Both caffeine and nicotine are stimulants that we use to propel the body forward artificially. It doesn’t matter as much as why I do something as what is causing it. It also doesn’t mean I can’t have a nice cup of coffee and conversation with someone without being a caffeine freak. I can’t condone smoking, sorry kids (well unless it’s smoking hot which we all know I am).
Front line workers, especially at the provider level, should always address the underlying problem. We should look to make overall wellness our goal, not just sobriety. We have more responsibility than recovery groups, yet we so often abdicate this when we should be driving this.