Substance abuse is a growing epidemic in this country and in most of the world. Millions are addicted to alcohol and drugs and far too often, both. Without treatment there is little to stop alcoholics and addicts from wrecking not only their lives but the lives of many they encounter.
Certainly, the first step to getting treatment is for the addict to acknowledge to him/herself that a real problem exists and that they cannot stop drinking or using.
Most addicts and alcoholics try as hard as they can, often with partial success, but ultimately they come to a common realization that they are helpless to stop using for an extended period. If they don’t find help they may fall prey to hopelessness which can be a precursor to the user hurting themselves or suicide. A goal is to stop the user before it gets anywhere near that bad. In most cases, the user has to hit “bottom” before he or she is even close to willing to really take a close look at the problems – and only with that sense of desperation can you have a chance of really connecting with the user to get to a solution.
For many, it “takes a village” in the sense that the help of friends and family are needed to cause the addict to recognize that a true life-threatening problem exists. And it is life-threatening. Death from the effects of the booze or drugs, or its effects on those the alcoholic surrounds him/her self with, raises the likelihood that they have put themselves in harm’s way. The user does not see it. He/she is often so out of touch with reality they do not comprehend the dangers they cause and somehow get past with regularity. And so after you and your support group go to the expense and trouble of finding a detox and rehab program, you think this is the answer. You have placed your son/daughter/husband/wife in the hands of learned caring professionals who want nothing more than to get your family member well. After all, the team members have lots of education, state certification, and lots of patients to make the facility far safer than the outside and free of dope and drink, right? Not necessarily so, I hate to say.
Medical vs Medically Supervised vs Medically Monitored Detox
Detox and rehab. Medical vs Medically Supervised vs Monitored. What are all of these different places. Do I need to know the differences?
Yes there is a difference and you need to know them. If you don’t there is a chance you will be sold into a facility which is not the right fit for you or your loved one. The first step for most users is that they need to get sober and stay sober for the initial evaluative period so that the person can get in a frame of mind that they can see what they are doing, have done, and the way out. The user needs to get all the mind altering chemical out of their system so they can know the parameters of their behaviors. The initial phase is detox.
Detox is the process in which a patient rids his or her body of the addictive substance. This is a process of a few days to a week or 10 days. You can’t learn new life changing patterns of action and thinking while high or intoxicated. You must dry them out. Not so fast partner. This phase costs many an addict their lives. Alcohol dependence, more than most, is very dangerous at this phase. The patient’s body has likely lived a lifetime on alcohol. Reaction to ridding the alcoholic’s body of alcohol can cause severe reactions, which is often enough for the alcoholic to shout “No way!” Thankfully, there are a variety of therapies and drug cocktails prescribed by physicians, particularly addiction specialists, to manage the withdrawal symptoms. During this phase the facility will encourage that patient to make use of the time to begin shaping new life experiences so they know it is not bad nor uncool to be sober. They begin the process of once again seeing the world through sobriety.
Like taking off dark glasses. The clarity can be shocking and frightful. For the drug user, there are also a number of options. Heroin detox takes the form of medications designed to wean him off the effects the drug has on pleasure receptors in the brain. The drug attacks the central nervous system by suppression of heart rate, blood pressure, respiration and temperature; just about all that keeps us going within a small range of variation. Medications are used to reduce the discomfort and the emotional withdrawal and the craving. The medications commonly used include anti-nausea, antidepressants, and anti convulsants to reduce the effects of nausea, cramps, diarrhea, tremors, fatigue, anxiety, insomnia, hypertension and craving.
For meth/crystal/amphetamine withdrawal the symptom complex typically includes sleepiness, fatigue, lethargy, general malaise, and the onset of craving for the drug after about 4 -5 day post use. There are few medications available to reduce the cravings for meth or to supplant the euphoria the patient experienced with the drug. Thankfully, aside from the lethargy, weakness and feelings of depression which can confront the patient, the cravings are reportedly not as severe as those associated with heroin. Few medications can take the edge off the withdrawal process however. The detox facility will monitor vital signs, and keep the patient comfortable and may prescribe meds to reduce panic attacks as well as one to reduce sleepiness. The sleepiness can occur for up to two weeks or more, followed by a period of insomnia.
Marijuana is not typically the only drug which causes a user to seek help but only of a number of illegal drugs the user takes to self medicate. Withdrawal symptoms for a heavy user may include poor sleep, poor appetite, and abdominal cramping. Tapering is one frequent method, which may be initiated by the user. Medications for headaches or muscle aches such at ibuprofen as well as metoclopramide can reduce nausea and vomiting in some patients.
Benzodiazepine (benzo, xanax, klonopin, ativan, valium, ambien) addiction causes shift in brain cell functionality reducing performance without the medication. These are dangerous to attempt withdrawal from these without medical supervision. Symptoms of tension, muscle spasm, insomnia can also lead to seizures which are life threatening. Medical management is essential. Withdrawal can peak within two to three weeks and can continue for months.
Now that we have taken a look at some of the most widely used substances of abuse lets focus on different levels of detox facilities in the state of California. In the Golden State, the Department of Healthcare Services oversees the detox and rehabilitation facilities, oversees the training required of personnel at the facilities, what level of supervision each patient will receive at the facility, how frequently the patient will be examined (if at all) by a physician, whether the facility will have a physician on duty, on call, available 24/7 or simply dialing 911 when an emergency happens. Lets take a look at the various levels of care.
Medical Detox is a highly supervised, rigorous process. It is the safest method and usually more expensive than non-medical. This type involves direct, continuous supervision by an on-site physician, and often a medical team to watch over the newly substance free patients. This level of service is in a hospital setting. Many of the physicians in this high level of care are addiction specialists, doctors very familiar with the mindset of the alcoholic and addict.
The Medically Managed level of care is the type which involves the oversight of a medical protocol by a licensed physician and most typically involves use of a variety of medications to help the body more easily, and more safely, get used to not being on the drugs or alcohol the patient formerly used. The doctor is available by phone at any time but is not usually on site. Staff in the facility are very knowledgeable and trained in the signs and symptoms associated with drug and alcohol use, withdrawal, and the types of behaviour associated the all use patterns. Staff will regularly check the status of the patient as well as regular vital signs taken and recorded with abnormalities called in to the doctor for adjustments in meds as necessary. Careful monitoring of the patient is expected at this level of care.
Monitored Residential level of care is for patients who do not need meds but who require supervision to significantly reduce the likelihood of relapse.
Non Residential detox programs are designed for those patients assessed as being at moderate to low risk of severe withdrawal symptoms and free of severe complications, physically or psychologically.
Following the cleansing phase provided by detox, the substance user needs the primary assistance of a rehabilitation program. Without rehab there is a strong likelihood that the substance abuser will return to the drug or alcohol within a short period of time. The primary purpose of rehab is to provide a safe haven and therapists for the patient to analyze why they got to where they were and how to stay out of the triggers and patterns of the addicts addiction. The patient is encouraged through a variety of tools to look at themselves, their good and bad behavior, and find those things which caused them to end up wrecking so much in their lives and the lives of those around them.
Drug and alcohol rehabilitation facilities are designed to help patients change their attitudes toward substances of abuse. Frequently, the alcoholic/addict denies that they have a problem; they tell their family that they are misunderstood, they are taken the wrong way. The addict may be so lost in the haze of addiction that they deny they have any problem at all. Not infrequently, they will rattle off the many benefits of their drug of choice. Matters not whether it is alcohol, heroin or meth. The addict knows how to justify the addiction and much more. This is a multi-faceted problem which requires extensive staffing and the care of many individuals to thrive. How in the world will you know whether they even have the staff to get the job done? (Get your family member sober and free of the chains of addiction.)
The object is to help the individual start on the path to live a drug-free, healthy life. Kind of like a spinning top; set the person into motion and the rest will kind of coast along as they know what to do to have success, right? Well think again. Generally, the program is customized to match the individual needs of the person under treatment. The professionals treating the individual design a detox and rehab program and help the individual through various stages of sobriety and treatment.
Abuse in the sanctuary of hope
However, there is a dark side to some alcohol and drug rehab centers. The facts are that rehab abuse occurs in drug and alcohol treatment centers; more than you might imagine. The surprising fact is that the abuse occurs at the hands of so-called caring professionals that are supposed to help the drug dependent individual that is in treatment.
Of course, there are thousands of drug treatment centers around the country that have helped millions of patients beat their addiction to drugs, alcohol, or some other type of substance. These facilities have helped return a fully functioning individual back to a normal life. These are professional centers with well-trained staff that are strongly focused on helping their patient tame their addiction. Unfortunately, anywhere you find an individual weakened by disease or mind numbing substances, you will find the type of person who will abuse. Abuse in treatment centers might include physical abuse, sexual abuse, financial abuse, and emotional abuse. Facility owners and managers know what to say to get patients in the front door. They are “holistic”, “caring”, “compassionate”. They are housed at “treatment centers” or a “ranch” or similarly cool sounding destination. Come for a laid back month or two one might think. Don’t believe it and don’t trust words. You must do a lot of digging to get to the bottom of what is really happening at the holistic zen compassionate palace of treatment center. You get the idea. Writing is of little effort. What you see is what is to be the basis for you to decide whether to send your family member to a temple of caring professionals, right?
News has surfaced about treatment caregivers that have given patients drugs which knocked them out in order to take advantage of them sexually. The fact is that people in a rehab center are very vulnerable. People treating them know this fact and might simply take advantage for their own gain. Patients are thus exposed to abuse just as they enter a life of sobriety. This is a recipe for disaster in the life of the alcoholic. It is important to recognize the symptoms of abuse and get legal help immediately if you or a loved one is victimized.
Visit the facility and be there on visitation days. This is one of the most important things you can do. To the extent possible call them regularly and check on their condition with the counselor assigned to your family member. Verify all that you are told about their activities and those of the other residents you meet. Careful, you can’t pry nor can you start an inquisition. You can see in their eyes the spark which frequently follows sobriety. Does it last? Does it appear that your loved one seems too chummy with the counselor. Look into it by asking the Program Director what is happening. Ask other counselors if need be. Ask for the patient to staff ratio at the facility and see if that ratio is really what is happening. Do not simply rely on their statement of a ratio, see it. Check to see what they offer the patient after the program. There should be significant resources and contacts made from the facility to be sure the patient is on track and not simply another statistic.
Check state records. The Department of Health Services oversees the administration of detox and substance rehab facilities in California. Check with their resources for information on the record of the facility in question. They are known to perform spot checks, and look at the records of the facility for patterns of low staffing, patient turn over and the like. You too can be aware of whether patients seem to leave quickly, or stay the allotted time. Look at hygiene, clothing and attitude. Seem consistent with someone heading off in a great new direction or of someone stuck in a bad situation?
Check credentials of staffers. Does staff seem they are gaining increased knowledge about the disease through education, training, emergency preparedness, doctorate level personnel, licenses such as CCDP(certified co-occurring disorder counselor), CAC (cert. addiction counselor), LPC (licensed professional counselor) and LADC (licensed alcohol and drug counselor).
These are suggestions of ways for you to get your loved one on track and assure yourself that things are well at the facility and in your loved ones life. These are not meant to be complete, nor authoritative. I write what I know as I have been there and back. I represent persons who have suffered abuse at the hands of caregivers whether in hospitals, nursing homes, alcohol and drug detox facilities, rehab facilities, half way houses, safe houses, clean houses, and you name it. Look after your loved ones.
Anyone with an alcohol or drug problem can be saved. The risk of death is real. Put resources into evaluating the treatment place you are thinking about and do not accept less than complete information. Contact the ombudsman for the place you are thinking of for treatment. Good luck and you have my heartfelt thanks for taking the time to read this drab piece. I hope it is helpful for you and your family. I mean it to help. If it didn’t or even if it did, please let me know. I am an attorney who handles a wide variety of injury and death cases from the circumstances I explore here.
Hopefully you do not need my services but if you do you can reach me at Moss and Hovden where I worked most of my practice. The website is mossandhovden.com and my current home, where you can likely reach me today and where I am Of Counsel, is at TLD Law: tldlaw.com. There my email address is [email protected].
My name is DEL HOVDEN, attorney at law. I am a consumer attorney. I fight for the rights of the injured and disabled.