This is in continuation of the last write-up.
In my experience I have found, pre-treatment motivation, detoxification, counselling done with empathy and challenge (tough love) for a few weeks including group and family counselling very effective. This was followed by and accompanied for a longer time peer support of recovering alcoholics, called Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) very vital for prevention of relapse. This was supplemented by rehabilitation stays of medium or longer duration and added to by half way homes as a stepping stone to re uniting with family or starting responsible independent life with the intention of re-integration into normal life as best as possible. Some of them needed medical assistance from assessments detoxification to other health issues. These steps helped as I mentioned in the first part of the article to achieve 80% sobriety rate even after two years after treatment which is very high and not very common. They are further briefed below.
1. The first is pre-treatment motivation.
Most persons with addiction problem tend to deny, rationalize, minimize and resist treatment which they need. Therefore, it is important to established rapport by spending enough time showing respect and inviting more of them to participate by helping them to look at themselves, the effects of these drugs on them physically, relationally, financially, in terms of their values and overall holistic functioning including job performance. Look at their dreams and whether they are being aided through these substances to achieve them. When they are honest, they will say that it is not so. In fact, they will, a lot of them want to change and they are compelled by strong cravings, physical dependence, psychological dependence making it very difficult for them. Time spent on this which can take a few individual and group discussions which in my experience resulted in greater number of affected persons participating and continuing with treatment and achieving better results for them selves.
The treatment itself consists of detoxification followed by individual counselling, group counselling, family counselling, peer support through Alcoholics Anonymous and any other supports. It’s not a short term program. Medium term to long term commitment is essential on the part of helpers.
2. Detoxification
This is a 7-to-10-day program where they are under medical supervision, sometimes on outpatient basis, sometimes inpatient basis. I prefer inpatient basis for this particular purpose of stopping from taking substances. This results in various bodily and mental reactions called ‘withdrawal symptoms’. There can be tremors, there can be dehydration, there can be manifestation of physical symptoms of pain, mental symptoms, disorientation, sometimes hallucinations and delusions temporarily. Therefore, this needs to be supervised by a medical specialist, medical doctor and nurses. And once they have gone through it, now their body will be detoxified, the poison removed and ready for further treatment components.
3.Counselling:
It takes some time and genuine concern for them. Would consist of willingness to pay attention to them for five years with decreasing frequency. So, they may achieve sobriety that is sustainable and emotional maturity with which they can handle their issues, cope with them with non-substance abuse, with other methods which are healthy, constructive, self-help and social support. They will receive guidance and facilitation in communication skills, conflict management skills, stress management strategic and assertiveness for a game free lifestyle. They are now stabilizing to be sober but the craving will be strong and they need some counselling for self-understanding and self-regulation. Individual counselling, group counselling, marriage counselling, family counselling, is what I do.
4. Alcoholic anonymous (AA):
Then while they are being strengthened, supported through counselling, they are referred to join a group started nearly 90 years ago by recovering addicts called Alcoholics Anonymous. It’s a peer support group were they meet and discuss, share and support each other to maintain sobriety. They follow what are called 12 steps of Alcoholics Anonymous, which is a profoundly transforming set of principles on which they reflect, come to terms with, admit that they are alcoholics, admit that they are powerless, that their life has become unmanageable and seek the help of a higher power by which ever name they may call it as this is for people of any faith and no faith as per their choice. They take a sincere and serious moral inventory; identify the wrongs they have done and are ready to confess, make amends unless making such could cause harm to the other persons. They commit themselves to practice, follow this daily and throughout their lives. They also make a commitment to spread the message to others in similar circumstances. And their testimony, their self-disclosure tends to become extremely powerful and strong in motivating people to obtain help along with other psycho-education. Once these pre-treatment motivation, detoxification, counselling, parallels and for a longer time, Alcoholics Anonymous or Narcotics Anonymous as the case may be. There are also support groups for family members. The participants will be strengthened and stabilized. Some of them also go to ‘rehabilitation centers’ for medium to long stay where there is a structured program of various procedures like deep breathing, meditation, work therapy, counselling, learning new skills, occupational therapy. Sometimes they also may be referred to ‘halfway home’ experiences before going back home. The families are also helped on how to act and respond and also are empathized, supported in the pain and suffering they have. With individual cooperation, family support, ongoing new group of social support peers who are all committed to sobriety, they improve, while some will relapse and can be helped to stabilize if they cooperate. As distinct from earlier times when the friends seemed to be those who indulged in abuse and even influenced others to join in that activity; in the new group, with new commitment, new encouragement, new confrontations is available in AA groups. Relapses are dealt with, taken in stride and helped to learn from it, rise up and keep moving. So, transformation sets in and lives are changed for the better demonstrating that though addiction is a serious problem to individual society, there is hope of recover. Prevention and treatment of substance abuse and addiction is a need with severe consequences to persons and society if not addressed. It requires training to be counsellors, but there is also place for laity, peers, and society in general, along with need for medical and other professionals to step in. I follow a multifactorial, multidisciplinary, inter-professional, holistic approach towards transformation of people.
A meaningful prayer used by recovering alcoholics in a secular context and which can be used by anyone who chooses to do so is as follows:
“Lord, grant me the courage to change what can be changed, serenity to accept what cannot be changed and the wisdom to know the difference”