Do I need Outpatient or Inpatient Treatment for Addiction? Guest post by Alek Sabin

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If you are struggling with addiction, or have a loved who deals with substance abuse, making the decision to seek treatment can be the most empowering decision you make in your life or theirs. Failing to do so can lead to lives and families being torn apart, and even runs the risk of an overdose. Of course, there are a variety of treatment options available, and many who are considering seeking treatment wonder whether outpatient or inpatient treatment is better suited for them. Here is a look at the key differences between outpatient and inpatient treatment.

Outpatient Treatment

This article here does a very good job at describing how well outpatient addiction recovery treatment works. Basically, outpatient treatment is an option that allows individuals to receive treatment that is less intensive than inpatient treatment. It is well suited for individuals who are seeking comprehensive treatment for alcohol or drug addiction, who need more support than weekly counseling but less support than inpatient treatment, and/or who have completed an inpatient programme and need continued support in recovery.

 

How Outpatient Works

Outpatient treatment typically draws on a variety of approaches in order to offer recovering addicts the healing they need. A comprehensive outpatient treatment might involve individual therapy, group therapy, education, and relapse prevention training. Recovering addicts will also explore a variety of therapy approaches, including cognitive behavioral therapy, motivational interviewing, and recreational therapy.

 

Benefits of Outpatient Treatment

Outpatient treatment can offer several benefits. For starters, individuals can receive treatment while protecting certain aspects of their current lifestyle, such as a job, education, or family responsibilities. Outpatient treatment also tends to be more affordable than inpatient treatment since you are not paying for room and board. It can also grant you more access to your family and friends, who might serve as a valuable source of support as you navigate recovery.

 

Different Levels of Treatment

Every outpatient program is different, and there are various types of outpatient programs, each offering a specific level of support. Three of the most common types of outpatient treatment are partial hospitalisation (day treatment), intensive outpatient treatment, and general outpatient treatment.

Partial hospitalisation, or day treatment, is a more intensive form of outpatient treatment that allows individuals to meet for to five days a week for several hours each day in order to receive intensive treatment. Intensive outpatient treatment is somewhat less intensive, and it is primarily for individuals who need an organized treatment program but who can navigate recovery in the course of their everyday activities. General outpatient treatment, meanwhile, is for individuals who require moderate support in order to achieve sobriety.

 

Inpatient treatment

Inpatient treatment, also known as residential treatment, involves the same treatment techniques as outpatient treatment, but it is more intensive because you typically check into a facility and live there throughout the duration of your program.

 

How Inpatient Works

Inpatient treatment draws on the same individual therapy, group therapy, and educational approaches as outpatient treatment, but it can include some more intensive techniques as well. Many recovering addicts seeking inpatient treatment, for example, will first undergo a medically assisted detoxification process in order to manage withdrawal symptoms. Inpatient treatment also involves around-the-clock care, which may be necessary for individuals who are recovering from abuse, trauma, or a co-existing mental disorder.

 

Benefits of Inpatient Treatment

Inpatient treatment can also offer several unique benefits. First, it gives recovering addicts the opportunity to focus on their recovery, without the distractions of everyday life. In addition, since individuals live within the care facility, there is no access to drugs or alcohol, reducing the chances of relapse significantly. Because it is a live-in facility, there may also be more specialized services available, such as a gym facility, yoga classes, acupuncture, or nutritional education.

 

One potential drawback to inpatient care is that it can limit your access to support from family and friends. For this reason, many inpatient programs include a specialized family program where family members can participate in the recovery of their loved ones—all while receiving the healing they need as well.

 

So What Is Right for You?

If you are seeking treatment for an alcohol or drug addiction, it’s important to consider not only the level of care that you need, but also those factors that might try to draw you away from your recovery. If you are living in an environment that is not conducive to a successful recovery, for example, then inpatient treatment may be the option for you, even if you think you may not require that level of care. When in doubt, you should always consult an addiction recovery facility. Many offer free assessments to help match you with the precise level of care that you need.

Please note: each country will have its own differing treatments and care. 

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Mental health stigma and drug addiction Guest post by Bill Weiss

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The stigma that some people see looming over drug addiction and drug abuse disorder will prevent thousands of people from getting the help they so desperately need and deserve. Viewing drug abuse as a disfigurement of one’s will and self-worth is very harmful and can leave people in active addiction.

The fear of admitting that they are struggling and the judgment that will face afterward can be catastrophic. It has been scientifically proven that drug abuse disorder and addiction is a disease of the mind and body. There should not be any negative views toward someone when they decide it is time to get help for this issue.

During active addiction, many users will take part in actions that the clean/sober them would never think about doing. From the outside looking in, these decisions and behaviors can seem unusual, most of the time they are.

Watching someone absolutely self-destruct is very difficult. You may just want to shake the person struggling and scream “WHY CAN’T YOU STOP?!”. If only it was that easy.

Drug abuse and addiction is a surface issue, it’s the problem the whole world can see, but over 80% of drug addicts struggle with underlying mental health issues.

 

Mental Health Issues and Drug Addiction  

Far too many of those currently in active addiction have never received proper care to help them with their mental health issues. Anxiety, depression, PTSD and bipolar are the most common underlying mental health issues that can easily influence drug abuse. When one does not receive proper therapy and/or medications to help them with these problems they may turn to drugs for relief. Self-medicating the problem provides temporary relief, but nothing is actually being done to resolve and work on the issues.

The longer someone uses the worse their mental health issues will become. Depressive episodes can turn into suicidal thoughts and ideations. Anxiety can turn into panic disorder. Drugs do not solve the problem, but for someone struggling with mental health issues will find a level of mental peace from the drugs. Even as their life spirals out of control, they may accept it and continue to get high.

This isn’t their fault. Long-term abuse of any narcotic substance will alter the way one’s brain reacts to and handles certain situations. The chemical balance has been thrown out of whack, the drugs now have near complete control.

Breaking free from the powerful grip of these drugs is not easy, especially if the person struggling believes they will be harshly judged as the stigma around addiction follows them.

 

Breaking the Drug Stigma

Accidental drug overdoses are now the number one cause of accidental death in the USA. We are facing a drug epidemic like never before, more US citizens passed away due to a drug overdose in 2017 than in the entire Vietnam War.

As a country we must help remove this stigma, it is literally a matter of life and death. Millions of people are currently struggling with drug addiction, tens of millions of families will be affected. How can you do your part of getting rid of the addiction stigma?

Educating yourself and others about drug addiction statistics and facts will help one truly understand the impact that drugs have had and will continue to have in this country. Drug addicts are not how they are commonly depicted in movies.

Addiction can affect anyone, any sex, religion and financial background can fall victim to substances and mental health issues. It is not just something that destroys the lives of the homeless and the poor. These are mothers & fathers, brothers & sisters, friends, aunts and uncles who are being destroyed by these terrible substances.

If someone you care about is currently struggling with drug abuse/addiction the best thing you can do for them is to let them know that you are there for them whenever they are ready to get help. While you may not 100% understand what they are going through, you know that they need help and that’s all that matters.

It is strongly suggested by most medical professional that anyone struggling with drug abuse or addiction issues gets professional help from a drug treatment center.

 

5 Ways to know your loved one may be secretly abusing drugs: Guest Post by Dr Nancy Irwin

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Addiction has many consequences, both on the addicted person and their loved ones. Something I see very often is that family members don’t understand how they did not recognize it sooner. They regret that their loved one got to such a dark place before they could see there was even a problem.

But the reality is that people abusing drugs learn very quickly how to lie and manipulate. Because they are regularly involved in illicit activities, they become pros at distorting reality. And it’s easiest to trick those they love, considering that they know their loved ones’ soft spots.

This is not a judgment on them. On the contrary, they are not liars by nature, and often they are trying to protect their families.

Around 10% of the US population abuses drugs, and it is therefore more important than ever to learn to spot drug abuse as early as possible. The good news is that even if the individual at risk is good at lying, there are warning signs that are fairly universal.

The following five things could be signs that a loved one is abusing drugs.

 

  1. Physical Factors

Perhaps the most obvious signs are physical. Individuals who are using increasing volumes of drugs show physical changes which may be hard to account for. Look out for the following:

  • Bloodshot eyes and/or dilated pupils
  • Changes in appetite
  • Changes in sleep patterns
  • Extreme weight loss or weight gain
  • Deteriorating physical appearance
  • Sudden decrease in hygiene
  • Unusual smells
  • Tremors or slurred speech

Of course, all of these changes can have many alternative sources. However, if an individual exhibits many of them at once, and they tie in with some of the other signs on this list, drug abuse may be the most plausible explanation.

 

  1. Problems at Work

People who have started abusing drugs tend to struggle at work or at school. Their attendance drops, they neglect responsibilities and make mistakes, and cause trouble with colleagues or peers. They may even do something so self-sabotaging that it leads to them losing their job or being expelled.

Once again, drug abuse need not be the first conclusion you jump to. There could be many reasons why an individual starts struggling with work or school, including mental illnesses such as anxiety and depression.

This is especially true with adolescents. Assuming they are using drug abuse without further evidence can decay trust between you, when they might be acting out because they are not coping for whatever reason.

When alternative possibilities are exhausted, or they exhibit other signs on this list, drug abuse may become the most reasonable conclusion.

 

  1. Sudden Financial Problems

Drug abuse becomes increasingly expensive as the person addicted becomes more and more dependent. Their tolerance grows and they start needing higher quantities of the substance on a more frequent basis. They end up spending more and more of their money on drugs, leaving them unable to finance other responsibilities.

These financial issues can be easier to spot with adolescents who are not earning money. They may start stealing money from you or get caught stealing from peers or from their school. In this case, it may be possible to track their theft directly to their drug abuse.

But you don’t always need as clear a sign as theft. If a loved one who is financially independent suddenly stops paying their debit orders, gets behind on loan payments, or starts asking you and other friends and family for loans, this is a sign that something is wrong. Look into why they suddenly cannot afford their way of life. If there is no legitimate explanation, and they are exhibiting one or more of the other signs, drug abuse may be the most logical conclusion.

 

  1. Behavioral Changes

Gradual behavioral changes are a sure sign that something is wrong. Of course, they do not necessarily point to drug abuse.

Sometimes, mental illness can be the source of the problem. Alternatively, they may have gone through a trauma or be in some sort of trouble.

However, if a loved one shows changes in personality, starts getting into fights, becomes secretive, and has extreme mood swings, drug abuse may well be the cause. Other behavioral warning signs include a loss of motivation, paranoia, as well as unexplained hours of euphoria followed immediately by a drop in mood.

They may begin to fracture relationships that have, until now, been strong.

 

  1. Lifestyle Changes

Drug abuse often becomes the centrepoint of the individual’s life. They need to spend time, money, and effort sourcing and taking their drug of choice. They therefore start spending time with friends who are also abusing drugs, hang out at places where illicit drug use is possible, and lose interest in hobbies and activities that were once important to them.

If a loved one starts displaying any of these warning signs, do not panic. Look at the possible reasons for these changes. In isolation, some of these changes are easily explained. Depending on your relationship with the individual, you may be able to discuss the causes with them.

Once you’ve started noticing any one of these signs, it becomes easier to spot the others. If you feel that drug abuse is a likely cause, speak to a professional immediately for advice on how to investigate further and help the person at risk.

 

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Dr. Nancy Irwin is co-author of “Breaking Through, Stories of Hope and Recovery” and a Primary Therapist at Seasons in Malibu World Class Addiction and Mental Health Treatment Center.

7 Reasons for Alcohol and Drug Addiction Stigma: By Ryan Jackson

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Stigma is a set of pre-conceived false beliefs that people have against a particular group of people. According to the World Health Organization’s website, stigma is a major cause leading to discrimination and exclusion. Not only does it disturb the personal life of a person, stigma can also limit their chances of obtaining proper jobs and housing. The unfortunate thing about stigma is that it’s not based on facts, but rather on assumptions and generalizations that have been embedded into society.

7 reasons addiction carries a stigma

The American Society of Addiction Medicine characterises addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” The National Institute on Drug Abuse defines addiction as a ‘chronic, relapsing brain disease” that changes the structure and functionality of the brain.

So, why do so many people still think of addiction as a moral failing? Why do they still refer to victims of substance misuse disorders as meth freaks, alcoholics, junkies, crackheads and garden-variety drunks?

The answer is simple as it is depressing: because that’s the way it’s always been.

Addicts are scorned by communities, and celebrities with addictions are exploited or hounded by paparazzi. And, while the government purports to view addiction as a disease, it often works in opposition to that position through the “War on Drugs,” which counts most drug users as criminals. Even those of us in the treatment community still—consciously or unconsciously—employ stigmatising programming and language—such as when we focus on “dirty” urine.

So despite widespread agreement that addiction is best understood as a complicated behavioural-biological scenario that requires treatment, the system is hard-wired to prolong stigmatisation, and stigma contributes to addiction’s lethality.

Of course, there is a long history of mental illness being misunderstood and stigmatised,  in state hospitals or prisons, which was beautifully captured by the director Lucy Winer in her recent highly-acclaimed documentary, Kings Park. Addiction and mental health problems are still spoken of in hushed tones, and patients and their families are still blamed. This is changing, but there is still stigma. 

The idea that those with addictive disorders are weak, deserving of their fate and less worthy of care is so inextricably tied to our zeitgeist that it’s impossible to separate addiction from shame and guilt. Addiction comes with a second punch in the gut: the burden of being treated like a second-class citizen and expected to act accordingly. Stigma impacts us all, both consciously and unconsciously, and is perhaps the single largest contributor to the mortality rate. Consider these eight points:

  1. People fail to seek treatment.

Most people who struggle with an addictive disorder fail to seek treatment, in part because of their concern that they will be labeled an “addict” and that the stigma will stick. 

Often, a crisis precipitates treatment, so the problem is already well-advanced. If we removed the stigma, guilt and shame from the equation, people would find it easier to make a realistic, objective assessment of their substance misuse and discuss it openly with a health care provider.

  1. The medical profession fails to treat addicts properly.

Can you think of other situations in which the health care system abdicated responsibility for dealing with a health care issue that afflicts such a huge segment of the population? For far too long, those people who did seek treatment, often following a crisis, found no appropriate reception from the medical community. Doctors were slow to recognize addiction as treatable, and so patients were encouraged to find help outside of the medical community, in 12-step programs that based on non-scientific practices, normally anathema to physicians.

12-step programs helped many, but those that did not succeed there found themselves in the unenviable position of having been directed to a place by their doctor, having the recommended solution ineffective and being reluctant to return to their physician for further help. A better paradigm? The medical community should recognize addictive behavior as part of its purview and would apply evidence-based approaches in their practices.

 

  1. The mental health profession ostracizes people with addictive disorders.

It is routine in some mental health settings for persons with substance misuse problems to be discharged from treatment when substance misuse is revealed. They’re told that the drinking or drug use renders them “unavailable” for the work of psychotherapy and that they need to “get clean” first by going to a chemical dependency or substance abuse treatment program. They are told that whatever issues seem pressing and paramount to them are “just the drugs talking’

It’s common for clinicians to believe that before they can help a patient with the various traumas, interpersonal conflicts, intrapsychic issues and other problems that other people are  helped with in psychotherapy (and which are, of course, related to their use of substances) the patient needs to first become abstinent from substances. Many patients who are sent to traditional drug treatment programs that are abstinence-focused end up neither “clean and sober” nor receiving good psychotherapy.

  1. Funding for addiction treatment is discriminatory.

In spite of the huge impact and cost of addictive disorders on society, the way that addiction treatment is funded (in America) is disproportionately low. Despite passage of Federal Mental Health Parity legislation, mental health and substance use disorders continue to be treated differently—and often poorly—compared to “medical” illnesses.

What if there was no stigma in addiction? Given its huge cost to society, addiction should be funded and paid for on a level playing field with medical problems.

 

  1. Addicts get sent to jail.

Where substances are concerned, people go to jail for the possession of something that is part and parcel of their addiction. Most of the money that governments spend on “drug control” is spent on criminal justice interdiction rather than treatment and prevention.

Here again, clearly, is a system with stigmatisation at its roots: blaming, punishing and making moral judgements instead of providing treatment and other help that would change behavior. The more of a stigmatising stance one takes towards substance misuse the more likely one is to support criminalisation of drug offenses and the less likely is to support insurance coverage and treatment for drug addiction. Taking the stigma out of addiction argues for prevention and treatment as opposed to prosecution and incarceration.

 

  1. Even when people do get to treatment, stigmatization can continue and contribute to poor treatment outcomes.

It is critical to recovery that treatment programs not send messages to patients that are blaming (for relapse) and shaming (for being weak). People enter treatment at a vulnerable moment, psychologically and in terms of their brain chemistry. Addiction comes with a hard-to-escape sense of failure that recapitulates prior disappointments and works in opposition to growth.

Patients have spent a lifetime trying to silence the “inner critic” that repeats “I’m-not-good-enough” messages, so it’s critical that the culture and language of treatment provide a healthy soil in which patients can grow seeds of hope that are vital to recovery. In an optimal treatment setting, patients aren’t expected to play the role of one-who-should-be-ashamed. Instead, they are intrinsically involved in planning their own treatment, helping to choose the goals and techniques of treatment.

  1. They confront stigma-based roadblocks constantly.

Those in recovery from addiction face ongoing stigma and discrimination. People in recovery are faced with obstacles, especially those who have been in treatment or in the criminal justice system for chemical dependency. Employment, education, insurance and the ability to vote are all fraught with uncertainty and discrimination for those in recovery.

People in recovery have a harder time finding and keeping jobs, getting licenses, food stamps, benefits that help their children.  In other words, important aspects of living that are so critical to a stable recovery for persons who have been treated for addiction, such as employment, housing and providing for one’s family are that much harder to get. Things need to change. Having struggled with addiction in the past should not make life that much more difficult now. End the stigma.

 

Guest post: 5 Tips to Survive Opiate Withdrawal by Bill Weiss

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Bill Weiss shares his knowledge about drug and opiate addiction and how to recover, talking us through the withdrawal process in a safe way. It must be done under medical supervision.

An addiction to heroin or one of the many prescription opiates, such as Vicodin or Percocet, comes with intense withdrawal symptoms. For many, the withdrawal symptoms are what drive them into an early relapse, in hopes of ending the symptoms rather than enduring them.

 The withdrawal process can be unbearable, but there are ways to make it easier. In order to prevent early relapse, let’s break down the opiate withdrawal timeline and how a person can alleviate some of those symptoms.

The Opiate Withdrawal Timeline

One thing that’s important to keep in mind is that each person’s withdrawal process will be a bit different from the other. Withdrawal symptoms fully depend on the individual, his or her habits while using, and the addict’s brain chemistry. Opiate withdrawal symptoms can range from mildly uncomfortable to severe and debilitating.

 The reason opiates cause such intense withdrawal symptoms is because of the effect they have on the user’s brain. Opiates impact the opioid receptors, which are found in the central nervous system. By targeting the opioid receptors, they adjust the brain’s response to pain while the drug is in the user’s system. This causes both physical and emotional effects, numbing the pain both physically and emotionally. Medically, this is why many doctors prescribe opiates as a pain killer.

 Unfortunately, if a person uses opiates long enough, it alters the chemistry of the brain. Eventually, the brain relies on the drug to control any amount of pain, big and small. When a person abruptly stops providing this supply of opiates to the brain, everything suddenly becomes unbearably painful as the body is no longer able to regulate pain. This sudden onset of pain signals flooding the brain is withdrawal.

 The early stage of withdrawal typically lasts for 24 to 48 hours, and it can start anywhere from a few hours to 30 hours after the last use of the drug. This can include muscle soreness, irritability, trouble sleeping, sweating, a rapid heartbeat and a lack of appetite.

 Fortunately, that earliest stages are the toughest. Later withdrawal symptoms can also be difficult, though, as cramping, shaking, nausea and vomiting may continue. The worst of these later withdrawals usually ends within a few days of sobriety, though for some may continue on for several weeks.

 Most people find that the majority of their withdrawal symptoms are gone after about a week. There may be some lingering anxiety and nausea afterwards, which can lead to a lack of appetite. Cravings for opiates, however, often last much longer.

Getting Through the Withdrawal Process

Opiate withdrawal is no picnic, but finding the right strategy to get through it can help. These are five of the best ways to get past those withdrawals for a successful detox and recovery.

1. Try Tapering

A popular method for people to stop using opiates is the taper technique. As the name suggests, it involves the person slowly tapering down the amount of opiates he uses. The benefit of this technique is that it causes less severe withdrawal symptoms than if the person simply decided to quit abruptly. However, it requires the mental discipline to keep reducing the amount of opiates used and eventually stopping use entirely.

 Just like a user will develop a tolerance for opiates and keep needing larger doses to get high, that process also works in reverse. If he can cut those doses down gradually, he’ll need less of the drug and his brain chemistry will start getting back to normal. For many, another option is to supplement the detox with Vivitrol. Vivitrol breaks the cycle of opioid addiction by lessening the symptoms of withdrawal.

2. Join a Support Group

One of the hardest parts of withdrawal is going through it alone. They can break a person down mentally and physically. A great way for the person to get support and stay on the right track is finding an addiction support group in his area.

 There are many ways that a support group can help with opiate withdrawal. Other members of the group can provide suggestions on what helped them get through the withdrawal process. Support groups also offer constructive activities, such as boosting self esteem during addiction recovery. These activities are crucial to surviving the withdrawal process and preventing relapse.

 Most importantly, being part of a group lets the person know that he is not alone in his struggle. If he has felt down on himself, a group of people who understand what he’s going through can help him maintain high self esteem.

3. Try Over-the-Counter Medications

Many of the most common symptoms of opiate withdrawal can be reduced by using popular over-the-counter medications. Tylenol and ibuprofen are two options that can help a person deal with the fevers, muscle aches, chills and sweating that come with withdrawal. Keep these medications on hand so that you can take them as needed.

4. Keep Getting Nutrients

Because of the nausea caused by opiate withdrawal, it’s often hard to eat or drink. This can make withdrawal even more difficult due to the lack of nutrients being consumed.

 Stocking up on foods that are easy to eat is a smart move before detoxing. Bananas are one option that tend to go down easy, or the person can purchase meal-replacement shakes. Multivitamins are a great choice for ensuring the person gets all the nutrients he needs even during withdrawals.

5. Set Up a Schedule in Advance

As the withdrawal process is an intense one, it is best to clear your schedule in advance. There are two key points to clearing your schedule during withdrawal.

 First, clear your schedule of any important responsibilities. Besides the fact that the symptoms will prevent you from doing anything at all, anything that you do during withdrawal will likely be of very low quality. If you are working then take time off of work, if possible. Find a safe, quiet, and secluded place in which you can focus on getting through the detox without any added stress.

 Second, is to set up a different daily routine. Routine is a problem when it comes to drug use because people often get used to their drug habits based on their daily routines. Many grow accustomed to using at a specific time of day, such as before bed or after getting home from work. Adjusting that daily routine can help the person avoid specific triggers that make him crave opiates.

 It may not be possible to avoid withdrawal symptoms entirely, but you can at least make them more bearable. With the right approach, you will be able to get and stay clean of opiates, rebuild your life and develop better coping habits to deal with life.

 Bill Weiss is an advocate of long-term sobriety. As a member of the recovery community, he feels it is important to spread awareness of alcohol and drug misuse in America and beyond. Being personally affected and having family members struggling, it is a personal quest of his to get the facts about substance misuse to light, ultimately enlightening people about this epidemic.

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