ADDICTION FAQs

1. What is addiction?

(Bryanna Villasenor, CADC): Addiction is the obsession of the mind to a person, place or thing.

(Amanda Ferguson, LVN II): Addiction is when an individual is using drugs or alcohol and having negative consequences but continues to use anyway. This can be intermittent or daily. Regardless of physical dependency, addiction can affect people who are high functioning and “binging” or people who are completely taken over and are using daily.

(Dr. Emily Eckstein, PsyD, LMFT): Addiction can easily be defined as a brain disease in which you continue compulsive use despite negative consequences.

(Jaana Woodbury, Video Interview):

2. What is mental health?

(BV): Mental Health is emotional and psychological well being and how we react to stress, situations, and make choices.

(AF): Mental Health is an area of medicine that involves psychiatric and behavioral disorders. Addiction is actually a diagnosis and listed in the Diagnostic Statistical Manual of psychiatric disorders. Mental Health disorders are sometimes related to a biological factor that they are born with, and some may be related to nurture of how they were raised. Some may be a little bit of both.

(EE): When we talk about mental health, we are looking at an individual’s perceived state of health and well-being which is reflected in their ability to handle day to day stressors and interpersonal relationships effectively.

3. What to do when a loved one is struggling?

(BV): What to do when a loved one is struggling-support their recovery any way we can and hold strong boundaries when in their addiction.

(AF): Often the best thing to do when a loved one is struggling is to reach out to any local mental health or substance abuse facility and talk to someone with experience to see what direction you should take for your loved one. Additionally seeking an appointment with a psychiatrist or an Medical Doctor that specializes in addiction can be helpful as a fist step.

(EE): In your communication and engagement with your loved on, share in an authentic way your concerns and observations. Let them know you are there for them. This is also a great time to seek your own support through a therapist or support group of peers, such as Al-Non. Remember, no one wakes up one day and takes joy in being an addict; it is a lonely disease and your loved one is likely hurting significantly.

(Jaana Woodbury, Video Interview):

4. What are signs and symptoms that you are experiencing to show that you are struggling with substance abuse or mental health? 

(BV): Signs/symptoms that I may experience that show I am struggling with addiction/mental health are: isolation, losing interest in things I normally enjoy, negative attitude, resentments against people, tiredness/napping often, not returning calls + texts, physical appearance suffering. 

(AF): Depending on the issue someone is struggling with the symptoms may vary. Mental health conditions can show a variety of signs but here are a few: isolation, weight gain or weight loss, increased persistent anxiety with no obvious cause, hallucinations, excessive speech, and insomnia. Substance abuse may show varied signs such as: Change in personality, frequent sickness, irritability, frequent lying or manipulation, isolation, increased anxiety, physical dependence, poor work performance, and insomnia.

(EE): There are multiple signs and symptoms that can indicate you are struggling with substance abuse or mental health challenges. Some of the main signs are in increased inability to function at work and/or at school and in your relationships in the same manner you were functioning. You may notice you are having to use more and more of your substance/s of choice to get the same effect and likewise, you may notice an inability to sleep or even wake up with an increase in mental health symptoms. And of course, if you have suffered either legal or health concerns as a result of either your substance use or mental health, this is a clear sign you need to seek support. Additionally, thoughts or urges to end your life or end the life of another is a clear sign to get help.

(Jaana Woodbury, Video Interview):

5. When is an intervention needed and what should it look like?

(BV): An intervention is needed when the individual is showing they cannot live life on life's terms, and cannot get sober on their own. By the time I was ready to finally get sober, I would have loved and accepted an intervention from my loved ones and had treatment already set up for me to go.

(AF): If you see your loved one going down the wrong path it's recommended that you approach them in a loving way to offer help. If they decline, which some people do because they don’t realized the severity of their issues, an interventionist may be helpful. Typically an intervention is only used for substance abuse issues rather than mental health issues. The interventionist should meet with the loved ones prior to approaching the family member and discuss the best way to approach the individual. The interventionist will also be able to inform you if an intervention is necessary if you are on the fence.

(EE): There are different kinds of interventions. Some loved ones will seek support in the form of an interventionist as simply they feel uneducated as what to do and instead of confronting the loved one struggling, the intervention will be more invitational, inviting them to accept support being offered while sharing concerns the family/friends may have at that time. There re more confrontational interventions that are used when the invitation for support has not been effective in the past. These often come with limits and boundaries as a result of the loved one being unwilling to accept support.

6. How do you vet a treatment facility?

(BV): I vet a treatment center on word of mouth, integrity and overall warmth of the staff, a full program including out patient, and what the program has to offer that other programs don't.

(AF): Vetting a treatment facility these days has never been more imperative. Asking the right questions can quickly decipher the quality of treatment provided. Here are some Good questions to ask: 

1. How often will the client see a Doctor? (If in detox should be daily, and if not then multiple times a week) 

2. Are the clinicians Licensed or Interns? ( Some interns are ok, but the majority of the clinical staff should be licensed) 

3. What type of family involvement do they offer? ( Addiction is a family disease and family involvement is very important, something once a week is important) 

4. What type of groups do you offer? (ask for a copy of the group schedule! This should be something everyone is willing to provide) 

5. Who runs the groups? ( Its important to check and see if the certified and licensed staff are running groups, vs the technicians that are not really trained to do so).

(EE): With so many great and more not so great treatment facilities, it is essential you know what to look for when deciding on where to receive treatment for yourself or a loved one. There are two main certifications that facilities can obtain – CARF and/or JCAHO. When you can confirm a facility maintains one of these certifications, you know they go through a strict process of evaluations to assure the duel diagnosis services being provided are clinical and ethically superior. You also want to confirm that the professionals providing services at these facilities are licensed and receive ongoing supervision and training. You want to confirm as well that the addictionologists and psychiatrists treating clients are Board-Certified.

7. What should detox provide and look like? (Frequency of visits with clinicians)

(BV): A detox should provide a doctor, medication, nursing, frequent checks/visits on clients, and compassion.

(AF): Detox level of care should have access to a assessment with a phsyician within the same day of arrival if not immediately. Medications should be based on an individual basis along with any medical testing prior to being fully admitted. Checking labs, EKG and vital signs before admission to detox is important. Detox staff should check on their patients every 30 minutes and also do vitals every 2 hours. Physicians should check in with their patients almost daily.

(EE): You want to make sure the detox process is being coordinated by a Board-Certified medical provider. They will have the experience and education to assure you are detoxed off of alcohol and drugs in an ethical and minimally uncomfortable way without further activating your addiction. If detoxing at an RTC or inpatient facility, you also want to assure they have nursing that are checking your vitals at least 3x a day during this detox process. Depending on how you are feeling, your therapists should be made available to you for brief sessions during this time.

(Jaana Woodbury, Video Interview):

8.  What is the role of a case manager?

(BV): The role of a case manager is to set up and hold the client accountable to a treatment plan.  The client will have weekly goals in the areas of substance abuse, family conflicts (help set up family sessions), and discharge planning. The case manager should be checking in with clients weekly on progress, help the client get connected with a recovery community, and help with any additional housing, medical, and financial needs/resources so that the client has the best chance at continuing recovery and increase the level of independent functioning.

(AF): Case managers are there to work mostly on the external. Case managers help clients plan their discharge, work on life skills, find classes, work on social arrangements and meeting schedules, promote recovery programs and sponsorship, give assignments and work with family.

(EE): The role of a case manager can look different in diverse systems. Often in an RTC or inpatient system of care, you will find that Case Managers are certified drug and alcohol counselors or specialists focused on introducing the client to the world of recovery, recovery meetings, and proving accountability around skill building. They may also play a role in supporting and coordinating aftercare plans with your other providers.

9.  What is the role of a therapist?

(BV): The role of a therapist is to provide the client with a safe, confidential, and supportive environment while in treatment.

(AF): A therapists job is to work on the internal. Therapists should meet with their clients a minimum of once per week if not more. They will work on emotional regulation, family patterns, traumatic events, and coping skills. The therapist will also refer the client to see a psychiatrist if they feel necessary.

(EE): A solid join with a therapist can be the number one external factor to sustained recovery in early sobriety. Your therapist will ideally create a safe space for you to explore your story and challenges as you work towards recovery day by day. Your sessions are where you reach deeper and explore the way behind your use and relationship with self and others.

10.  What are different therapeutic modalities that are used?

(BV): Different therapeutic modalities that are used include group therapy, CBT, seeking safety, coping skills, yoga, mindfulness, nutrition.

(EE): You should look for a combination of evidenced-based modalities such as Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (CBT), experiential (breath works, surf therapy, yoga, expressive arts), and groups and curriculum focused on relapse prevention and life skills.

11.  What should residential treatment (RTC) provide and look like? (Frequency of visits with clinicians)

(BV): RTC should provide clients with: scheduled group times during the day, recovery group meetings in the evenings, a therapist and case manager on site daily, support staff to help with any immediate concerns/questions, and patience, understanding, and compassion for the clients.

(EE): Each program, much like each person struggling with substance abuse or mental health challenges, looks different! While some provide more one on one sessions with your therapists (sometimes as much as 6 times a week), others provide less one on one but are heavier on group curriculum and lectures. At the RTC level of care you are being provided 24-hour support in a confidential environment in which you live and eat. You are often living with peers who share in your experience and you want to ensure that the program you chose will meet you where you are at and does not offer a one size fits all approach. Feel free to call ahead of time in your research and ask to talk to someone on the clinical team!

(Jaana Woodbury, Video Interview):

12. What should a family program look like?

(BV): A family program should include family groups weekly for the client as well as just the family members. Addiction/alcoholism is a family disease, and everyone should have the opportunity to treat it.

(EE): Addiction nor recovery happen in a bubble and more so, addiction is a family disease. You want to look for a family program that will effectively educate the family about addiction and their role in the cycle of addiction and how to best support their loved one while practicing self-care. While many families report group sessions being uncomfortable, there can be power and connection found in multi-family groups were families can join around shared experiences.

13.How can the family best support themselves and the addict that’s struggling?

(BV): The family can best support themselves and the addict that is struggling by attending Alanon and/or the treatment center's family programs to educate themselves on the disease and also help themselves hold boundaries with the addict.

(EE): The three main ways in which a loved one can support themselves and the addict is to (1) educate themselves about the disease of addiction, (2) learn the role of heathy boundaries in relationships, and (3) seek their own support through therapy, spiritual mentorship, or a peer support group.

14.What should partial hospitalization program (PHP) provide and look like? (Frequency of visits with clinicians) 

(BV): PHP, or partial hospitalization program, is an outpatient service that allows substance abuse and mental health clients to attend groups 6 hours/per day, and reside either at home or a transitional living environment.

(EE): PHP level of care can be anywhere from 6-12 hours of support a day. You no longer live at a residential facility and instead, live independently or in a supported, sober living environment. You can plan on seeing a therapist anywhere from 3-5 times a week, with the remainder of time being focused on group curriculum surrounding relapse prevention, coping skills, and daily living skills.

15.What does a solid aftercare program look like? (Self-care) 

(BV): A solid aftercare program looks like PHP/IOP, a transitional living environment with other sober individuals, recovery meetings and/or sponsorship. The client should continue to see their addiction/primary health doctor once weekly for any medication changes and check-ins, and ongoing therapy is encouraged.

(EE): Simply, therapeutic support in some form, a commitment to a like-minded community (such as 12-step), and a solid routine which includes proper nutrition, exercise, and follow up with a medical provider.

16.What should intensive outpatient (IOP) provide and look like? (Frequency of visits with clinicians)

(BV): IOP should provide groups held during the day(or evening), a case manager to meet with the client weekly to address tx plan and goals, therapy 1x/wk, weekly doctor visits for medication adjustments/check-ins.

(EE): IOP often looks like 3-5 hours a week or programming, 3-5 days a week. Usually, individuals transitioning from RTC or PHP will start with 5 days a week of IOP and transition to 3 days a week. Programming at the IOP level of care consists of 2-3 individual or family sessions a week with a therapist and daily groups focused on release prevention, coping, and life skills. You are also receiving monitoring services through your IOP provider. You can also receive case management or even educational or vocational support at this level of care.

17.What should outpatient (OP) provide and look like? (Frequency of visits with clinicians) 

(BV): OP should be your closest transition to "the real world". By this time, clients are programming 1-2 days/wk, hopefully have obtained employment, still meet with case manager 1x/wk, and Outside therapy encouraged. At this level of care, therapy is no longer provided by the treatment center.

(EE): Outpatient is usually referring to a step down from an IOP level of care and looks like once a week session with a therapist and possible ongoing monitoring for added support and accountability. The individual has usually returned to work or school and has shown a pattern of success at a lower level of care.

18.What should monitoring look like?

(BV): Monitoring should include, breathalization & UA multiple times/week, and Sober Link encouraged. Family is not usually chosen to hold the addict accountable with any of these options due to codependency.

(EE): This can be accomplished in different ways. Urinalysis, breathalyzing, and virtual monitoring through a service such as SoberLink, are all common means of monitoring. Monitoring is facilitated in order to increase a sense of accountability for the addict and can often bring a sense of ease to the loved ones, while everyone is working towards regained trust within the family/friend system.

19.What are natural highs and how can you obtain them? 

(BV): Some natural highs one can obtain in sobriety are breathworks, yoga, exercise/sports, and being of service, in my opinion.

(EE): Natural highs are experienced when the body releases “feel-good” chemicals in the brain or endorphins. This release of endorphins works much the same as the high one gets from heroin use! Integrating in a routine exercise program is a safe and healthy option to obtain natural highs in early recovery. Massages, time spent with an intimate partner, and even dark chocolate release these same natural high endorphins!

20.What’s the best way to maintain sobriety?

(BV): The best ways for me to maintain sobriety are to stay connected to my higher power, stay involved in my recovery community, continue meetings, work with a sponsor and newcomers, stay honest, and be of service.

(EE): ? A structured, daily routine and connection and accountability through a community of likeminded individuals are two effective means of maintaining sobriety.