Is preventing addiction possible?
My office looks out on a residential treatment center parking lot. So I am privy to the expressions on the faces of people as they arrive for their first day in rehab – arguably what will be both the worst and best day of their lives. To a person, they look shattered. I’m in recovery myself, and I can empathize with how they are feeling.
By the time an individual rolls their suitcase up the ramp to Sanford Admissions, they have run out of loopholes, excuses and obfuscations. They are also facing the relationship, job, medical, and even legal ramifications of their drug and alcohol use. All the while feeling the oddly ambivalent combination of hope and resistance. As a marketing professional I think about this a lot. How do we “market” the concept of the important first day of treatment? Step right up! You know the thing that has occupied your every living minute for the past five/ten/fifteen years? The substance you think you can’t live without? You are going to quit using that today. And you are going to change just about everything in your life forever. You are probably not going to feel solid for a year or more either … So, step right up with a bow on it!
Of course I know that in three to five days those same people will start feeling and looking better. The concept of recovery will begin to make sense. But on their first day, I know another thing our clients are thinking. They are wondering how they got to this point. How did this happen? And was there a divining moment somewhere along the way, where they could have stopped before it became a full-blown substance use disorder (SUD)?
An Ounce of Prevention …
In fact, greater impact is likely to be achieved by reducing substance misuse in the general population – that is among people who are not addicted – than among those with severe substance use problems.
The Surgeon General’s Report on Alcohol, Drugs and Health (2016)
Eight out of ten people use drugs and alcohol responsibly. Just like the beer ads tell us to do. They take their prescribed medications as designated on the bottle and properly dispose of the leftovers. In states where cannabis is legal, they bite off the head of a low THC gummy in the safety of their homes. And they sip a single glass of wine with dinner (the lie police officers hear every time they stop someone for driving erratically). But for the two out of ten who are at risk, is it possible to prevent addiction? And what are the warning signs?
Responsible Drug and Alcohol Use
I think most folks are surprised when they see the size of a “standard drink”. A standard drink, as defined by the National Institute on Health (NIH) is: 12 ounces of beer; 5 ounces of wine; and 1.5 ounces of distilled spirits. The NIH also defines moderate drinking as up to two alcoholic drinks for men of legal drinking age per day, and one drink for women of legal drinking age per day. If right now you are wondering if you can stockpile your daily allotment and drink them all on Friday night (that is a warning sign), the answer is NO. Per day means per day (see “binge drinking” below).
When it comes to prescription medication, responsible use is defined as taking the medication only as intended by the prescribing doctor. This also means not sharing medicine with others; storing medications safely; not mixing medications; and disposing of unused medicine correctly and in a timely manner.
The cost benefit ratio for early treatment is 1:10. For every dollar investment in early treatment and preventing addiction, there is a $10 savings in health costs and lost productivity. We have a higher likelihood of successful outcomes if we implement effective prevention programs.
Sanford Founder, Rae Green, Capital Area Opioid & Pain Conference – Michigan State University (2020)
Drug and Alcohol Misuse
Alcohol and drug misuse is defined by the Surgeon General as, “The use of any substance in a manner, situation, amount, or frequency that can cause harm to users or to those around them. For some substances or individuals, any use would constitute misuse (e.g.,underage drinking, injection drug use).”
Binge drinking is a pattern of drinking that brings blood alcohol concentration to 0.08 percent or higher. This typically happens after 5 or more alcoholic drinks for men, and 4 or more alcoholic drinks for women on a single occasion (in about two hours). Heavy drinking is defined as consuming more than the “responsible use” criteria above. In other words, more than one drink per day for women and more than two drinks per day for men.
The consequences of drug and alcohol misuse may cause havoc for the user or those around them. Everything from a fist fight on a street corner, to long-term medical conditions or repeated employment and relationship mishaps. However, this is the stage that is often called “high functioning“. In other words, the misuse might only happen on a Saturday night, or after five. And the user is able to perform most daily tasks acceptably.
This is the stage, if convinced, that the misuser has an opportunity to nip a substance use disorder in the bud. It is also the stage where you may hear your loved one say something like, “What? I was just letting off steam and having some fun … I won’t do that again for ages!” So it’s tricky. Education about who is at risk, understanding the disease of addiction, and self-reflection are key.
Drug and Alcohol Dependence
The NIH defines “dependence” as: a state in which an organism functions normally only in the presence of a drug. Manifested as a physical disturbance when the drug is removed (withdrawal).” This is usually the stage when a stay in a residential treatment center is required. And at that time, we also establish a long-term continuum of care which increases successful outcomes in recovery.
How do we prevent an SUD from getting a stronghold? By talking about addiction – creating awareness and educating those at higher risk to tread carefully. Also, by delaying the first use of alcohol or other drugs. Research shows that those who begin drinking or drug use under the age of 14 are more likely to develop a dependence to drugs and alcohol later in life.
Preventing Addiction – Early Education
It takes a village. Because, the same preventive message about drugs and alcohol must be delivered by multiple messengers. Teachers, parents, doctors, local communities all have to repeat the same message throughout childhood and adolescence for best results.
Preventing Addiction – Ongoing Education
We are never too old to learn about drug and alcohol misuse and dependence. An open dialogue and the use of non-stigmatizing language in communities, schools, families and workplaces encourages early intervention. Those who need help, will ask for help. And Outpatient classes on Healthy Living, Mindfulness and Relapse Prevention can bolster confidence and provide healthy community.
The predictive markers for SUDs are genetics, environment, trauma and for opioids chronic pain, lifestyle and peer influences. Avoid (and help others avoid) beginning drug and alcohol use under the age of 21. For those at risk, no matter what the age, limit access to/use of addictive substances.
Assess Negative Consequences
Does it ever really make sense to take a sippy-cup of wine to your elementary school child’s soccer game? Or to throw a punch at a party? Or to get inebriated in front of colleagues at a corporate retreat? Honesty is always the best policy when it comes to assessing the negative consequences of one’s drug or alcohol use.
Times are changing, but it is still prudent to advocate for yourself in doctor’s and dentist’s offices or in the hospital. Do not be embarrassed to discuss drug choices, always disclose the fact you are in recovery. And accurately report drug and alcohol use when asked by a medical professional.
All that open dialogue instills lifelong recognition that societal pressure, advertising influences and the overwhelming prevalence of drug and alcohol acceptance can be avoided. Peer pressure can just as easily be peer support, so choose your friends wisely.
Addressing trauma, past hurts, and adverse childhood experiences with a reputable therapist is key. Also, addressing co-occurring disorders that may precipitate SUDs, like anxiety and depression. Group therapy is an excellent way to incorporate treatment with positive peer support and connection.
Proper assessment, diagnosis and treatment
Finally, a proper assessment and diagnosis will determine the course of treatment. Not everyone needs a stay in detox or to start in residential treatment. Outpatient treatment includes group work and family psychoeducation augmented by community support. It also incorporates continuing psychoeducation designed for a variety of demographics including those whose drug and alcohol misuse has become untenable.
Who is responsible for preventing addiction?
We must work together to develop and support preventative measures, including more comprehensive education in our schools and workplaces. There are no shortcuts. Everyone needs to be an advocate, for prevention is the key to solving this crisis.
Sanford Founder, Rae Green, Capital Area Opioid & Pain Conference – Michigan State University (2020)
My office also looks out onto the patio where our clients take their breaks. And one of my favorite things about working at Sanford, is seeing the change in our clients after they have been with us a few days. Their hair, skin and eyes are shinier, brighter and whiter. But it’s more than that. They are lighter, somehow. I see them laughing and talking earnestly with new friends. A glimmer of the whole person they were before the SUD.
It is said, that 80 percent of success in life is just showing up. On some level, that works in treatment for a substance use disorder too. As difficult as the first day can be – the trip from the car to admissions – showing up and trusting in a process, is the beginning of a revitalized life. And if we can engage more people at the point of misuse, before their disease escalates to a progressed, chronic state, we dramatically increase our likelihood of preventing addiction and engendering improved outcomes.