Getting Help: Drug Addiction Series Part III
What do you do when you find out your child is a drug addict?
by Kim Duffy
When a family finally checks their adolescent or adult child into detox for substance abuse, it often feels like the solution. It may have taken months or decades for that child to agree to get help, and the family heaves a sigh of relief that the problem is finally going to be solved. Then the child begins calling incessantly to come home, insisting that it's creepy, it's not helping, or the staff is inept. Or they walk off the unit (if they're over 18), or they are truculent in the family meetings and sullen with the staff. After two or three days when the drug has drained out of the body but not out of the brain, the addict is released. According to the National Institute on Drug Abuse (NIDA), "Patients who go through medically assisted withdrawal but do not receive any further treatment show drug abuse patterns similar to those who were never treated."
The family, for its part, is frequently uneducated about the ways in which they actually support their child's addiction. They feel sorry for their child who seems locked up in a scary place with a bunch of weirdoes, and they struggle with bailing them out early. Parents would do well to remember that their child's illness is in the hands of professionals-perhaps for the first time-and that while their child was seeking and using drugs they were in far more frightening situations than detox. As for the weirdoes, they are probably representative of the people their child has been hanging out with, long before detox.
To answer questions about what detox is and is not, Michael Crookston, M.D. is an ideal choice. A psychiatrist trained in child and adolescent psychiatry, he also specializes in addiction psychiatry. Crookston is on the board of the Utah State Division of Substance Abuse and Mental Health, and is medical director of adult Dayspring, a substance abuse program of Intermountain Healthcare (IHC).
NIDA outlines three stages of treatment: detox, rehabilitation, and continuing care. Will you describe what detox is?
Detox is more correctly termed a "prerequisite" to treatment. The purpose is to safely and comfortably remove the drugs from the patients, stabilize them, and engage them in the next phase.
A lot of people cannot or will not start treatment because they are afraid of withdrawal or they think it's dangerous-and it is, for certain substances. Though detox alone is not effective, it's widely practiced. Much of my time with patients is spent trying to get them to understand that getting detoxed isn't going to change anything, and that what comes afterward is more important.
I've noticed over the years that some people will come in just for detox, and then I could bring them along. They weren't ready to commit to six weeks of treatment until they got to know me, until they started feeling better, and until their mind cleared.
It would be reassuring to families and addicts to hear exactly what goes on in inpatient detox. Will you demystify that?
A psychiatrist sees the patient and does a psychiatric evaluation, including past medical, family, and social history. A nurse practitioner does a full physical exam, and blood work is ordered. The nurses check vitals at least every four hours. The patients engage in group therapy sessions two to three times a day if they want to, but some sleep all day. Most detox meds are ordered to be taken as needed, and if patients want medication they must go to the nurse's station to ask for it. Some patients will ask for anything they can get, even when they can barely keep their eyes open, but the nurse decides if they really need it.
The patients and all of their belongings are searched for contraband upon arrival. Cell phones are not allowed, but patients can make calls from the unit phone, except during group. No smoking is allowed. The detox unit is locked and patients aren't allowed to leave the unit to smoke.
Strict confidentiality is practiced. Substance abuse records are more confidential and protected than any other records, including psychiatric. Even parents may not get information about their adult child unless the patient signs consent. There are set visiting hours, and anyone who has the patient's secret code may call or visit.
The average stay is about three days. The psychiatrist meets with the patient daily and with the family upon discharge.
What if the family isn't present at discharge – isn't the patient too addled to understand their instructions?
Yes. We rely on them to tell their family what's going on, and they don't always, or they forget, or they don't want their family to know they were referred to treatment. Our new outpatient detox unit requires that a family member drive the patient to and from the program.
It sounds like detox can be a dangerous opportunity for somebody to begin recovery. Do people usually follow up with treatment?
In my experience probably less than half, and that is predictive of who is going to relapse, and how quickly. We're hoping that by opening an outpatient detox program here at Wasatch Canyons-where we already have outpatient treatment and continuing care -we will be able to get patients to transition right into treatment after detoxing here. We begin some treatment in detox, but even six weeks of outpatient recovery isn't enough for patients to change their lives. That's why our aftercare is two years long.
Where else is detox offered in the valley?
University Neuropsychiatric Institute (UNI), the VA, and Highland Ridge Hospital.
What is "social detox" which is offered at Volunteers of America (VOA)?
It is supportive detox where they get encouragement, fluids, and a place to rest.
In detox, how do you prepare the addict to consider treatment afterwards?
Patients are admitted usually late in the day, and I see them the following day. By then they've talked to the nurse practitioner and the social worker. Hopefully they are all giving the same message. What's missing is that the family isn't sitting there hearing these conversations.
When I ask the patient what they're going to do next, some say they're going to get a job or get back in school. I say, "No, what are you going to do for treatment, because this isn't going to change anything." I show them scientific research from NIDA, that the treatment has to be of sufficient duration, that the threshold of improvement is 90 days; that detox isn't treatment; and that in spite of treatment people relapse.
That's a lot of bad news to deliver to someone who feels like hell.
Right, and if they're with us for three days, I have three opportunities to convince them. It's good when they have to come back and see me for a prescription, and they bring a family member. That's when everybody hears the rest of the story, and the spouse or sister will say, "Why aren't you going into treatment!"
What does an average hospital detox cost?
It's costly. Sometimes insurance pays, but two to three days can cost $7,000. The patients get good care and their safety comes first. I do think they could re-evaluate the cost and the enormous burden it presents at a time when patient are so fragile.
What will outpatient detox cost at Wasatch Canyons?
About $210-$220 a day. They'll be here for three hours each time. I'll pull them out one at a time to do the physician's part and write the prescriptions. The rest of the time they and their family will be getting educated. I think that's going to help immensely.
If a patient is taken to a hospital emergency department, say at LDS Hospital, and they have no money, and the VOA is full, will the hospital take them upstairs to detox?
We admit them at LDS if it's life-threatening.
Do you refer patients needing residential treatment out of IHC, inasmuch as they don't offer it?
Yes, but most insurance companies don't cover the cost.
What is this new detox that uses three medications and takes three days to detox?
It is called Prometa, and it uses Neurontin, Vistaril and Romazicon. It costs about $12,000 to $15,000. I've been to a couple of seminars on this-it's supposed to reset certain receptors in the brain. Success rates in one drug court study were about 80%. That's unheard of. And they say the patients are alert and able to do treatment from day one. But it's controversial because of the commercialization, the cost, and that fact that it hasn't really been studied.
How do attitudes need to change to ease the pain brought on by addiction?
We have this misconception that people using drugs and alcohol are in this blissful state of euphoria with no worries, no anxieties. This is patently false. That myth allows us to be self-righteous and angry at people who use drugs. In reality, people who are addicted suffer tremendously. We've begun to see that people don't have to hit bottom, that maybe we can raise that level and they don't have to lose everything before entering treatment. Motivation for treatment doesn't have to be pain; a relationship between a patient and a clinician can spark motivation.
Make no mistake; addiction is a painful, destructive slide into an abyss. A hell.
Dr. Crookston can be contacted at 265-3049. Kim Hancey Duffy is a freelance writer living in Salt Lake City. (Author's note: The links in the first two articles seem to have lost something in the translation. See the articles online for corrected hyperlinks or email questions to email@example.com.)
See the 13 Principles of Drug Addiction Treatment at catalystmagazine.net (accompanying this story) or www.nida.nih.gov/PODAT/PODAT1.html . (National Institute on Drug Abuse)