Beyond Drug Busts and Binges
Will My Insurance Pay for Rehab?
Beyond Drug Busts and Binges
Recovery coaching and recovery coaches are somewhat controversial in the professional treatment community, in part, due to a perceived lack of clarity between the roles performed by therapists, recovery coaches and other providers. Nevertheless, recovery coaches, often with years of "lived experience" in connection to addiction, are a part of the treatment spectrum, providing support and helping clients understand and navigate the clinical, legal and other practical aspects of recovery. Graeme Alford uses the experience he gained over the course of his own dramatic recovery journey to help others still struggling to gain traction in their own recovery.....Richard Juman
My work with those struggling with addiction is based on personal experience. Once a successful attorney, alcoholism destroyed my career, my family and my status in the community. Eventually, I was incarcerated three times, finally for armed robbery. In prison, where I was considered a “hopeless case,” I started to fight my way back to a way of life based on self-understanding, self-improvement and a rigorous pursuit of important life goals.
I now have over 30 years of sobriety. Like many recovery coaches and counselors, I use the insights gained in my own recovery to help others. But I am always aware of the limits in my training and expertise, so one of the key elements of my approach is an understanding of the need to work collaboratively with the professional community. My recent work with two clients who suffer from depression highlights some key aspects of my approach.
“Jimmy” has been on medication for depression (a mild form of bipolar) for approximately 10 years, and has been on the merry-go-round of treatment for his drug and alcohol addiction for 15 years. Over the journey he has done several rehabs, some lasting up to 60 days, seen a variety of psychologists and been treated by numerous physicians. He has enjoyed several periods of up to 12 months of abstinence from both drugs and alcohol, during which he got his in life in order only to go bust again.
One of his busts resulted in a near-fatal experience. In an alcohol- and drug-fueled binge, he went to a neighbor’s house where a party was in full swing. His poor behavior caused a fight to break out, which resulted in Jimmy being rushed to the hospital suffering from multiple stab wounds and nearly dying on the operating table. As he left the hospital, he swore he would never touch the booze or drugs again; yet three months later, he was back smoking marijuana, using cocaine and heavily into drinking.
I first met with Jimmy about three years ago (just prior to his stabbing). He had been in-and-out of AA for years, had two sponsors, yet really struggled to find a pathway within AA that would work for him.
Over several sessions with Jimmy a picture started to develop:
His busts were inevitably linked to him going off his medication. When I asked him why he would periodically stop taking the medication, he told me that “it dulls my libido.” Jimmy is a very social person who makes new friends easily, thrives in the company of others and craves the highs that come with using alcohol and cocaine. Over the years, he has been in-and-out of many relationships. His work history mirrored his personality. Employers would initially be thrilled with the results Jimmy achieved, they would persevere with him during his initial busts and then they would finally become fed up with his late starts and days off then they'd terminate him.
His living arrangements for the past 10 years have been nomadic. Jimmy has moved from apartment-to-apartment, always leaving when he could not pay the rent. In between apartments, he would stay with friends, often sleeping on their couches. This would last until he had worn out his welcome. Being in his mid-thirties, he saw himself as a failure when he compared his life to those of the people in his social network. They all had steady jobs, families, a house and money in the bank; he began to despair that he would never overcome his drug and alcohol problem. He was desperate for AA to work for him, and yet could not understand why he had busted after numerous periods of sobriety.
During my initial sessions with Jimmy, I did not offer any suggestions about the pathway forward. It was abundantly clear there were two separate, yet interwoven, issues: His diagnosed depression, and his addiction to drugs and alcohol. Once I had a fairly detailed background, my first port of call was to speak to Jimmy’s treating physician. Jimmy had been upfront with his doctor about his dislike of the prescribed treatment for the depression and why he would periodically stop taking it. His physician had done his best to try different medications and was continuing to work with Jimmy to find the best possible solution.
Following my meeting with his doctor, I met with Jimmy and we prepared a plan to move forward, based on him remaining compliant with his physician’s orders around the depression treatment. Jimmy understood that the treatment he was receiving for depression was non-negotiable; he had to continue taking it, come hell or high water, and he would work with his physician to fine-tune the prescription as needed. The reason was obvious—every bust in the past 10 years had been precipitated by going off his medication. Once he had been without medication for a few weeks, he would start self-medicating with drugs and alcohol.
As treatment proceeded, Jimmy continued to take his medication, and eventually started a new career, got married and had a child. We agreed that he would reduce his 12-step meetings to twice per week. This plan worked perfectly until six weeks ago when he went on a huge drug and alcohol binge. When I spoke to him about this, he admitted he had stopped taking his medication three weeks prior to picking up again. Of course, he hadn’t mentioned this to either me or his physician. Currently, Jimmy is back in rehab, and while it is far too early to be optimistic, there appears to be a degree of introspection he has not had before about what he needs to do when he comes out.
My work with “Clint” highlights another important aspect of my approach. Like Jimmy, Clint had been on medication for depression (again, a mild form of bipolar) for several years when I began working with him. He is also a binge-drinking alcoholic who has increased the regularity of his drinking during the past 18 months. Over the past 18 months, he has started to drink on a more regular basis. Over several sessions, we established his binges tend to last between one and three days where he checks into a hotel and writes himself off. Like Jimmy, his binges were predominately preceded by him going off his depression medication. Clint detests the medication, as it makes him feel flat, takes away his high energy levels, dulls his enthusiasm and also reduces his libido. He thrives on the feeling of excitement, which might be described as hypomania, and when he is on this type of high he feels like he is unstoppable, especially in business.
He has been around AA for several years but has struggled with the religious aspects of the program; he has had two sponsors but was unable to click with either of them. That said, he felt the answer for his sobriety was within AA. He is also seeing a psychologist and has found these sessions to be beneficial. I should add that Clint owns his own small business and despite a few hiccups has managed to keep the business moving forward.
We developed the following plan with Clint: He would take his medication no matter what, and he would continue to see his psychologist since he felt that it was benefitting him. We would maintain a constant vigilance in monitoring his mood, because we both knew that it was critical that he stay on a level plane. To help with this we created an “excitement meter,” with 10 being “over the top” and one being “absolutely flat.” Clint’s challenge is to stay somewhere between 5-8 on a regular basis. I check-in with him each night to see how he going with his “excitement level,” and he really likes the way the concept and the metering concept is keeping him on an even keel. We also changed his AA schedule around to do three meetings a week, including the creation of a home group, which he selected after attending a variety of meetings in his area. Beyond that, he is also undertaking a series of exercises to improve his feelings of self-worth and confidence. While it is early days (four months), Clint has been extremely diligent with his program, and this is the longest period of sobriety he has enjoyed since he left school.
I hope that these two case studies provide some useful ideas and information. When someone enters recovery they may well have other issues that need to be dealt with—apart from their addiction. It is imperative for a clinician to get a detailed history of the client prior to making any decisions about how to proceed (I appreciate that this may seem to be stating the obvious). When you have a client with a medically-diagnosed illness, for example a depressive disorder, it is imperative that the treatment of that issue be conducted by an appropriately qualified practitioner. The clinician needs to work with the treating doctors and psychologists to ensure there is a comprehensive plan in place to address all the issues. For example, Clint works with a physician, a psychologist and a recovery coach, and we all work together.
It is critical for the client to address the issues they face in a timely manner and feel confident the treatment plan makes sense. Further, the potential for conflict within any treatment plan must be managed through consultation involving all of the relevant parties. Where AA or NA is part of a treatment plan, it should be personalized to fit the needs of the client. To just “send them to a meeting” and hope they come into contact with members who are a good fit for them is simply rolling the dice and hoping the right number comes up. Sponsors and other members of 12-step fellowships should never offer advice about taking or not taking any medications. That domain should be left to the licensed professionals!
Graeme Alford is the founder of Recovery Beyond Belief. Released from prison in 1986, Graeme started out laboring in a scrap metal yard and went on to become one of Australia’s foremost seminar promoters and created “The World Masters of Business” which featured amongst others, the legendary Lee Iacocca, Stephen Covey, Norman Schwarzkopf, Mikhail Gorbachev and Nelson Mandela. He has written three books including the bestselling “Never Give Up,” and is now in his 33rd year of sobriety. Over the past 12 years Graeme has developed an extensive practice in working with recovering alcoholics to navigate the turbulent waters of early recovery and then unwrap the gift of sobriety. www.graemealford.com