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How to Stay Sober and Maintain Clean Living

PUBLISHED: Sunday, April 12, 2020 by Dr. Ronald F. Young, M.D., F.A.C.S.

 

INTRODUCTION

Addiction to alcohol and drugs, more correctly called Substance Use Disorder (SUD), affects millions of people with dire consequences not only for the individual involved but also for family members, co-workers, and society as a whole.

The National Institute of Drug Abuse estimated that about 22.5 million people or 8.5% of the US population required treatment for an "illicit" drug abuse problem. Alcohol addiction alone is estimated to affect 14% of the US adult population.

Young adults and even children may suffer from SUD. In addition to alcohol and drugs, people may be addicted to gambling, eating, sex, the internet, and also work.

SUD is defined by the Substance Abuse and Mental Health Services Administration of the US Department of Health and Human Services.

It is when the use of alcohol or drugs leads to negative consequences either for the individual or for those around him or her. Such results may include health problems, disability, and failure to meet primary responsibilities at work, school, or home.

In this article, we shall use the term "drugs" to include alcohol, opiates, methamphetamine, PCP, Cannabis, where illegal, all other drugs of abuse, and also abuse of prescription medications.

Stopping the abuse of drugs and alcohol and staying sober is not easy, but there is help and effective treatment for SUD. Before discussing sobriety, we need to understand SUD. In this article, we will discuss SUD, including how both physical, medical, and psychological treatment can help a person with SUD become sober and maintain clean living. Along the way, we will give you tips for staying sober and where to get help when you need it.

CAUSES

The causes of SUD are not certain, but genetics and the environment together seem to predict this disorder. Drug addiction is not your fault. It does not represent a weakness in your character.

 A history of SUD in a family increases the chances that someone else in the family will develop it. Adverse childhood experiences such as child abuse are predictors that a person will develop SUD as a young adult or later in life.

Drugs have strong interactions with nerve cells and brain cells that cause brain circuits to change that affects the mind. These changes lead to a desire for even more drugs. According to a recent study, some people have a genetic tendency to drug addiction. Other studies suggest that the use of drugs can cause permanent changes in DNA, which then promotes the addiction syndrome.

SYMPTOMS

One of the most important signs of substance addiction or dependence is the use of drugs many times over, despite experiencing serious negative consequences. People with SUD often blame others, such as family members, co-workers, bosses, and law enforcement, for their problems. They are in a state of denial about their substance abuse.

Tolerance is another symptom of SUD. Tolerance is a condition in which more and more drugs are needed to cause the same effects. Tolerance often leads to illegal activity to obtain more drugs.

Craving is a strong need, desire, or urge to keep drinking or to use drugs. The addict becomes anxious, irritable, and desperate if he or she cannot get them.

Loss of control is also a symptom of SUD. The person may use more drugs than planned and cause a car accident or get into a fight or engage in illegal activity such as stealing to obtain money to purchase more substances to abuse. Combined drug use, such as opiates and alcohol, is dangerous and can lead to accidental death or suicide attempts. Deaths due to the opioid crisis are estimated to kill 130 people a day in the USA.

DIAGNOSIS

The diagnosis of SUD is a combination of a medical/physical and a psychological evaluation and an assessment of the social impact . The MEDICAL/PHYSICAL diagnosis includes a general medical history and a physical examination. The physical and medical diagnosis is carried out by a physician and depends on the number of drugs consumed and the effects they have on producing physical symptoms that affect the body. These symptoms may include the need for more drugs when tolerance occurs, withdrawal symptoms, vitamin deficiencies, memory loss, and injury to the addict or others when under the influence of drugs.

The PSYCHOLOGICAL DIAGNOSIS is made by a clinical psychologist and depends on finding problems such as anxiety and depression, which are the triggers for drug use and addiction. Major depression, attention-deficit hyperactivity disorder, borderline personality disorder and social anxiety disorder frequently accompany SUD.

The SOCIAL ASSESSMENT performed by a social worker looks at issues with family, loved ones, and general social interactions. The social assessment is a critical part of the diagnosis and subsequent treatment of SUD.

TREATMENT

SUD is a chronic disease somewhat like diabetes or high blood pressure. Just as with those illnesses, effective treatment is available for SUD, but there is no cure. A recent report suggests that a cure may be possible soon, however. People who suffer from SUD may become sober, maintain clean living, and no longer feel the need to use drugs with proper treatment.

The treatments for SUD are medical, involving different medications, psychological and social including various kinds of counseling.

The goals of treatment are to get the person to stop using drugs, or put another way to get them sober. The other essential goals are to keep them drug-free and to help them to be productive in their families, at work, and in society, that is to maintain clean living.

There is no "one size fits all" simple treatment for SUD. Treatment may involve medications and different kinds of outpatient or inpatient psychological and social therapies according to each person's individual needs.

 

Medical Treatment

The first step in medical treatment is to detoxify the person with SUD and get them off of drugs and alcohol. Medical therapy of SUD almost always involves a variety of medications. The purpose of these medications is to decrease or prevent unpleasant and potentially dangerous aspects of drug withdrawal. The medicines can also be useful for long term treatment to prevent relapse.

For opioid addiction, the most common kind of drug addiction, there are two effective medications: Methadone and buprenorphine.   Methadone and buprenorphine act on the same targets in the brain as heroin and morphine and suppress withdrawal symptoms and relieve cravings. Another drug, naloxone, blocks the effects of opioids at their receptor sites in the brain and is useful after someone has been detoxified.

Three medications are useful to treat alcohol addiction. They are naltrexone, Acamprosate, and disulfiram. The first two reduce the reward feelings associated with alcohol and minimize withdrawal symptoms such as insomnia, anxiety, restlessness, and dysphoria (generally feeling unwell or unhappy). Disulfiram causes unpleasant reactions that include flushing (warmth and redness in the face), nausea, and irregular heartbeat if the person drinks alcohol.

A variety of other new and promising treatments for SUD are on the horizon. One of those treatments may be able to predict the risk of opioid addiction and use a novel gene-editing approach for therapy. Acupuncture, physical therapy, nutritional support therapy, and exercise therapy may be helpful additions to a SUD treatment program.

According to a recent report, "abstinence is a primary goal of treatment; for, without abstinence, no other recovery will be possible. The remaining goals of recovery are detoxification, medical evaluation, stabilization of life-threatening emotional issues, education, identification of barriers to recovery, readjustment of behavior toward recovery, and orientation and membership in a self-help group." 

Psychological Treatment

The second and equally important phase of treatment of SUD is a variety of forms of psychological therapy. The goals of psychological treatment are to help people with SUD to modify their attitudes and behaviors related to drug use, to increase healthy life skills, and to persist with other forms of treatment, such as medication, so that they can remain sober.

Cognitive-behavioral therapy is an essential form of psychological treatment for SUD. This method helps patients recognize, avoid, and cope with the situations in which they are most likely to use drugs. Other forms of psychological treatment, such as multidimensional family therapy, motivational interviewing, and motivational incentives, also called contingency management, may also be used to treat SUD.

In December 2018, the FDA cleared a mobile medical application, reSET®, to help manage opioid use disorders. This application is a prescription cognitive behavioral therapy. It is used in conjunction with treatment that includes buprenorphine and contingency management.

Role of the Family and Social Treatment

The participation of the addict's family in treatment is essential because the physical, emotional, and spiritual effects on family members can be just as profound on them as they are on the addict. It will be very difficult or impossible for a recovered addict to stay sober return to society and maintain clean living without family support. Family support and treatment are particularly vital for childhood or young adult addicts.  If you spend time with loved ones during treatment, your recovery will be something to remember together.

HOW TO MAINTAIN SOBRIETY

The first step in the treatment process of SUD is to obtain sobriety, that is, stop the use of drugs and alcohol. A combination of medications and psychological treatment can terminate drug use. The next step is to maintain sobriety. In other words, how to stop using drugs, stay sober and maintain clean living.

The next step is often the most difficult because the individual may have to face many of the situations that lead to SUD in the first place, like anxiety and poor self-worth. Mental health problems like depression are frequently associated with SUD.

Drug abuse changes the function of the brain, and many things can "trigger" drug cravings within the brain. It's critical for those in treatment, especially those treated at an inpatient facility or prison, to learn how to recognize, avoid, and cope with triggers they are likely to be exposed to after treatment.

Inpatient or residential treatment centers can be essential ways to transition from a medical treatment environment to society.  Licensed residential treatment facilities offer 24-hour structured and intensive care, including safe housing and medical attention.

Residential treatment facilities may use a variety of therapeutic approaches, generally aimed at helping the patient live a drug-free, crime-free lifestyle after treatment.

It is essential to choose a rehab center that has a measure of official accreditation. The Commission on Accreditation of Rehabilitation Facilities, known as CARF, is a nonprofit organization that offers certification of rehabilitation and behavioral health centers. To receive CARF accreditation, facilities must meet a variety of requirements. A CARF-accredited facility must demonstrate the use of high-quality programs and treatments that are tailored to each individual.

Short-term residential treatment may also be a useful way for someone with SUD to transition from an intensive inpatient treatment program to an open society. These programs typically focus on detoxification as well as providing initial intensive counseling and preparation for treatment in a community-based setting.

Recovery housing provides supervised, short-term housing for patients, often following other types of inpatient or residential treatment. Recovery housing can help people make the transition to an independent life—for example, helping them learn how to manage finances or seek employment, as well as connecting them to support services in the community.

Many treatment centers and facilities offer alumni programs that allow program graduates to stay involved for years to come. Alumni programs will enable the formation of a network of new friends. They provide accountability and enable individuals to remain actively involved in a supportive recovery community. In this way, a support group can be established. A right rehab will help the individual to cultivate or connect with this type of community during treatment. That gives the individual the best chance for continuity upon leaving rehab.

TWELVE-STEP PROGRAMS

You have probably heard of Alcoholics Anonymous or often simply called AA. AA, according to its website is "a group of principles, spiritual in their nature, which, if practiced as a way of life, can expel the obsession to drink and enable the sufferer to become happily and usefully whole." This is the so-called "Twelve Step" approach.

Narcotics Anonymous or NA is a similar type of support group for the management of narcotic addiction. Still, it can apply to any form of addiction to other drugs or habits such as eating, gambling, sex, internet, and work. NA uses the same 12-step program as AA does.

How successful is NA? It is not an easy question to answer, but a few things seem clear. The longer that someone continues to attend NA meetings, the more likely they will remain sober. Charlie Sheen suggested that only 5% of AA members stay sober, but "addiction specialists" are said to quote rates of 8-12% for sobriety after the first year of AA membership.

A New York Times article suggested that AA claimed a 75% success rate. An extensive study of the results of AA treatment concluded that people who attended AA were twice as likely to remain sober as those who did not.

Finding success rates for drug rehab programs, whether they use the 12-step approach or other approaches, is even more difficult than finding success rates for AA. There is also confusion about what the terms addiction, treatment, and recovery mean. Programs may claim success rates of 30%, but those are only people who complete the programs. It is a fact that 70-80% of people drop out of drug rehab programs in the first 3-6 months.

No matter what kind of drug rehab program you might decide to pursue, it is imperative that you stick with the program. After it is over, you should engage in some kind of long-term support system such as mentoring, becoming part of long-term support groups, and be sure to include your family in your plans. One source suggested that "rather than putting an arbitrary label on what defines true success in recovery, it's important to appreciate each day in recovery as the successful experience it is." That seems an excellent way to approach staying sober and maintaining clean living.

CONCLUSIONS 

Those seeking rehab should be especially cautious of any program that advertises to "cure" addiction. Addiction is a relapsing, chronic disease for which there is no cure.

The condition can be managed, and lifetime recovery is possible, but there is no magic treatment that will make addiction disappear.

 Long-term recovery with sustained sobriety and clean living is achievable for everyone who is struggling with addiction or substance abuse issues according to this source. With proper guidance and support groups, recovery can be reached, and relapse can be avoided.

In this article, we have given you the necessary, good information that you need to understand drug addiction, its causes, and treatments. We have also made suggestions as to how you might stay sober and maintain clean living.

You are not alone! The National Institute of Drug Abuse is an excellent source of additional information.  The Substance Abuse and Mental Health Services Administration offers a helpline that you can call at 1-800-662-help or 1-800-662-4357.