Addiction and Alcoholism: Beyond 12 Steps
3. Do make sure you feel safe and understood by the therapist or treatment approach you choose.
While evidence-based techniques are valuable, their effectiveness relies on the listening skills and empathy of therapists who use them. In fact, therapists’ abilities in these areas are directly linked to good outcomes.
“You should feel respected and feel that the person is interested in understanding your perspective, not imposing their reality on you,” Miller says. While many people feel that an ex-addict or alcoholic counselor will be more likely to empathize, in fact, the counselor’s own experience is less relevant than her actual skills in relating to clients, he adds: “’Is this a kind person?’ ‘Did I come away with skills I didn’t have before?’ is a good litmus test.”
4. Do get as much social support as possible—and don’t limit your search to traditional support groups.
The research is clear that social support for a healthy lifestyle is an important part of recovery. But this doesn’t have to come from 12-step groups—it can come from your friends, family, even from a hobby, church group or other interest group that opposes—or simply doesn’t involve—drinking or other drug use. “Look for people who are rooting for you to get free,” Miller says. “If you don’t have them in your natural network, it’s important to find them.”
SMART Recovery is one of the largest alternative recovery support groups. Says Tom Horvath, president of SMART, “We’re pushing 400 groups worldwide, with some in correctional facilities and we have a strong presence online.” SMART’s website had about 16,000 unique visitors in March. “It’s a practical, pragmatic, problem-solving approach,” says Horvath, “The tools we incorporate into our meetings have been studied—it’s as close to evidence-based as we can get.”
Other recovery support groups include Women for Sobriety, LifeRing Recovery and, for people with drinking problems who want to moderate but not quit, Moderation Management. Many churches, temples and mosques also have religion-specific recovery groups.
5. Do consider the use of anti-addiction medications.
Some anti-addiction medications offer considerable help to those trying to kick drugs, when used in conjunction with other support.
Acamprosate (Campral) works by calming the brain’s glutamate system, which is believed to be over-active during alcohol withdrawal and thereafter (though some studies failed to find a benefit) and disulfiram (Antabuse) produces an extremely unpleasant reaction if alcohol is consumed.
Interestingly, Antabuse also seems to reduce cocaine use—and not just by making it impossible for people to drink while trying to come down or by causing a bad reaction to cocaine. “Something’s going on,” says Frank Vocci, Ph.D., director of the Division of Pharmacotherapy for the National Institute on Drug Abuse. “We’re not quite sure what.”
Two other medications that are approved by the U.S. Food and Drug Administration for other conditions, topiramate (Topamax) and ondansetron (Zofran), have also been found to help alcoholics quit. “There’s sufficient evidence for physicians to feel comfortable prescribing them,” says Vocci.
For heroin or painkiller addiction, buprenorphine (Suboxone, Subutex) can be used either for detox or for maintenance and can be prescribed by doctors, not just specialized clinics.
Methadone is also useful, especially for those who have used opioids for long periods of time at high doses. Maintenance treatment does not mean that the person is still “high” or “not really in recovery”—neither methadone nor buprenorphine produces ongoing impairment when used as prescribed.
For methamphetamine, new research suggests that for people who use less than 18 times a month, the antidepressant bupropion (Wellbutrin) may help increase abstinence.
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