4-12-2008

Brian: Good afternoon Atlanta and welcome the Breakthrough Addition Recovery Hour. My name is Brian Fujii and today we have our guest with us again, Dr. Lois Dutton, and she is working with us at our program and she is doing a fantastic job in doing some nursing and also to be able to bring in some of our clients and giving them the medical attention that they need. My co-host Jill Mattingly is away and will be away also next week, and so I hope that you will be calling us and also to look forward to having her back, probably in about two weeks.

So Lois, welcome again to the Breakthrough Addiction Recovery Hour, and you know last week we were talking about a very important subject and this was how has drug addiction treatment changed over the last 25-30 years? And we are looking over the spectrum and we have really seen some very dramatic changes. Last week we talked about how initially we saw drug addiction treatment being basically seen as like a sin, where people came in with a lot of guilt, a lot of shame, a lot of condemnation, and very, very low self-esteem as a result of that, and really not being able to find addiction treatment modalities to really help them improve.

And we see this happen even today. Many times people still see themselves as fractured, they see themselves as not having enough character, not enough will power. All of these things that are really self-devaluating, and it really impacts the ability for people to try to find addiction treatment. And I know we here at Breakthrough Addiction Recovery really try to work on that self-esteem piece, to really help them to understand it’s not really a character defect, we see it as an illness.

Lois: That’s right. When we talk about substance addiction as being a sinful behavior, built into that is the condemnation and the judgment that goes along when you begin to look at people as being weak in character, not having enough faith, not praying hard enough, not having what it takes from a spiritual point of view – to bind the spirit of addiction, if you will. And the other folks in the church really viewing them, pretty much that way, makes it very, very difficult to pull yourself up by the bootstraps when you don’t have that starch in your system that’s left because of the condemnation and the judgment. It gets to be a very heavy-duty thing for a person to walk around carrying. And that’s not to say, you and I both are very, very much strong, strong believers and have our own personal spiritual programs and know how vital that is to our lives and would never ever say that resorting to the God as one understands him, is not a part of a whole recovery program, but it’s not the only part of it. It’s very important for people to understand that it’s not because you have not been on your knees enough hours, it’s not because your faith is lacking, it’s not because you are a weak charactered person, that you’re not able to get on top of your addiction and stay there.

Brian: Again as we take a look at people’s thoughts about themselves, I know one of the areas that we try to help people to really strengthen their- areas of life is that many times if people are going to change their behavior, they get into a lot of this ‘the shoulds’ or ‘the oughts’, all of these words that really put them into a place. The definition of a ’should’ is the unrealistic expectations that we place upon ourselves and other people. And when you think about this idea that many times people who are having this real internal struggle with alcoholism or drug addiction, they’re seeing themselves as if they’re fractured, that they are damaged individuals.

Lois: Broken, completely broken.

Brian: And totally irreparable. And when you think in those terms, it really begins to eat away at that self-esteem that’s already is low as it is. But when you start then putting these unrealistic expectations, “I should not be doing this.” Or, “I ought not to be gong and doing this.”

Now these expectations begin to even lay a heavier burden on themselves and therefore they don’t seek help.

Lois: Absolutely. I think that many people do, from that very strong legalistic background, that many of us grew up with in our churches, where there’s so much of our lives that have been given to us as absolute. You do not do this; you don’t do that; you should do this; you ought to do that; and if you do not do as it’s dictated and prescribed for you, then you are less than everybody else who can live according to those dictates. And that is very damaging to all of us. Not just individuals who then go on to become addicted.

Brian: I really appreciate you saying that too, because when you take a look at a healthy spirituality, I think so many times a lot of folks have a toxic faith, a kind of belief that they only see condemnation rather than seeing assistance and support and help, and I think many times if we can begin looking at one’s spirituality. One of the things I try to do when I’m doing addiction treatment, is I ask the people, you know we’re talking about spirituality, but we’re talking really a lot about our value clarification – values – and when we begin looking at these values such as truth, and honesty, and openness, and compassion, all of these play a vital role. In fact many, many times, when people are in addiction, the value systems begins to degenerate as a result of the addiction because they’re trying to solve some kind of either emotional issue or maybe some physical issue. We see so many people, probably 95-98% of the individuals who come into our programs have a psychiatric condition - major depressiveness, bipolar disorder, anxiety disorder - so they’re not only coming in seen using alcohol, but no we got them coming in using Xanax, or Valium, on top of that trying to calm themselves. And as a result, it really complicates, so if take a look at the values, many times our clients say, ‘Yeah, that’s right, I gotta use my alcohol but I can’t let anybody know what I’m doing.’

So now they’re into lying, now they’re into hiding, and we have a saying, “We are as sick as our secrets.” And secrecy plays a big, vital role in maintaining addiction and certainly not getting rid of addiction.

Lois: Absolutely, perpetuating it farther and farther down the road. Most of us, Brian, in our world, our values are rooted in our spiritual journey and we draw from that, but when it begins to come back and really bite us because of the misconception we have about those values and what all of the ’shoulds’ and ’shouldn’ts’ really translate to us, then we end up having yet another “monkey on our back” to deal with, and that’s that whole spiritual condemnation piece that many, many people that come in to see us struggle with.

Brian: And that’s how we can help them. If this is a topic that is really getting a thought through your mind or something you’d like to participate in, we’d like for you to give us a call here at 770-226-0920, or if you’re outside the area it’s 1-888-920-2665, and we’d love to hear your opinions and thoughts. And Lois, as we continue here, we do know, as you said, when spirituality is used in a positive, affirming, gracious way, we know how powerful and how healing that can really be because it really does boost the self-esteem, it helps confidence, it reduces self-condemnation, and it really produces hope. So when you look at those positive boundaries in spirituality, we know that that particularly part is very, very powerful.

Lois: Absolutely, and for people who have a strong spiritual program and a spiritual belief that guides their life, to bring that into their recovery as a very powerful tool that’s going to stand them in good stead down the road as they really try and heal from what is a very complex, very devastating, very baffling, cunning disease that has developed over time. That spiritual background will definitely be a strong support for anybody who’s trying to recover. By the same token, it can also be a stick to beat somebody down even further, and that’s part of what we try to do in our Breakthrough Recovery orientation toward addiction treatment is for people to take the tools they have in their lives and get them to be very positive, positive steps toward helping them in their healing process.

Brian: I like what you said there, it is a tool. I want to help our people to realize that. Well, we’re coming to a break already. We’re going to continue this when we get back. We’ll try to help you understand how this spiritual tool can really be a powerful influence in recovery. We’ll be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and my special guest today is Dr. Lois Dutton, and she is a colleague there with me at the Breakthrough Addiction Recovery Center. We’re glad to have Lois here, and we are talking today about the ways substance addiction addiction treatment has evolved over the last 25-30 years.

Lois: Yeah, the kind of thing that sustains you over time. When for 24-hours a day you don’t have your physician or your therapist or your confidant there, but you always have your spiritual program. For us, it would be God who’s always with us, 24/7, a lot of people have that same basic belief and it’s a positive experience that we recommend that folks really evolve into in their spiritual side of recovery.

Brian: As we take a look at this next section, as we move now from this area where we used to see it only as sin, but now society began realizing as people began to experience alcohol addiction, cocaine addiction, or heroine addiction, many times because of that feeling that they weren’t worthy and they didn’t seek the help, then it began moving into anti-social behavior. That’s when the individuals began to not know where to go, where to turn, where to seek help, and so as a result, instead of their addiction diminishing, it only accelerated. It became worse and worse, and now they had to turn to criminal behavior in order for them to maintain their habit, not realizing that it was causing a burden for society. That’s when we started having violence, we begin having things like robberies going on, or people becoming involved in family violence. It’s really interesting to note that one study that shows about people incarcerated, especially for those domestic violence, it’s not so much the illicit drugs that produces the problem, it’s alcohol! Alcohol, which is a legal drug, at the same time it produces more domestic violence, the cause of more domestic violence than any other illegal drug.

Lois: Absolutely, and the spiraling of people’s lives as a result of alcohol and other drugs, but predominately alcohol where we watched people, Brian, lose everything in the world to them and end up in the streets, on skid row, and then their intoxication became public. So there was even a charge that we called “public intoxication” that would get people incarcerated and have them thrown into jail for no other reason than being drunk. Over time, we began to see the notion in our society that these folks need to be separated from the rest of us. So we incarcerated . . .

Brian: They were different.

Lois: They were different. They were incarcerated, they were labeled, and they were thrown away in society or in the back ward of a state hospital somewhere and out of sight, out of mind. You have some statistics with you and so do I where we now know that untreated substance addiction in our criminal system is rampant where I read one study that said something like 52% of incarcerated women and 44% of incarcerated men actually qualified by the DSM-4 Diagnostic Manual, as substance dependent. Now that’s a staggering statistic.

Brian: I’m glad you said it. Let me clarify again, there is a difference between using and abusing and being dependent. What Lois is saying here is that these individuals not only were abusing it, which meant they were actually having difficulty now with their drinking or drugging, like with a DUI or domestic violence, or maybe they were having problems with their work, but these individuals now actually had problems with tolerance, meaning they need more and more in order for them to get the same effect. They were experiencing withdrawal if they weren’t using, and then using in spite of known negative consequences. So that means they were truly out of control, they had no control because most individuals, if they knew that they were going to get into trouble, they’d stop. And that’s what I hear so many times from the families of my clients. ‘Why can’t they just stop?’ And that’s because we know it’s an illness. But somehow in society we find out that there’s a big rift, there’s a real desire for us to not to look at this as an illness, we always want to see it as a character defect.

Lois: ‘Well Uncle Joe set his bottle down 25 years ago and never picked it up again. Why can’t you do that?’

Brian: Oh have we heard that often?

Lois: We hear that all the time, don’t we?

Brian: That’s right, we do. And they would try to make that the standard, the gold standard. And unfortunately that is really an aberration more than a standard. In fact the majority of people are individuals who are struggling every single day, trying to stop, trying to get off this wagon. I’ve heard so many times my clients say to their family members, ‘If I knew how to stop, don’t you think I’d have done it earlier?’

And how true that is. So we really need to help families try to understand it. I think this is where we moved into self-help programs. Self-help programs really began around . . .

Lois: . . . 1935, with Bill W., the AA program, the basis of which was very well-grounded, Brian. We both agree with that.

Brian: We know that works for many, many people, but we know it doesn’t work for everyone. And we know many times the recidivism rate or that relapse rate is very high, but for many years because there wasn’t anything more than that, that’s the reason why we began to say, ‘Is there something else?’ And as we begin to look at the system, we began to realize there’s more than just high confrontation and a lot of self-demeaning. And I know it’s better now, but in the early stages that’s all it was. People were being put down and then because they thought the tough way was the best way, and we know different in many ways.

Lois: And that’s when we had the programs develop like Synanon and Daytop and some of those really harsh, confrontational programs.

Brian: Okay, looks like we’re coming to a break again. If you are us interested in being a part of our discussion, give us a call at 770-226-0920, and we’ll be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and my special guest with me is Dr. Lois Dutton. Jill Mattingly is away today and we’ll look forward to having her back next couple of weeks, hope she’s enjoying her vacation.

We’re talking today about how drug addiction treatment has changed over the last 25-30 years. In the very first part of our program we talked about how people used to look at drug and alcohol addiction as bring a sin which really put a lot of condemnation and guilt and shame, and now we begin moving it toward seeing it as a crime, where now people were being incarcerated because of their addiction, and as a result now receiving a label as a criminal. We do know that how this has really impacted negatively so many individuals because they’re self-esteem already is low, and now they’re seeing themselves as criminals as a result of this addiction. And so now they’re being placed in jails and in many ways not getting any help. For a long time we had the old drunk tank which you talked about last week, and so we saw people being placed in these kinds of facilities more as punishment rather than as rehabilitation.

Lois: Absolutely. We went from people being sinful and being condemned to being criminals, being really aberrant people in our society and they needed to be punished for the crime of addiction, if you will. Because that’s exactly the way it plays out, Brian. When somebody is thrown in jail for whatever the offensive behavior is, and that’s not to say again, that we believe that addiction is an excuse for anybody’s behavior . . .

Brian: I’m glad you said that – that’s right, we don’t.

Lois: We don’t believe that at all.

Brian: People need to be accountable.

Lois: They need to held accountable for breaking the law and doing things like that. We’re not saying that at all. What we are saying is that there is an underlying cause, many, many times, for why people do the things they do. And for a lot of the individuals who are incarcerated today, drug use and alcoholism are very much a part of that underlying causation for the criminal behavior, and if that underlying causation is ignored, then what we have is people come out and the recidivism rate is very, very high, so it’s a revolving door. It’s going in and out, in and out, in and out, with nothing ever changing except that the behaviors, the criminal behaviors get more and more egregious as we go along.

Brian: That’s right. If this subject is really touching your heart and you’d like to give us your opinion, we’d certainly love to hear it – 770-226-0920, and if you’re out of the area, it’s 1-888-920-2665. My special guest today is Dr. Lois Dutton. She is one of our clinicians and nurses there that works with a lot of our clients in areas of trying to do drug and alcohol detoxification from alcohol and opiates, and Lois, do talk a little bit about the area of medications. We’re going to get into more detail, but tell us something at least about how we do the drug and alcohol detoxing. We do ambulatory drug and alcohol detox, do we not, for alcohol?

Lois: We do with alcohol. Our mainstay in the withdrawal of alcohol, we know that alcohol withdrawal is probably the most devastating of all withdrawals.

Brian: And dangerous.

Lois: And dangerous. We use Phenothiazine that’s been around for a long time. We use Librium, and then we do a taper program so that we prevent the withdrawal symptoms from actually showing themselves in these individuals. Our belief is we want to stay on top of the symptoms and not get behind, so that we’re chasing the symptoms with individuals who are withdrawing, because then we lose people in addiction treatment when that happens. Because we’re an outpatient program, we don’t have people 24/7 under wrap and key with us. They’re in their homes or they’re being monitored in a private suite, and if we let those symptoms get ahead of us, and we’re constantly chasing them, then our clients and anybody else knows that there is a ready solution to that impending feeling that they’re getting and we’ll lose them in addiction treatment. So we’re very aggressive with our drug and alcohol detox program and we stay on top of those symptoms and we just don’t let people hurt in that withdrawal process.

We our opiate users, we substitute with Siloxone, and we’re able to do it. It’s not a substitution drug at all. What it does is replace the opiate in the brain chemistry and gives us an opportunity for that individual to gradually come down and gradually pull their brain back into some kind of a normal semblance. When they’re using the Siloxone they don’t get the same feeling that they get when they’re using the other opiates – heroine, Oxycotton, the Vicodin, or some of the others. So we’re able to do that in a very safe, very medically stable way. And it works.

Brian: And that’s what we say. We say that we are a medically managed program, where we take this medication – and it is medication – and I hope that our listening audience is hearing that.

We’re coming to a break again Lois, and I want to continue this discussion because as we take a look at how we move from criminality to addiction treatment, we’re going to really spend some time with that.

If you’re listening out there and really want to get into this discussion, call at us 770-226-0920 or 1-888-920-2665. We’ll be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and with me is Dr. Lois Dutton. And we’re talking about how addiction treatment has changed over the last 25-30 years, but Lois it looks like we have a call from Robert from Newnan. Welcome to the Breakthrough Addiction Recovery Hour, Robert.

Robert: Hey, thanks very much. I appreciate you taking my call. I wanted to throw a different spin on the incarceration of drug addicts and the crazy circle of addiction. As a recovering addict myself, who’s actually a patient of Breakthrough, something kind if clicked as I was listening to your discussion today which is pretty awesome. I think a lot of people wind up in jail in the middle of their recovery. I think that when you take away their drug, it creates this huge void inside of them and a void that can be filled with something positive like spirituality which has really helped me out quite a bit, I think they maybe choose to fill with some kind of negative behavior which leads to their incarceration and going to jail, something that creates a chemical response in their bodies, sort of an adrenalin rush or what-not.

I remember a story my dad told about coming out of Vietnam. He said there were a lot of guys coming out with a really bad heroine addiction and they couldn’t get a hold of their drug of choice, so they chose to go out and rob banks instead. It created such a huge rush inside of them. These guys wound up in jail in the middle of their recovery and not actually taking their drug at all.

Brian: That’s a very good example about how – and you said “a void” – and that is such an accurate description, Robert, because that’s what we have. When you choose to start getting clean and sober, one of the things in addiction treatment we always say is, “How many hours a day do you spend in either obtaining your drug of choice, using your drug of choice, overcoming the effects of using your drug of choice and figuring out how you’re going to get some more?” And some people told me the other day. “Every waking hour.”

When you think about that, when you stop and you choose to say, ‘I want to be in recovery,’ if we don’t replace some positive activities in the void, we will go back to using. You’re exactly correct. It’s one of the things we got to figure out. What are some of the positive things we can do. But you said the word. They got a real adrenalin rush by doing these other negative behaviors, and I think that’s what addiction treatment is really all about.

Lois: Right. Hi Robert, this is Lois. How are you?

Robert: Good, how are you?

Lois: I’m fine, thank you. I think it’s extremely important Robert, what you just said that spirituality has been a big part of your recovery. I think that a lot of individuals who do not find something to put in the void in their lives will resort to all kinds of behaviors that normally they may or may not have even though about. I think you have a very valid point. And I think you’re right, there’s a lot of people who get into trouble after they’ve even been in addiction treatment, even if they’ve learned some things about the addictive process, and yet they choose to go out and do things that they normally probably wouldn’t do.

Brian: And if they don’t learn some new behaviors, in fact that’s one of the things we do at Breakthrough Addiction Recovery, and that is, we do we call cognitive restructuring. What in the world does that mean? It just means we help them think differently. And if they can think differently and begin to feeling differently about their new behavior, typically they’re going to stay with that new behavior, and that’s the positive reinforcement that we can do. Not only help them feel better, but really start doing something better.

Robert, we appreciate your call, keep listening. If you have another question later on, give us a call back.

Robert: Thanks a lot.

Brian: Alright, thanks for your call. Well that’s a great call. And you know that is so, so true. Many, many people who spend literally hours every day using their drugs of choice, find it very difficult to find some other positive replacement for their drinking and drugging and so we have to really sit down and go over a lot of different alternatives. That part we call ‘coping skills’.

Lois: And the time we spend a lot of times Brian, in day addiction treatment, asking basic questions, “What do you really like to do?” And it’s been so long since many of our clients have done anything that’s really been fun for them that was not related to their drinking and drugging that they no longer remember the kinds of fun things that they used to do. And it’s really heartwarming to watch this group begin to share with each other and the light go on, ‘Oh yeah, I can get into an exercise program.’ Or ‘I can do this,’ or ‘I can do that.’ Taking some of that creativity that they used to apply to finding their medications, finding their drugs, hiding their alcohol, all of the very creative ways that these individuals manage to perpetuate their addiction. They now have that same creative juice flowing in terms of replacing those behaviors with something that’s going to be very positive in their lives.

Brian: That’s so true Lois. And when we take a look at most individuals, especially many of the alcoholics that I work with, they are very high functioning. And as a result of that high functioning capacity, most people who observe their behavior go, ‘My goodness. What’s wrong with them? There can’t be anything wrong.’ Because they do very well in the work environment, they will always say, ‘Never miss a day of work!’ ‘Got all the projects done.’ And we begin realizing that’s a great cover, but we also know that they use that as a coping skill so they can continue to use.

Just a follow-up from the time of the break, you mentioning about the way that the drug and alcohol detox goes and how we need to make sure that the medication is helping to stabilize them, they don’t go into the DT’s, having a seizure, or a stroke, making sure that they’re very stable. Now we know that we’re moving from that sinful component where they’re seen as having all the guilt and shame, moving now into incarceration where they saw it as a crime and then they got labeled. Now we take a look at this piece called ‘medical’, because now we understand that addiction is an illness, not just a sinfulness, not just a crime, it truly is a treatable, however chronic illness. Long term, long term. And so what I’d like to do is once they get stable, what typically do we now do once they’re able to think through. Most of the time the drug and alcohol detox is about 3-5 days for alcohol, and about 2 or 3, usually just about 2 days for opiates. What do we do from there?

Lois: Well, before they even get completely through their drug and alcohol detox, we go ahead and start the whole addiction treatment piece of it by putting them in day addiction treatment or individual therapy, or putting them into group, whatever they need,. And the beauty that we have, is that we’ve got individuals who are going each and every day after they come to addiction treatment, back to their own environment. So we’ve got an opportunity to really work with the real honest-to-goodness, day-to-day problems that they face.

Brian: Well listen, we got a call from Mike, but we are coming to a break. So Mike, hang on and we’ll be right back with you at the break. Give us a call at us 770-226-0920. We’ll be right back.

Brian: Welcome back to the Breakthrough Addiction Recovery Hour. My name is Brian Fujii, and my guest is Dr. Lois Dutton. And we have a call from Mike in Snellville. Mike we only have a few minutes left so we look forward to your call and what’s your question.

Mike: I was really glad to hear your topic today. I belong to a religious community that teaches against all kinds of health things, including tea and coffee, but I really like your approach because I’m uncomfortable with incarcerating people for doing things that primarily hurt themselves. They’re doing other crimes, but just for the crime of addiction I don’t believe they ought to be incarcerated. But from an economic standpoint, I think it would cost us a lot less, on a purely economic standpoint, if that’s your only consideration, to treat people rather than putting them in jail for that. I wonder if you have some statistics that bear that out. I believe that’s true – that’s it’s cheaper to treat people and give them some help than it is to throw them in jail.

Lois: Oh absolutely, absolutely Mike. I’ve got a statistic right here that says that untreated substance addiction adds tremendous cost, and it’s estimated that $181 billion dollars we spend every years in drug addiction and $107 billion of that is associated with drug-related crime. We know that successful drug addiction addiction treatment in the criminal justice system can help reduce crime, it can reduce diseases, like HIV, like tuberculosis, like some of the other diseases that we see when people are incarcerated or they’re out on the street. So you’re absolutely correct. It is far more economically feasible for us to treat addiction than it is to incarcerate because then the incarcerated individual goes in, does his time in jail, comes back out on the street, begins to use again, goes back into the system, pays his debt to society, comes back out, so it’s a revolving door and that is very, very costly.

Brian: And that’s where the cost continues to increase. Well we appreciate your call Mike, we’re really glad you’re listening and call us back again. Love to hear your questions.

Mike: Will do.

Brian: Alright, thank you.

Mike: Okay, bye-bye.

Brian: That was an excellent question and again, cost is on people’s mind but Mike is exactly correct. If we don’t treat people, and this is also what we’re finding not only through our drug courts, but now we actually have programs that are being utilized in various communities here in Georgia, called Mental Health Courts. That they’re realizing that they’re needing also the assistance. Because we also know don’t we Lois, that between 95-98% of the people that we see usually have co-occurring disorder. That means they have a psychiatric illness along with the drug addiction. And so many times what? It’s usually that psychiatric illness that is in some was perpetuating the drug addiction because they’re trying to feel better.

Well again, our time is gone and we have just touched the tip of the iceberg, but I hope that our listening audience has been feeling informed and also finding it a stimulating discussion. We have wonderful website that you can go to, it’s www.BreakthroughAddictionRecovery.com. We offer always a free consultation for any individual or family member that would like to get more information about addiction treatment for their loved one, and so we invite you to visit that website.Now Lois, I appreciate you being here. We’re going to probably get you back here real soon. And we’re looking forward to looking to having Jill back within the next couple of weeks. I hope you join us again, and thank you for listening.