Canada Drug Rehab

By Daniel Jordan
General Manager
Sunshine Coast Health Center

In Part 1 of this article I highlighted the importance of designing a clinical brochure that is current, user-friendly, and comprehensive. Originally, I had planned to jump right in and explain our “integrated approach” to addiction treatment. However, as I was preparing for Part 2 I realized that exploring the complexity of residential addiction treatment is a necessary first step before attempting to explain our unique method of treatment.

Complexity #1: The Living Vs. Non-Living Universe

This may seem obvious but living entities are much more complex than inorganic objects. Neuroscientists point out that there are more synapses in the brain than stars in the galaxy and that the brain is the most complex device in the known universe. * The interesting part, however, is how we approach problems associated with living vs. non-living objects. In his book, Guide for the Perplexed, economist E.F. Schumacher argues that there are two types of problems in the world: (1) convergent and (2) divergent. 

Convergent problems are ones in which attempted solutions gradually focus on one solution or answer. Of primary importance is that convergent problems are those where that all tend to point to the non-living universe. Take, for example, the problem of manned flight. In the early days of aviation, there were many different contraptions that inventors hoped would become the first successful flying machine. Perhaps you have seen the old movie footage of planes with 4 sets of wings, or wings that would flap up and down, etc. Finally, after a lot of trial and error, Orville and Wilbur Wright made the world’s first flight in a powered, heavier-than-air machine on December 17, 1903 near Kitty Hawk, North Carolina. 100 years later, aeronautical engineers continue to improve on the Wright Brother’s original design, however, all manufacturers such as Boeing, Bombardier, or Airbus, build planes that follow remarkably similar design principles. The same is true for automobiles, cell phones, and portable computers.

Divergent problems are ones which we must find multiple solutions to a single problem and are typically found when we are dealing with living organisms, particularly human beings. For example, if you are trying to solve the problem of HIV/AIDS, handing out condoms or clean needles may be a start but it’s not going to completely solve the problem. Another agency may start a 24 hour help line and this may help as well. But these are just 2 of many possible solutions. The ongoing search for a cure to cancer, which is basically a living organism within a larger living organism (us), is another good example.  

(*) Source: Nuts, bolts of who we are, Princeton Weekly Bulletin, May 1, 2000.

Complexity #2: Chronic Conditions Vs. Acute Conditions

While many people may consider addiction a chronic condition *, the truth is that addiction has a lot more in common with diabetes, high blood pressure, and arthritis than it does with acute medical conditions such as a broken leg or appendicitis. This misconception is clearly evident whenever scientists claim to have found the gene responsible for alcoholism or pharmaceutical companies promote a new drug as the cure for addiction.

Even residential alcohol and drug treatment centers that should know better typically operate like hospital emergency wards, throwing everything they have at the client during primary treatment and leaving precious few resources for follow-up or relapse.

(*) Note: for more information on the chronic nature of addiction refer to William White’s articles on bhrm.org .

Complexity #3: Addiction Impacts All Life Domains

Unlike many medical conditions, addiction cannot be treated by localising the problem to a particular part of the body and then treating it. Addiction is a Biopsychosocial condition that impacts all life domains - biological, psychological, social and spiritual. For example, all may be well with a client while he is in the safe confines of residential treatment, however, what happens when he gets home where the same job, family, and old haunts await his return? Furthermore, most addictions impact negatively on the body (liver damaged by alcohol, tooth enamel destroyed by crystal meth or crack cocaine, etc.). Psychotherapy can be particularly challenging if a client is also suffering from cognitive impairment, or mental illness.

Not only does addiction require a diverse team of professionals to be involved in treatment, it means that often treatment often has to be applied concurrently, and that the discharge plan must include community resources that also embrace the Biopsychosocial nature of addiction.

Complexity #4: Addiction Defies Simple Definitions

The origins of addiction have been a source of lively debate for hundreds of years. Is it a learned behaviour or is it a disease? Is addiction a choice or is it a genetic predisposition? Is addiction caused by developmental factors or do some people have addictive personalities? Are addicts created by eating a diet deficient in certain nutrients? Or is addiction a response to feeling disconnected from the world?

As Ken Wilber in his book Integral Psychology states, “The great problem with psychology as it has historically unfolded is that, for the most part, different schools of psychology have often taken one of those aspects of the extraordinarily rich and multifaceted phenomenon of consciousness and announced that it is the only aspect worth studying (or even that it is the only aspect that actually exists).” Dr. David Burns, author of Feeling Good: The New Mood Therapy, calls it the “schools over tools” approach. This tendency towards over-simplification, commonly referred to as reductionism, is alive and well in the treatment of addiction. This is most unfortunate since addiction is a complex condition that impacts all aspects of health and lifestyle.  

Now combine debate among competing schools in psychology with the medical community and you begin to see why the matter of deciding on effective treatment for addiction is far from settled.

Complexity #5: Addiction Requires More Than Mere Abstinence

Even the goal of addiction treatment is a topic of lively debate. Some will reason that if only the addict will stop using his/her drug or process of choice (gambling, online porn, etc.) then the problems associated with addiction will go away. Unfortunately, just as health is more than the absence of disease, recovery requires a fundamental shift that impacts all life domains mentioned in Complexity #3.

At Sunshine Coast Health Center, we believe that abstinence is a by-product, not a goal of alcohol and drug rehabilitation. When an individual discovers his true calling and begins the process of living a life of purpose, we believe that ’external’ solutions and unhealthy attachments will be discarded in favour of being true to one’s self.

Complexity #6: Not Everyone With an Addiction is Motivated to Quit

Another point to ponder is that people with addictions actually need a reason to stop. Having something to lose (health, marriage, career) may work for a brief period of time but, long term, a fundamental shift or transformation is often required for abstinence to become permanent. Unlike most disorders or medical conditions, addiction produces a positive benefit for the individual such as dissociation (numbing out) or escaping from, what Narcotics Anonymous calls, the ”meaningless, monotonous, and boring” life of an addict.

Complexity #7: Primary Residential Treatment Vs. Outpatient Treatment

The last point to make on complexity is that residential addiction treatment, is more than just counselling with room and board thrown in for good measure. Social skills associated with the give and take of living 24/7 with a peer group is an issue for residential treatment while the same can’t be said for outpatient.

Furthermore, group therapy, commonplace in residential treatment, is rarely provided in most outpatient settings. Group therapy is, by nature, a dynamic process that can have remarkable therapeutic effect in the hands of a skilled psychotherapist.

Complexity #8: Addiction is More Than Just Drugs and Alcohol

Cross-addiction (having more than one addiction) is a common occurence for individuals who struggle with drugs or alcohol. Sunshine Coast recognizes this tendency and is redesigning its program to expand the definition of addiction to include process addictions such as gambling, gaming, sex, even eating disorders.

Conclusion

Addiction is a complex condition that requires an equally complex approach to treatment. Sunshine Coast Health Center recognizes these challenges and has been continually finding new ways to enhance program effectiveness. in Part 3 of The Challenge of Writing a Clinical Brochure, I will examine how other individuals and groups are integrating their approach to address complex problems.

By Daniel Jordan

We get a lot of calls from family members looking for help for their loved ones and, occassionally, we are asked whether it is possible to lock someone up to keep them from their drug of choice. To spouses, parents, and siblings in distress, it must be hard to imagine that anything less than prison could keep their family members from drinking or getting high. We do explain to family members, however, that there are other ways to keep individuals in treatment and, almost as importantly, prepare them to live productive, fulfilling lives in recovery. 

I have observed over the years that clients, for the most part, adapt quickly to their new environment. And just because their home life is in disarray doesn’t preclude them from pointing out our faults as an alcohol and drug treatment center. Any time a client has a complaint or suggestion, we pay attention and, if the client has a valid point, we make a change *. After 4 and a half years in operation, all of these suggestions (and a “few” of our own) have created a program and facility that, we believe, is efficient, responsive, and organized.  Invariably, clients benefit from having a well-structured program. The protective “bubble” that exists in residential drug treatment is, however, a double-edged sword that has both pros and cons for the client.

Structure Benefits the Client

One of the main reasons why individuals choose residential over outpatient treatment is because of the amount of structure present in residential treatment. When clients first arrive, they frequently report not having slept for days (especially the crack cocaine users) and can’t remember the last time they have sat down for a proper meal. If basic life essentials like sleep and food can take a back seat to drugs, then it’s easy to understand why showing up for an outpatient session at a clinic across town can be a monumental, if not impossible, undertaking.

While some clients may grumble about all of the rules and restrictions of residential treatment, most seem to understand the need for structure and slowly begin to rebuild their lives due, in part, to putting structure into their own daily routine.

Structure Also Benefits the Treatment Provider

Like any business, staff and management of treatment centers also benefit from structure. Structure provides some sense of predictabilty for staff which is so important when working with clients who go through many highs and lows during the course of treatment. Management loves structure because it makes it possible to plan for the future rather than lurching day to day, from one crisis to the next.

Structure, however, has its limitations and may even be detrimental to the client if taken to the extreme.

The Disadvantages of Living in the “Bubble”

As our clients know from personal experience, too much of a good thing is usually a bad thing. So it goes with structure as it can create an artificial sense of security - a protective “bubble” of sorts- that can collapse when tested by the trials and tribulations of real life.

My colleague (and sister), Melanie Alsager, told me once how life was like as a teenager attending a private boarding school on Vancouver Island. A wake-up bell  would tell Melanie and her classmates when it was time for breakfast and another bell would tell them it was time for class. Another bell would ring to signal the end of class while another would announce lunch time. This would continue right through to “prep” at 9:30 PM. Furthermore, staff would mill about checking to make sure that homework was done and assignments handed in on time. At the time, Melanie and her classmates would grumble a bit but eventually got used to it.

The problem with this environment, however, did not appear until these boarding school graduates went on to university where there were no bells and no instructors to check up on them. In this new environment of independence, many of the boarding school’s “star” pupils were either put on academic probation or dropped out from college altogether.

The Importance of Empowering the Client

So, the life experiences and personal philosophy of ownership, suggestions from staff who have worked at other facilities, and feedback from clients have all culminated in our current approach where the extent of program structure has been tempered by the need to empower clients and help them find the resilience to face the inevitable challenges awaiting them back home.

Relaxing the Rules of Treatment to Empower Clients

Over time, many of our rules have changed as we have come to appreciate the importance of having clients experience “teachable moments” during treatment rather than after they go home. Examples of these rule changes include:

1. giving clients day or weekend passes
2. allowing clients to go down to the beach or the fitness center without a buddy or staff member
3. taking clients to convenience stores for extras (cigarettes, pop, chips, etc.) that also stock liquor
4. showing movies with scenes of drinking or drug use

Each of these rule changes were carefully considered and implemented with certain precautions. For example, clients on day or weekend passes need to be accompanied by an approved companion and are drug-tested when they return. Movies are pre-screened and a clinical staff member checks in with clients for a discussion session at the conclusion of a show.

Conclusion

The more proficient staff and management get at running an alcohol and drug rehabilitation program, the less the treatment environment resembles what awaits clients back home. Relaxing the rules is just one of the ways Sunshine Coast Health Center has tried to make for a smoother transition to life after recovery.

Admittedly, this is a contentious issue in the tradition-bound world of private addiction treatment. We understand the criticism that being too flexible with clients or exposing them to triggers can endanger clients and their early recovery. We are sensitive to these concerns and have built in provisions to minimize these risks.

In the end, however, life after treatment will always be infinitely more challenging than treatment itself. Far better, we believe, for clients to be exposed to some of these risks where they can be processed with the help of a counsellor than to give clients a false sense of security by postponing the inevitable.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center. His posts in “Life in the Drug Rehab Business” are designed to lower the veil on the secretive world of addiction treatment. By being transparent, Daniel believes that Sunshine Coast can help lower the stigma attached addiction and, at the same time, raise the standard of today’s addiction treatment programs. 

(*) Note: the clinical debate over where to draw the line with complaining clients will be the subject of a future blog posting.