• Addiction treatment on Kaua‘i: consider the alternative
Addiction treatment on Kaua‘i: consider the alternative
By Gerald McKenna M.D. and Michael Foley Psy. D
Over the past several months many different suggestions have been discussed as ways to address the alcohol and drug problems on Kaua‘i. People from various backgrounds and disciplines have worked diligently to suggest the best practice to address this long-standing problem on our island. The overriding concern with most of the suggestions seems to be: what is the best setting and who is going to operate the several different programs proposed. One promising residential treatment program failed because of a lack of “homework” done on the part of those responsible to lead this program.
Drug and alcohol addiction are very sophisticated diseases. It not only takes a staff of well-trained professionals with a multidisciplinary background to effectively treat this illness, it takes careful planning and coordination with the community to ensure proper placement of a treatment program and adequate assurances to the community that safeguards will be in place to protect surrounding communities. Obviously, this includes assuring the community that the administrative and clinical staff has the background and expertise to deliver on their promises.
There is a continuum of treatment options needed to address addiction, in the same way that there are a continuum of care options available for people with diabetes, ranging from adjustments to diet, medication, exercise, oral antidiabetic agents or injectible insulin. Some people with diabetes can manage this disease on an outpatient basis; others required hospitalization. Most of us have some familiarity with the complexities of an illness such as diabetes.
Because chemical dependence often appears as a bad habit rather than a disease, there is less understanding that this is also a complex, chronic, multifaceted illness that requires a continuum of treatment options to adequately intervene and control the illness.
Many individuals with addiction are mandated into treatment programs or community 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous. Forcing people into treatment under threat of incarceration or some other punishment yields mixed results. These individuals are often in the “precontemplation” stage of decision-making regarding their use of chemicals. That is, they may not be aware that they have a chemical dependence problem and have not even thought about getting help. Forced interventions at this stage are often unsuccessful because the individual seeks ways to sabotage any treatment efforts, whether in a treatment program or a 12-step program. They can also have a negative influence on other group members. This can make others who want help reluctant to share their true feelings or problems because of confidentiality issues. This then detracts from the commitment of the group to continue the recovery process.
A maxim of those in the treatment community is to “treat people where they are at “. Placing individuals in a group of like-minded people could move them from the precontemplation stage into a mindset that is receptive of treatment and recovery. This part of the recovery continuum could be helpful to the courts, probation, and families of clinically dependent individuals.
Recent newspaper articles seem to imply that there is no available treatment for addiction on Kaua‘i. Outpatient treatment has been available since the late 1980s and represents an effective treatment model for many people with addictive disorders. Our island has outpatient treatment for both adults and adolescents, with space available. There are two treatment programs in Lihu‘e, both of which offer treatment schedules designed for those who work or who are in school.
Outpatient treatment is a critical part of any continuum of addiction treatment and has been recognized as such nationally. It has the advantage of allowing people to continue to live and work in their community, to remain within their family and at the same time receive ongoing treatment for this deadly problem.
Residential treatment is also a critical part of this continuum. This is not available on Kaua‘i and represents a serious lack in the continuum of available treatment. It is this part which has been addressed by a variety of groups recently interviewed in the press.
The administrative organization and treatment staff of residential treatment programs must be as highly skilled and trained as those offering outpatient treatment. Our community needs to maintain careful oversight of the quality of treatment programs that we bring into our island for the treatment of our children and adults who have this complex, chronic illness that by its very nature is treatment resistant.
The treatment programs must have firm boundaries and these boundaries must be adhered to for quality sobriety to follow. This structure is helpful for long term recovery but difficult to maintain. There is no room in any recovery program, for meanness or punishment on the part of the treatment team. The crossover from strict boundaries to punishment can become a very fine line.
There are committed professionals on our island who are currently at work providing part of this continuum of care. This work is difficult, with often few rewards. The relapse rate is high, though probably no higher than the relapse rate for any other chronic, life-threatening medical illness.
Many of the people that we see in treatment have co-occurring disorders. They have some type of psychiatric disorder, such as anxiety or depression, in addition to their addiction. These problems frequently co-occur with addictive disorders and must be treated simultaneously. Without treatment the relapse rate is even higher.
Fortunately there is a continuum of medications to treat psychiatric disorders and a growing number of medications that are useful in treating addictive disorders. The main current focus of research in the field of addiction medicine is the development of medications to decrease drug craving, relapse, and to modify the underlying errant brain chemistry which drives this illness.
Spirituality is an integral part of recovery and our island is a perfect place to discover or rekindle spirituality. Spirituality carries no moral judgment and is not synonymous with religious belief or practice. Alcoholism and other forms of drug addiction are not moral weaknesses. If the message that it is a weakness becomes a part of a person’s recovery it is detrimental to a solid, ongoing healing process.
Many people on Kaua‘i have both long-term and quality sobriety who are available and willing to reach out to those on the Island who are struggling with addiction. This group of recovering people understand the nature of addiction and the fear that clinically dependent people have about getting treatment. Addicts are often afraid to continue using drugs and are equally afraid to stop. The recovery community could be helpful in many ways: introducing people to 12-step meetings where they will meet clean and sober people struggling to make their lives better; showing them by example how to lead a happy life clean and sober.
Each community of recovery has something to offer whether it is teaching skills such as throwing net, fishing, or child-rearing. The recovery community could extend this list endlessly because each person seeking recovery has his or her own particular needs. The recovery community and its willingness to reach out are only waiting to be asked to become part of the healing process by sharing their experience, strength and hope.
Since we are blessed on our island to have a strong recovery community, perhaps we should solicit their help in dealing with our drug and alcohol problems. I am sure they would be more than willing to help and become a critical resource in addressing this ongoing problem, which has reached epidemic proportions not only on our island but throughout our country.
