September is National Recovery Month. The National Institutes of Health estimates that over 20 million Americans have suffered from some form of substance use disorder (SUD). The understanding of the words “addiction” and “recovery” among clinicians and researchers has changed dramatically in the past 20 years, and approaches to treatment are following this knowledge.
The stories that society tells itself about addiction are very different than the lived experiences of those suffering through the disease. Addiction, like diabetes or heart disease, often results from an inborn tendency that is triggered by voluntary behaviors over time. Clinicians have learned that each person’s path to recovery is as unique as their addiction story. And recovery is possible in more ways than ever; while faith and counseling could make the difference for some, medication and meditation could be the key for others.
UAB Addiction Recovery Program (ARP) Director Bronwyn McInturff, MSW, LICSW, says it is time to replace the outdated assumption that addiction is a moral failing.
“Treating substance use disorders with professional services is still a relatively new idea in the medical world,” McInturff says. “We have updated our approaches to keep up with a rapidly evolving understanding of how addiction works, which we can all see now is a complex disease.”
In 2019, the American Society of Addiction Medicine (ASAM) released this broad yet hopeful definition of addiction: “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences. Prevention efforts and treatment approaches for addiction are generally as successful as those for other chronic diseases.”
Addiction treatments should be uniquely flexible and personal, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). In fact, one of its guiding principles of recovery is, “many pathways”.
The ARP is a group of physicians, counselors, and certified peer support specialists who walk with patients through the recovery process for their SUD. It offers inpatient detoxification, intensive outpatient treatment, and ongoing care through two years of recovery.
McInturff says the program has grown more flexible in the past decade. The patient experience is built upon peer-supported personal growth and individualized programs, which include a variety of 12-step options (i.e. Alcoholics Anonymous), cognitive behavioral therapy (CBT), medication-assisted treatment (MAT), and numerous holistic activities. This approach may be called the “many paths to recovery.” It hinges on an institution-wide understanding of addiction as a complex disease with unique solutions, and everyone on the team has something to offer.
Meeting Patients Where They Are
“Any pathway requires patient buy-in,” McInturff says. “The first step is meeting the patient where they are in their own journey.” She insists that there is no wrong time to visit the ARP; it’s always an opportunity.
“Consequences make people show up,” says Peer Support Specialist Al Cotton. “Those consequences of an SUD might be legal, familial, health, spiritual, or physical, but the important step is moving from simple consequence avoidance to a desire for positive change.”
After assessing a patient for an SUD, McInturff learns about the patient’s history, values, and past experiences with recovery. Many patients have tried recovery strategies on their own and have deep knowledge of their own triggers and tendencies. The ARP is supportive of any activity that moves them in a healthy direction. Its recovery plans are backed by medical evaluations and peer support specialists, and the ARP encourages patients to attend support groups of their choosing.
“One patient may struggle primarily with cravings, another may dislike 12-step programs with a spiritual slant, another may want to engage with faith-based groups, and others may want to try one-on-one counseling as part of their path,” McInturff says.
The ARP team practices harm-reduction as a first line-strategy for patients who are not ready for recovery, and this strategy may include medications to keep them from overdosing. “Believe it or not, using medication to fight addiction would have been frowned upon 30 years ago,” McInturff says.
Peer Support Along the Path
Peer support specialists are a unique aspect of the ARP. Peer support specialists are recovery guides who understand patients’ unique challenges and options. After all, they themselves are in long-term recovery. These specialists undergo a 40-hour training program offered by the Alabama Department of Mental Health, learning proven skills in cognitive behavior therapy and motivational interviewing while becoming familiar with various pathways to recovery.
Peer Support Specialist Sheila Tyson helps patients understand the significance of each piece of their plan, from moving through the 12 steps to getting in their fitness steps. “It’s going to be a new way of life,” Tyson says, “and they need to know how important structure will be to controlling their SUD.”
Tyson and Cotton help patients practice good recovery hygiene, encouraging them to engage with literature, groups, healthy socializing, and spiritualty. They also serve as important resources when things don’t go well, helping the entire ARP team respond to relapses.
McInturff says part of the new approach to SUDs is destigmatizing relapse. For many, it is just part of the journey. The ARP prepares an emergency plan for each patient to follow in case of a relapse. “We want to do everything possible to avoid going back to square one with them,” she says.
Cotton and Tyson are there for patients, offering empathy and motivation in these cases. Tyson reminds patients that it took her eight attempts to find the right pathway for sustained recovery and growth 19 years ago. “I always tell them to consider self-love as an important pathway, or ‘Once I start loving me, I stop hurting me.’”
SAMHSA defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. Recovery touches on every aspect of one’s well-being.” The ARP helps patients lay the groundwork for a more meaningful life, and part of that is “actively staying stopped,” Tyson adds.
No matter what happened yesterday, the ARP team has a message of hope: There is a pathway for you, even if you haven’t found it yet.
Click here to learn more about the UAB Addiction Recovery Program.