The Doctors television show invites specialists from health and wellness fields to work alongside Dr. Travis Stork and his team of doctors and dive into real-life stories. On the September 12, 2019, episode, Dr. Travis Stork and Dr. Judy Ho met with Jane Carter and her son, Aaron Carter, to discuss the severity of her drinking. Holly Wagner, VP and Program Director of Ocean Hills Recovery, was invited to be part of this show and was available to offer Jane help with her treatment.
Addiction is a complex disorder that impacts millions of people today. Holly was able to continue this important conversation by answering some questions about alcoholism and addiction treatment:
Jane tells Dr. Travis Stork that she consumes an entire pint of vodka when she wakes up in the morning, to get her moving, give her energy, etc. When someone talks about how much they are drinking or using a substance, how often are they under-estimating what they are consuming?
It is very common for a person suffering from addiction to underestimate the amount of alcohol or drugs they are consuming. This is not always the case, but sometimes this can be a mechanism of “minimization” of the problem, or in other words the way in which the addict can justify their use, or explain why the problem is “not that bad.”
I do not think this is the case with Jane, as she was very open and honest regarding her use of alcohol. However, it is very common to find discrepancies in the reported amount of use, versus the actual use. That is why at Ocean Hills Recovery, we complete an extensive assessment process. Our assessment process includes gathering a complete substance use and mental health history not only from the client, but we also interview family members to get their input and opinion on how much the client is using, their perception of the severity of the use, and the consequences the client has experienced as a result of their use.
It is imperative that we have an accurate picture of how much the client is using and precisely what substances the client is using as this information influences the treatment process and helps us determine the best method to safely detoxify clients upon admission to our program.
Aaron mentioned that Jane put the needs of her children before her own needs. How often do you see moms needing treatment?
At Ocean Hills Recovery, we frequently treat individuals that are parents, both mothers, and fathers. I would estimate that 30-50 percent of our clients are parents, possibly more. The unique model that Ocean Hills Recovery uses to address the whole family has demonstrated effectiveness and allowed the entire family to begin the healing process, not just the client.
We offer family therapy group two times monthly in which children are welcome to come and participate to work through the family issues surrounding their mother or father’s use of drugs or alcohol. We also include family members in the treatment planning process and encourage them to be as involved as possible in their loved one’s treatment.
We strongly recommend that family members of an addict begin to attend Al-Anon meetings in their local home area so that regardless of the outcome or behavior exhibited by the addict, they can develop healthy coping mechanisms and have a source of support. Al-Anon is a twelve-step program designed as the counterpart to Alcoholics Anonymous for family members or loved ones of a person suffering from addiction. There are tremendous resources online, and there are Al-Anon groups all over the country. Al-Anon is free to attend to anyone who has a desire to learn how to cope more effectively with the addict in their life.
What can you say about functional addiction/alcoholism? At what point does a person start to lose function or how long can a person struggle with functional addiction before it becomes dysfunctional or too much to hide/control?
To me, the word “functional alcoholic” is a misnomer in the sense that if you really start to analyze the relationships and life of someone who is abusing alcohol, are they really living or are they just surviving?
Most people define functional as showing up for work every day; however, if you were to compare a functional alcoholic or addict with a person that is not abusing substances, chances are the addict will have a much higher frequency of missed workdays, tardiness, or absenteeism.
Often functional alcoholics will be binge drinkers, meaning they can stop drinking for long periods, but when they do pick up a drink, they drink to excess and incur the same type of consequences as someone who is a daily drinker. These consequences can include relationship problems, health problems, or contact with the criminal justice system for driving under the influence, as an example. If the addict continues to abuse drugs or alcohol, it is highly likely that at some point they will incur a consequence that cannot be overcome without help and they will lose the perception of “functionality.” Without intervention the ultimate consequence for continued drug and alcohol use is death.
Many addicts can continue to use for many years, particularly if they have people in their life that are enabling their behavior. Enabling is defined as caretaking a person’s needs such that they do not have to take responsibility for their own choices or consequences of their choices. Enabling behaviors may include providing financial support, housing, or bailing the addict out of situations that would typically result in consequences such as paying their bills, writing excuses for missing school or work, or assisting the client in avoiding contact with the criminal justice system as a result of their behaviors.
When someone is in a cycle of alcohol abuse, how difficult is it for them to stop on their own?
In my experience, it is nearly impossible for a true alcoholic to stop drinking on their own permanently.
As I mentioned previously, there are some alcoholics that binge drink and can go long periods without using alcohol; however, when they do drink, the result is disastrous. To achieve good quality sobriety, alcoholics need help.
Help can come in the form of twelve-step programs, such as Alcoholics Anonymous, and many have successfully stopped drinking after committing and joining the program in their local communities. For some, however, medically supervised treatment is required and recommended. It can be very dangerous, even fatal, for an alcoholic to attempt to detoxify their body on their own in an unsupervised environment. That is why at Ocean Hills Recovery we offer a medically supervised detoxification program so that if necessary, our clients can be prescribed medications during the detox process to alleviate the risk of complications such as seizures, heart attack, or other medical issues.
Aaron has struggled with addiction openly and now his mom is admitting to her struggles as well. How often do you see addiction running in families?
Addiction is defined as a “family disease.” This means that addiction not only affects the addict themselves but creates a pattern of dysfunction and maladaptive coping mechanisms for all members of the family. It has been proven that there is a genetic component to addiction which can be identified by specific genes and biological processes within the body. It is very common to see a pattern of addictive behavior run in families.
One of the ways in which an alcoholic can better understand their family history is to complete a genogram during the treatment process. A genogram is similar to mapping out a family tree in which the addict identifies family members from each generation and notes patterns of behavior such as addiction. This can be a helpful tool for addicts to understand the disease concept of addiction and realize that their addiction is not a personal shortcoming or a lack of will power, but a medical condition that is passed down throughout the generations of a family.
Is what happened on the show similar to what an intervention might look like?
Dr. Travis Stork and Dr. Judy Ho did a fantastic job on the show of getting to the root of the issues for Jane and her family. Their approach was similar to an intervention.
An intervention is not about blaming the addict for their behavior but outlining truthfully what is happening and the consequences that the addict is experiencing as the result of their alcohol or drug use. An intervention is conducted with love and empathy, expressing genuine concern for the addict and helping the addict to recognize consequences to their relationships and their health if they continue to abuse drugs or alcohol.
Not all interventions are successful, as ultimately, it is up to the addict to choose to accept help. Ideally, if an intervention is conducted appropriately, family, loved ones, and a group of professionals can set the stage to make it more likely or easier for the addict to say yes and to accept treatment.
It is not recommended that families conduct an intervention without professional advisement. There are guidelines and a strategy used to ensure that the intervention process remains healthy and does not devolve into a family argument.
Another benefit of having professional help is that the person conducting the intervention can act as a neutral third party and understand both the family’s perception as well as the experience of the addict so that the addict does not feel threatened or unfairly treated during the process.
When someone gets to rehab, what’s the first step?
At Ocean Hills Recovery, the first step in treatment is to complete a thorough assessment process. The assessment process consists of a complete history and physical conducted by a medical doctor or a physician’s assistant. During this initial medical assessment, the client will also be screened for possible mental health diagnoses or co-occurring disorders. If necessary, during the medical assessment, the client will be prescribed medication for a medically assisted detox.
The next assessment, completed on the second day of treatment, is a clinical assessment in which the client meets with a licensed intake counselor to review all aspects of the client’s life to gather a complete picture of the whole person. Topics discussed during the clinical assessment include substance use and mental health history, family history, past trauma, problems in living such as financial or employment concerns, involvement with the criminal justice system, and the client’s religious preferences. The clinical assessment also explores the client’s strengths so that those can be utilized to create a positive treatment outcome.
Once these assessments are completed, the client will also be assessed by a psychiatrist or nurse practitioner to determine if there are underlying mental health disorders and if psychotropic medications may be necessary to help the client cope with disorders such as depression, anxiety, or bipolar.
The goal of the extensive assessment process at Ocean Hills Recovery is to use the information obtained to develop a comprehensive treatment plan using a collaborative process in which the client and their family have input into setting realistic goals in conjunction with the primary counselor for the best possible treatment outcome.
What does medically supervised detox mean? When does a person typically need it?
Medically supervised detox means that our Medical Director Dr. Alejandro Alva and his team oversee the client’s treatment throughout the detox period and beyond. It can be unsafe to detox from certain substances such as alcohol and benzodiazepines (prescription drugs) without the assistance of medications designed to reduce the risk of withdrawal symptoms, seizures, heart attack, or other medical complications.
It is not recommended that anyone attempt to detoxify their body at home without the supervision of a medical professional. Whether or not an individual requires a medically supervised detox is determined based on the following factors: drug use history, specific substances being used, amount and frequency of substances being used, age, body weight, and medical history are all considered in determining the need for supervised detoxification.
How involved can family members be in the process? At what point are they allowed to be a part of treatment (if allowed)?
At Ocean Hills Recovery, we encourage the involvement of the family throughout the entire treatment process. Once a client is admitted to our program, their primary counselor will contact the family to conduct an interview in which the family can give input and opinion regarding their loved one’s substance abuse.
We also offer family group therapy sessions two times monthly in which family members can come and complete a process facilitated by professional licensed addiction counselors. During this family group process, family members will also have the opportunity to interact with other families so that they can observe similarities to their own family and realize that they are not alone.
Often families experiencing addiction feel shame and may feel like no one understands what they are going through. It is incredibly valuable for them to come and experience the healing and education that occurs during our family group sessions. The process is very structured, and each person participating is given “homework” to prepare their thoughts in advance. We begin the group by speaking about hurts or resentments. Next, we process things we would like to ask forgiveness for, and finally we end the day with loves and appreciations in which the family can express gratitude to each other.
Throughout the treatment process, the family can receive progress updates from the primary counselor if they wish, and if the client consents to the sharing of this information. Additionally, once a client has completed specific tasks and earned the privilege for off-campus passes, the client can have the opportunity to spend time with their family immediately following the family group sessions and on Sundays from 12 pm to 5 pm.
What does addiction treatment look like?
The treatment program at Ocean Hills Recovery is designed to treat the whole person. Our program offers treatment at all levels of care which include the detox process, residential treatment, partial day treatment, and intensive outpatient and outpatient programming.
Through our assessment process, we determine the appropriate program for each client on a case by case basis at the time of admission. We match the client with a primary counselor that is best suited to address their specific needs. There is a collaborative treatment planning process in which the family, the client, and their primary counselor outline goals and tasks designed to achieve those goals so that the treatment is focused and success can be measured by achievements along the way.
The treatment program at Ocean Hills Recovery is a twelve-step program, and participation in the outside twelve-step community is mandatory. Clients are required to obtain a sponsor, and the idea is for them to develop relationships with other sober people that will persist and provide support well beyond their actual time in treatment.
At Ocean Hills, we want to teach our clients healthy coping skills and how to socialize and have fun without the use of drugs or alcohol. We offer yoga classes and the opportunity for our clients to exercise at a local gym three times per week. There is catered food provided that is planned and reviewed by a licensed nutritionist, and we can accommodate any special food requests such as a low sodium diet, diabetic-friendly foods, gluten-free, or vegetarian options.
We also attempt to engage our clients in the community by scheduling activities once a week that may include a day at the beach, attending a museum or local sporting events, and around the holidays we participate in feed the homeless events to give back to our community.
What happens after treatment? What kinds of support are available to someone after treatment?
When the client’s treatment experience is nearing completion, the aftercare planning and discharge process will begin approximately 7-10 days before the client’s planned exit date.
The aftercare planning process consists of making arrangements for the client to continue to receive services or care if necessary. For example, this could involve setting follow up appointments with a primary care physician, a psychiatrist, or a therapist in the client’s home area so that they may continue to be monitored, receive medication refills if necessary, and to continue working through personal issues in a supportive environment.
The client will also complete a relapse prevention plan with their primary therapist in which possible triggers for substance use are outlined, and specific actions to take when the client may have a craving are outlined.
The relapse prevention plan also includes a list of support persons and their phone numbers the client can call if they are experiencing the urge to use, along with a schedule of the twelve-step meetings, date, times, and address, that the client plans on attending.
Sobriety is about the maintenance of the behaviors learned during treatment, and we attempt to make the transition and return to life as seamless as possible for our clients by setting them up with adequate support when they return home.
In addition to our recommendation that clients continue with their twelve-step participation, medication compliance, and follow up appointments as needed, there are many online resources available to clients as well. There are online meeting forums and chats so that the client can make connections with other sober persons regardless of their location or the time of day.
What’s the best way to help someone who is struggling with addiction?
The best way to help someone suffering with addiction is to do something. By doing something, I mean that the addict needs to know that help is available even if they are not ready to accept the help right away.
We cannot force or coerce an addict to seek help, but as family and professionals that care, it is our responsibility to remind the addict that they are loved; they are worthwhile and can have the opportunity for help if they desire it. I have found that help is best accepted if it is offered in such a way as “when you are ready” here are the resources or options that we have found for you.
Printing literature or information about possible treatment programs and leaving it with the addict to review on their own time can be helpful. I know many addicts that found a brochure, a printout, or a phone number that was given to them by someone that they did not utilize right away. But, when they hit their point at which they were willing to seek and accept help, the resource was there, and they were able to call and get help right away on their own terms.
Addiction is a deadly disease, and we cannot sit back and let an addict continue to harm themselves without feeling like we have given them every opportunity to get well. There is a difference between letting the addict know help is available to them and enabling behavior. It is vital for the family to maintain healthy boundaries with the addict and to not become overinvolved in problems created by the addict. However, it is not always a matter of “tough love” either and often these strict approaches of no contact or conversation with the addict actually create an environment of further isolation and depression for the addict. There is a way to offer help while still maintaining appropriate boundaries and without enabling. Al-Anon can be very helpful as a resource to families attempting to navigate the process of helping the addict in their life.
About the author:
Nicole earned her doctoral degree in Psychology with an emphasis on marriage and family therapy at California School of Professional Psychology. Her doctoral thesis was a grounded theory study exploring the role of alienation and connectedness in the life course of addiction. She specializes in treating addiction and trauma. She is certified in DBT and EMDR, two of the most highly regarded evidence-based methods in psychotherapy. Dr. Doss is a strong LGBT advocate and provides open and affirming support to her LGBT clients.
Dr. Doss’s earlier education included graduating cum laude from the University of California, Irvine in June of 2007 with a Bachelor’s degree in Psychology. While there, she received honors recognition by Psi Chi and Golden Key honor societies.
Nicole has been working with alcoholics and addicts in our California drug and alcohol rehab center as an advisor and counselor for many years. She is passionate about providing quality counseling and care to her clients. Her main focus is on integrating the 12 Step and disease models of addiction with experiential therapeutic theory. She is married to Greg; they have two adorable sons together and an energetic yellow Labrador Retriever.