Philosophy of Treatment
Treatment for the disease of addiction
Addiction is a disease that affects the brain. Like any organ of the body that can be diseased, there are many factors that come into play in assessing why that disease exists and the proper modality of therapy to treat the condition. For example, if an individual is suffering with diabetes, the pancreas is not producing insulin properly. Therefore, the person’s blood sugar is too high and treatment is directed toward the lowering of the blood sugar level to a normal range. Similarly, when a person has the disease of addiction, the dysfunction is in the brain, and like all diseases of the brain, the disease manifests itself in impaired behavior, thinking, judgment and changing level of consciousness and moods.
What separates people with the disease of addiction from mere drug abusers is that the true addict does not have the ability to control their drug or alcohol use. In fact, impaired control of behavior is one of hallmarks of addiction. People who suffer from the disease often know and understand, intellectually, the potential harm that may result from the continued use of the drug or alcohol, but their brains are incapable of turning off the switch that controls their desire for more and more of the very substance that they fully appreciate will cause them and the people around them harm. Patients, in order to be considered an addict, must meet the recognized standards listed in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV), which sets forth the established criteria for the diagnosis of addiction
When dealing with adolescents with addiction the recovery process is more complex. Addiction affects their everyday life, but in addition, has a tremendous impact on their physical and emotion growth as well as their inability to move through normal stages of growth and maturation. The use of substances will impair their success in obtaining an education, attaining a safe level of independence, and in acquiring coping skills necessary to live a full and productive life. The treatment of addiction in adolescents and young adults needs to be very specialized, and requires a staff that is specifically trained and qualified to provide appropriate care.
Addiction and the Developing Brain:
When we are born, our brains have very limited function. A new born baby cannot even control his or her eyes. As the baby continues to grow, the cells in the brain develop connections and mature by a process of myelination. The brain matures as the cells become wrapped in a coating, called myelin, that allows very rapid communication between cells. This myelin is like the outside plastic covering of electrical cords.
As rapidly as this process occurs, it still is not entirely complete until the individual is 25-27 years old. It takes this long to create a fully functioning adult brain.
The blue color shows the areas of myelination. As the brain develops, the frontal cortex is the last area to mature. For females this occurs at age 25, for males: age 26 or 27.
The very last portion of the brain to mature is the frontal lobes. This area of the brain, which is located behind the forehead, has the responsibility for what we call executive functions like: controlling our impulses, making good decisions, weighing and balancing consequences and rewards for certain behaviors, planning, organizing and valuing things like family, education, health and freedom. Unfortunately, many of the drugs of abuse can interfere with the brain working properly, particularly the frontal lobes. The younger a person is when they begin to use drugs, the greater the impairment. The behavior problem you see when this area is under the influence of drugs is impulsivity, poor judgment, poor planning, and irresponsibility. Young people have an even bigger problem since this part of their brain is not even working yet.
Since the disease of addiction affects all aspects of a person’s life, all these areas must be addressed in order to provide the best possibility of recovery. When working with adults in early recovery, we call this rehabilitation, often shortened to “rehab”. Patients who are seeking treatment go to “rehab”. This concept is based on the fact that we are working to help the person back to their previous level of functioning. When we talk about the treatment of adolescents and young adults, we have to think more in terms of “habilitation”.
the assisting of a child with achieving developmental skills when impairments (in this case, addiction and drug use) have caused delaying or blocking of initial acquisition of life skills. Habilitation can include cognitive, social, fine motor, gross motor, or other skills that contribute to mobility, communication, and performance of ACTIVITIES OF DAILY LIVING and enhance the quality of life.
We must assist them in not only learning the skills needed to manage the disease of addiction, but we need also to provide them with education and training to “catch” up in terms of their education, emotional and social growth.
Many of these young people come from supportive homes where their families are actively involved and interested in the recovery process. However, even within these ideal family situations are issues of lack of trust, anger, confusion and fear, which need to be addressed. Families need education about the disease process and what role they can plan in the recovery process. Relationships need to be healed and communication enhanced.
For others, ties with families may be badly damaged or even broken. Families may not have the resources or even the willingness to assist in the recovery work of their child. These children require even more services and resources, especially if there are legal issues, such as criminal charges or custody issues. Staff needs to have an expanded knowledge of community services and resources to assist in the treatment and habilitation of these children.
Psychiatric and other co-occurring disorders:
Many people with addiction also suffer with other psychiatric disorders. There is a high correlation between addiction and illnesses such as, depression, ADHD, anxiety disorders, schizophrenia and bipolar disorders. Ideally, patients need to be treated in a facility that can address all diagnoses at one time. Specialty training is needed for psychiatrists and psychologists to accurately diagnose and treat addiction, in addition to other psychiatric problems.
We often find that people who have been using and abusing drugs and alcohol have significant medical problems. Again, many traditionally trained physicians are not equipped to safely treat children and young adults with medical co-occurring disorders. Many medications are contraindicated in addicts, such as medications for pain, insomnia and anxiety. Even a cough syrup may be potentially addicting and cause relapse. Treatment of problems like Hepatitis C, HIV, and sexually transmitted diseases are required for many young people with addiction, and most pediatric physicians are not well versed in addressing these issues. Again, specialty training for pediatricians and family medicine doctors is required since these physicians are an essential part of the treatment team.
Treatment of adolescents and young adults is complex and challenging. It requires a fully integrated treatment team with a wide skill set. Because of all the challenges and because of what we know about the recovering adolescent brain, a much longer length of stay is required when treating this population. While 90-120 days is the usual recommended length of stay for adults, we know that to be most successful with young people, a length of stay must be 6 months to a year and maybe longer.