Sometimes Just Saying No Isn’t Enough

In the field of addiction recovery, there are many different philosophies and treatment modalities available to those who seek help. Sadly, the complexities of treatment and prevention are often times boiled down into a single catchphrase or slogan for popular consumption. Ever hear, “Just Say No.”?

Each person’s situation and manifestation of addiction is unique and there is no single magic treatment plan. Societal stigma and a lack of support keep many in need from seeking treatment. Even those who seek treatment to “get clean” encounter major hurdles to overcome during and after treatment.

Let me share with you a real world example of this. When I was the Director of a hospital-based inpatient medical detoxification program, a young patient entered my office and asked if he could have a seat. He was in a very good mood and seemed much more alert and cognitively aware than he had been 4 days earlier. He excitedly told me he was ready for discharge and that he was willing to make a change in his life. All great news, I told him.

However, as the conversation progressed, his mood began to change. His enthusiasm started to wane and I wanted to know why. He went on to paint a bleak picture of his life following discharge — after he would walk out our doors and into the real world. As soon as he got home he would run straight up to his room and shut the door, trying not to notice the myriad of drugs on the kitchen table. He would try to ignore the family and friends who would frequent his shared residence at all times of day and night, looking to entice him to get high. He would be shunned, called names, and have no one to lean on for support. Knowing he didn’t have the skills necessary to make it on his own, he felt trapped. His chances of continued recovery were slim. He would be able to hold out for a while, but sooner rather than later he would be back, he said. He would be back in my office, talking about how excited he was to finally “get clean” and he would mean it. Again.

Addiction treatment does not end at the time of discharge. Services such as job training, housing assistance, support group enrollment, individual and group counseling and peer support all need to be in place for a successful recovery. It is very unlikely that a patient that returns to the same living environment, hangs around the same people, and is tempted by the same substances they sought treatment for will have the strength and fortitude to withstand and remain clean. Unfortunately, it is very difficult to monitor individuals once they return to their community. Often times their socioeconomics will dictate their ability to change their living environment and escape detrimental influences.

However, an inpatient addiction treatment program that offers NA or AA meetings on-site and encourages patient attendance prior to discharge affords their patients an increased chance of continued sobriety post discharge. Housing support and job training programs along with emotional support is key to continued recovery. As a profession and a society, we need to continue to find better ways to develop, fund and encourage the use of aftercare programs and support systems so the story outlined above becomes the exception and not the norm. Sometimes it’s not as simple as, Just Say No.