Dr. Ken Roy, medical director at Addiction Recovery Resources of New Orleans (4836 Wabash St., Suite 202, Metairie, 780-2766 or 1-866-399-4673; www.arrno.com), discusses how to manage addictions to drugs and alcohol.
Q: Your center deals with a range of addictions. What all does that include?
A: We don't treat people for process addictions unless these are part of the presenting addiction to alcohol or drugs. We don't do sexual addiction, gambling addiction, that kind of thing, except when those are part of a chemical addictive disorder. We treat people for addiction to any kind of drug, with the exception of nicotine ... although we believe nicotine addiction is serious and devastating. We treat alcoholism, stimulant addiction and narcotic addiction, including pain pills as well as street drugs.
Q: Are most of your patients addicted to narcotics that are prescribed for them, street drugs or alcohol?
A: We actually have a range. Our patients are pretty over-represented by working people and professional people. We have very rare patients who are not employed at some level, and we frequently have professional people in treatment. The drugs that they use are across the spectrum. Of course in these days, we have a lot of prescription pain medication addictions, but we also see a whole lot of alcoholism and poly-substance addiction where alcohol is a part of that: drinking and smoking marijuana or drinking and using cocaine or ecstasy or taking somebody's Xanax.
Q: Have you noticed an increase in new patients or relapses since Hurricanes Katrina and Rita?
A: We've had a whole lot of people relapse. It's very unfortunate. People who were doing fairly well in recovery are finding they have huge losses including their support system. Fortunately, a lot of those people have been able to get back into treatment and get back on track.
Q: Are the reasons for the relapses more stress and depression or because the patients have a good "excuse" to start using substances and people are less judgmental about it right now?
A: People with an addiction drink or use drugs because they have an addictive disease. If they are in recovery, their relapse triggers can be events of life or a psychiatric illness, developing a depressive or anxiety disorder, or some people have other psychiatric illnesses such as Attention Deficit Disorder or bipolar disorder that go unnoticed while they are drinking or using because drinking or using are the most visible characteristic they have.
Q: Physiologically, what makes one person an alcoholic and another just a social or heavy drinker?
A: Research has hinted at a potential for some differences in individual biology that would predict a drug of choice, but for the most part, addiction is addiction is addiction, and the drug of choice has more to do with where you went to high school, who your friends are, what they use. In cultures where drugs are the norm, it's not uncommon for people to seek out groups of people who like to use marijuana, or stimulants or pills obtained on the street, whereas in cultures where drug use is rare and adherence to law and custom is the rule, we see alcoholism and prescription drug abuse.
Q: When do you recommend inpatient care as opposed to outpatient therapy?
A: Once addiction is identified, the treatment for addiction should last at least a year; that's the professional component. Where that starts depends on the individual's need for detoxification and their ability to discontinue use with just social support. If people can only stop using in a locked environment, then that is where they need to start. If they have need for a nurse or doctor 24 hours a day, then they need to start in a hospital. Some people can detoxify on an outpatient basis and take treatment on an outpatient basis. Those aren't the only two options. Some people, because of relapse issues or recurrent inability to maintain abstinence in recovery, whether or not they detoxify inpatient or outpatient, they do better in recovery in residential treatment with other people who are also in the recovery process.
Q: When can you go with 12-step programs and counseling as opposed to treatments with medicines, such as Buprenorphine for opiate addiction?
A: Those are all individual decisions made in the context of the doctor-patient relationship. Addiction is a medical disease, and the treatment should be supervised by a physician. That generally works best in a multidisciplinary team environment, where doctors, nurses, social workers and trained addiction counselors are all available and have input. ... If 100 people came to me for treatment, there would be 100 different treatment plans.
Q: Do you also treat medical problems aside from addiction?
A: I'm comfortable treating some things (that are) obvious consequences of drug or alcohol use and have a network of respected specialists that are available to participate in some part of the treatment of those people. There's an interesting concept that I think is real, and that is that everyone eventually would hit a bottom severe enough that they would want to get well. My job as a professional is to bring that bottom up to the person. The earlier you get to the treatment, the fewer problems persist. Our goal is getting to the person early and to address their relapse issues. All our programs embrace the ideas of 12-step recovery, and all our programs include an introduction to 12-step recovery and introduce them into 12-step recovery as part of their maintenance.
Q: I understand that you follow patients for two years. Do you feel that if they stay sober for that amount of time they probably have beaten the addiction?
A: No. I feel that at that time, if or when they need professional assistance, they'll have the skills and knowledge to return and ask for help. Addiction is like diabetes and high blood pressure, it's a disease that requires daily attention. During those two years I help the patient develop a rational and beneficial and doable process that keeps them in recovery.
Q: When you have addicted patients, do you also need to help their families?
A: All of our programs involve (bringing into the program) a significant other intensely, and the extended family on an at-least-weekly basis, at least during the primary or intensive part of the treatment. Our intensive outpatient treatment meets five nights a week for six weeks. The significant other is invited and expected to attend those sessions. Our belief is that addiction never develops in a vacuum, and if one person in the relationship has addictive disease, then the relationship has addictive disease and both people in the relationship need to get well from it.