Abstract
Without stabilization in areas such as physical, (withdrawal and medicine) mental, (identifying mental illness issues) and social, (concurrent, dependent, anti social behaviors), recovery from addiction is very difficult. Therapy helps patients gain insight not only into their particular situation but also it helps to predict pitfalls and helps to develop plans and strategies to move forward in their lives and reach desired goals.
Years ago when we first started treating OUD (opioid use disorder) patients, the then current studies showed, that positive outcomes for opioid addiction, did not increase with the use of therapy. In looking more closely at those studies we realized that the individuals in the groups that were being studied were very narrowly chosen to be substantially without comorbidities or dual diagnosis. So, therapy strictly for opiate addiction, did not seem to increase the success rate.
Once we started to gain experience in the reality of actually treating the patient demographic that is the majority, we realized that it is much more complicated than previously thought. The majority of OUD patients have other issues. Some are “dependent comorbidities” and some are “independent comorbidities) meaning that some are caused by the drug use and other problems are part of the patient prior to their drug use. The problems that patients may have can be external or internal. The external problems are usually things caused by the patient’s drug use (Dependent) and they can be things such as antisocial behaviors like lying, theft or reclusiveness etc. They can also be mental or psychological issues such as drug related dysphoria i.e. depression, psychosis, fear of withdrawal symptoms etc.
Due to the fact that many of our patients have multiple other issues, we realized that therapy is extremely useful to help the patient overcome those problems and disadvantages of having dual diagnosis or comorbidities whether dependent or not. Chances of increased overall patient health and happiness are greatly improved when CBT or other therapies are instituted.
One of the reasons that a patient may have trouble stopping their use of opioids is due to fear and disinformation. Another may be that the patients social and or family network of support has collapsed and their remaining relationships or new relationships may be very unhealthy and triggering. Therapy then, as a way of realigning the patients values and habits in a way so as to support a more positive outcome, is it extremely useful and has proven itself as something that helps both the doctors and the patients move through the process more comfortably.
Likewise, patients who become addicted to opioids, most probably will have damage to their limbic system, where impulses, correct or not, turn into actions and then are repeatedly rewarded whether correct or not thus reinforcing the harmful behavior.
Damage is also seen in the prefrontal cortex where are the ability to say no is stunted in the OUD (addicted) patient. Some patients literally cannot say no! They know what could happen and they understand the risks but they are unable to assign enough weight to the action to make them change course. Their ability to predict negative outcomes is inhibited and their consequential thinking can go astray. Its as if that part of their brain has reverted, in that way, to the adolescent brain that functions on impulse and emotion. This is where brain and habit re-training comes in via therapy.
Another aspect of opioid addiction is patient isolation. The OUD patient usually feels that there is no one for them to talk to and no one who will understand. There is a great stigma and very much misunderstanding about the reality of this disease as some people still do not think of it as an actual disease. The patient becomes more and more isolated more and more introverted and less likely to communicate not only about what they’re going through but about what kind of possibilities there are to correct the situation.
A therapist can be that person who can reflect back to the patient their ideas. The patients then if they have trust with the therapist, may feel more comfortable speaking freely about their situation, the causes, and the ways to correct the issues.
Just having an outlet for ideas and concerns can help a patient learn to work through them on their own even if only because they need to formulate their ideas in order to get them across to the therapist.
The process of the formation of ideas alone is therapeutic, just the fact that the patient is beginning to think about the problems that plague them and recognize and submit the problem and possible solutions to the therapist can be very productive. This exercising of the damaged parts of the brain is one of the first and most important steps in the healing process.
The patients can then accept where they are and begin to have a vision for a new and correct path where they can see the light at the end of the tunnel or at least some vision of how to get there. This predictive thinking step is critical and is immensely helpful in the brain rebuilding process.
After patients have been in remission for quite some time, and their brain has started to heal, most realize that the way in which they were thinking during active addiction, was absolutely wrong. The patient while still in the throws of addiction, think that they are thinking correctly. To have an outside third-party that the patient can trust and who can speak intelligently to them and listen to them, helps the patient to create a new point of reference from which to view their disease as well as the perspective of how to remediate it and move on to a better place.
Please respond with arguments, questions or concerns or even requests for other topics and we will respond.