This post was originally published on August 25, 2013.
If I were the parent of a teenager who had a drug problem today, I wouldn’t know what to do. There’s such a glut of information—probably 100 times the information that was out there in 2000, when I went to rehab—and all of it seems to contradict itself. A simple Google search would only turn up whichever treatment centers had paid the most to rank high in such searches and I would surely click through treatment center after treatment center without a clue about which one would be right. Words like group therapy, cognitive behavioral therapy and equine therapy would eventually probably join together and play on an endless loop in my already overly rattled head. And if someone recommended a certain treatment center, how would I know if that one was right?
In an effort to make sense of the possibilities—and to try to give potential rehab seekers an idea of what they should be looking for—I turned to the person with the greatest expertise in this area that I know of: Earl Hightower, a top interventionist for the past three decades who’s won numerous awards—including, earlier this year, the Champion of Recovery Award from the White House. As it turned out, he had strong opinions on the matter.
AD: What would you say to parents if, say, their college-aged son came home from school and it seemed clear or he told them that he was on drugs? Should they address the problem right away?
EARL HIGHTOWER: Well, let’s take the scenario even further. Let’s say the parents took him to a therapist and he blurted out in the middle of the session that he’d been doing OxyContin for the past nine months.
AD: What would you recommend parents do at that point?
EH: Let’s assume that the parents know nothing about drugs or addiction or any of this. Probably the therapist would offer a treatment plan to address his addiction and would recommend a facility that supposedly does well with treating prescription drug abuse and also provides medical detox, rehab and discharge planning.
AD: Should the parents just accept the first recommendation or should they ask for more?
EH: I think the first question they should ask should be one they ask themselves, which is how they want their son to return.
AD: What does that mean?
EH: Well, the majority of the treatment centers out there are 12-step based, which means that the goal for them is for their clients to achieve abstinence. This would be the choice to make if the parents want to get their son back in the same condition that he was in before he got on drugs: drug-free.
AD: But you can’t say for certain that a 19-year-old who was doing Oxy for nine months is definitely an addict who will need 12-step.
EH: You can’t. Maybe he was just dabbling; treatment would be able to help determine that. But maybe treatment will prove something else—maybe treatment will prove that this wasn’t an isolated incident. Maybe he’ll get in there and confess that he’s been using pot since he was 12 and maybe other conversations will turn up the fact that there’s a genetic predisposition toward addiction in the family. And if that’s the case, I believe he will need community-based support in staying clean once he returns home. It could go either way: good ongoing clinical assessment is the backbone of early treatment to determine the direction of care.
AD: But not all rehabs recommend 12-step or even full abstinence.
EH: Yes. And that’s why parents—people—need to know is that if an addict is going to a facility which subscribes to medication-assisted treatment and recovery, the goal is different. Loved ones need to know what medication-assisted treatment really means, which is that treatment will be radically re-defined and their child could be put on a medication which he would remain on for a long time, if not the rest of his life.
AD: So that’s what you mean when you talk about parents asking themselves how they want their child to return.
EH: Yes. But I can tell you from 30 years of doing this work that most parents want their child to come home drug-free—or they at least they want a shot at that. But some members of the treatment community will tell parents—or the addicts themselves—that we have to let go of this notion of abstinence and move more in the direction of medication-assisted treatment. And that means that people who could thrive without being on anything at all are leaving treatment centers on very powerful opiate replacement drugs.
AD: I think there’s so much misinformation out there about medication that people get overwhelmed. There are sober people who tell other sober people that they shouldn’t be taking anti-depressants.
EH: Comparing anti-depressants and opiate replacement drugs is like comparing apples and battleships. One is an intoxicant and one isn’t. And I’m telling you that I’ve seen people go through every detox you can imagine—heroin, benzodiazepines, alcohol, you name it—and by far the worst detox I’ve ever seen are in those coming off of opioid-replacement drugs.
AD: But not all treatment centers keep addicts on the opiate replacements. Many use them just for detox.
EH: Many do—very successfully, I might add—but some keep the clients on these drugs through and after their discharge, telling them that they’re quote-unquote sober. And I believe that when a family sends a loved one to treatment, the expectation is that the addiction will be addressed and not replaced with a new dependency. The expectation is not that the addict will come home with no exit strategy in place to get off of the opiate replacements or have to go to the doctor once a month to continue to get those drugs. How can the answer to a pill problem be another pill?
AD: Just to play devil’s advocate for a second: why is being on an opiate replacement drug so bad? Are the odds of staying sober—meaning drinking or doing other drugs in addition to the opiate replacement drug—really that much worse?
EH: Not only is the relapse rate far worse than it is when someone is directed toward more traditional methods of treatment but also the misuse and abuse of opiate-replacement drugs is significant. A great deal of non-conflicting evidence-based research is currently surfacing, which is what drives my position.
AD: So what should parents—or any loved ones—do?
EH: They should be very careful about gathering as much information as possible about what the disease of addiction is—find out what abstinence-based treatment versus medication-assisted treatment is. They should try to find out what they can reasonably expect when their child returns.
AD: What sorts of questions should they ask the treatment centers?
EH: They should ask what the weekly schedule at the treatment center is like, what the emphasis is on—whether it’s on science, education, one-on-one therapy or group therapy. They should ask the treatment center what their goals are with clients and try to find out how individualized the care is going to be and whether or not the parents will be allowed to participate and what changes they’re likely to see in their child. And they should try to find out what they need to do to prepare for the day after treatment. Their overall goal should be to try to become a part of the solution and not be a part of the problem.
AD: Which do you think is better—an emphasis on science, education, one-on-one therapy or group therapy?
EH: I think you should try to strike a balance. Now, I’m pretty old-fashioned and so I believe that every addict should have a shot at abstinence. And I think that treatment centers should be careful about not doing anything that could block that possibility from occurring. Treatment is triage at first but once you’ve stopped the bleeding, you should be giving the patient the tools they need to progress and participate in their own recovery process.
AD: So what, exactly, should happen after detox? What are those tools?
EH: After detox, the questions that need to be asked should mostly be focused on what obstacles exist within this individual. What are the conditions he feels he needs to medicate? Is he resistant to sobriety? Does he have a co-occurring disorder? If so, can you get him in therapy to address this problem while he’s attending community-based recovery?
AD: Where does science fit in to this?
Science is very much a part of that—12-step and community support can’t do it all alone. And I believe that, as time goes on, science and 12-step will increasingly work more and more together. Scientists are making discoveries about the brain that can be quite helpful in recovery—we know now, for example, that because different parts of the brain detox at different rates, nine months of sobriety is supposed to be a low point. And I believe that at nine months, a sober addict should be hearing about that from the people he entrusted with his treatment, rather than being sent for the ninth time to a doctor to get dangerous drugs he may well not need.
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