Christine is a 29-year-old white female with a history of alcohol use disorder, generalized anxiety disorder, and depressive disorder NOS. Christine was admitted to the hospital for detoxification following 5 days of binge drinking alone in her apartment after a breakup with her fiancé. On the third day of her detoxification, the patient felt sad, hopeless, guilty, and worthless because of her life circumstances. She denied any suicidal ideation but wasn’t sure her life could improve. She has a history of two previous detoxes and one 30-day rehab stay, but quickly relapsed within 3 weeks of discharge. Christine is ambivalent about going back to a rehab at this time.
Patients completing detoxification programs are at a crossroads and face difficult decisions about next steps in treatment. Patients can a feel myriad of emotions such as fear, sadness, relief, worry, guilt, shame, anxiety, and anger. It is critical to provide support, build trust, and optimize communication with patients in order to help them gather the strength to maintain movement in the direction of recovery.
Dr. Nicole Kosanke
Recovery is a process that can take on different meanings to different people, and there is no agreed-upon definition among scientists and clinicians.
Although recovery might require total abstinence from substances, many argue that this is not necessary. More broadly, recovery from a substance use disorder (SUD) can be thought of as developing mindfulness, awareness, and adaptive skills. The individual in recovery must learn to act in more reflective and less reactive ways. Recovery involves acceptance of one’s particular set of strengths and vulnerabilities while moving toward mental, emotional, physical, and spiritual balance.
Discussion with patients offers a way of being with them that can help promote positive behavioral change. During that discussion, we should:
1. Provide psychoeducation about the nature of a substance use disorder as a medical condition. The clinician should explain to the patient that a substance use disorder is not a moral defect but rather a medical condition that needs to be treated like every other chronic medical condition. A person who is suffering from diabetes who needs to be admitted to the hospital is no different from a person suffering from an SUD who has a setback and requires detox. Patients should be provided information regarding the high prevalence of co-occurring mental health conditions present in the context of an SUD such as anxiety, depression, attention-deficit/hyperactivity disorder, or trauma. When these other conditions are treated, overall treatment outcomes are improved.