Please help me to help my client recover naturally
Dear Dr. Peele:
I am relatively new to direct treatment in addictions, although I have been in the social work field for over 25 years (BA, MSW, and a year of graduate-level addictions studies). I am in private practice, and have a client coming off 9 years of heavy heroin use. She is 34 yrs, and detoxed before she contacted me. She has been clean 21 days, and is climbing the walls with anxiety attacks, and roller-coaster emotional swings. She got clean on her own no treatment so shows a lot of personal strength, and I think she may be one of the minority that can make it. Addiction training spends little time on how to assist someone at this stage. Her GP is cooperative, and would prescribe meds to deal with anxiety etc. but he also has not encountered a "natural recovering" heroin addict at this stage. Can you help us with a strategy?
A majority of people recover either without receiving treatment, or else even though they have received treatment at a point when their treatment is not salient. The issues involved are for them to deal with life without the drug, and to be able to encounter and accept negative moods and situations without resort to the drug. The helpful MD is very helpful, and please don't get too carried away with the idea that this situation is unusual. The physician should prescribe anti-anxiety drugs cautiously but as necessary, as would be required with a typical anxiety-prone individual. At the same time, explore non-drug ways to achieve anxiety-reduction (e.g., meditation, church meetings, running or other exercise exercise really helps people to sleep). The trick is to communicate to a person "Look, you want to leave drugs behind and have taken this remarkable step of quitting on your own. Be aware that many others have done so and you can too. This does not mean that it will be effortless, only that you will have to apply the motivation and creativity that you used to quit the drug to stay off it and live life drug free."
Your lack of experience in drug treatment is a plus, Will. You are not loaded down with inaccurate truisms accepted in the field. Remember the keys for a client's mental health and productive living and they apply equally well here (e.g., work, family, companionship, interests with which to fill free time constructively, a commitment to health, peace of mind). Also, without suggesting that the person try heroin again, keep in mind (and communicate to your client in a constructive way), should she somehow slip and take heroin, this is not the equivalent of a return to where she was during her nine-year addiction. It is a slip and she can pick up where she left off and quit again. She should certainly not take such a misstep as a proof of personal weakness or that she is doomed to failure.
Let me know how the case proceeds. I feel that this is a good case with a high prognosis for success, and in several months everyone (you, the client, and the physician) will look back and think that your intense anxiety at this point is hard to comprehend.