Alpha House Offers Hope for Substance Abusers

I can say that the individuals that come through our program have changed from the 26 years of my employment at Alpha House, Inc. When I first started, the majority of our population was individuals addicted to heroin, who had co-occurring disorders, although not reported as such. A lot of these individuals also exhibited personality oriented disorders, such as Narcissistic Personality Disorder, Histrionic Personality Disorder, and the like. We were a 9-12month program because, once again, we treated people who have/had extensive history of abuse with criminal activity directly related to their need to sustain the addiction. The drug of choice changed throughout the years, and there was an increase in the use of cocaine. I believe this occurred as a result of a change in the route of administration. Individuals transitioned from snorting cocaine, to cooking it in rock form, which is commonly referred to as crack. This afforded a more intense, immediate sense of euphoria, and usage in this form increased dramatically. Our program increased from 9-12 months to 12-15 months, due in part because cocaine users needed the additional time to become reoriented to time, space, and place. Then there was the implementation of managed care, which dramatically reduced the length of time required to treat an individual with an addiction problem. This reduction, as I understand, was supported by empirical research. Our program was reduced to 6-9 months; it still included substance users with extensive histories of addiction, criminal involvement, and co-occurring diagnosis. The added issue, however, was in the co-occurring disorder. At that point, Alpha House, Inc., began to see more severe secondary diagnosis individuals in our program. What was once Narcissistic Personality Disorder, Histrionic Personality Disorder, and the like became Bipolar, Borderline disorders that required greater attention in the treatment process. Most recently, there has been a resurgence of heroin use again. I associate the increase with cost and content. Heroin is relatively inexpensive with a feeling that last longer than crack cocaine, and its desire for the user is to continue to use and seek the same pleasure initially derived from the first use. Secondly, heroin is being “cut” with much stronger chemicals, like fentanyl. The distorted cognitions of an individual with an active addiction allow them to want to obtain the best “high” so to speak.

Some of this answer is provided in the first question, Alpha House, Inc., has witnessed an overall increase in people seeking treatment for heroin. Unfortunately, there has been an increase in the number of clients previously treated who have overdosed and died. As far as heroin being the most challenging addiction to break, I find that difficult to answer. Breaking the addiction relies solely on the person and their readiness to do the work required of them to break such an addiction. In my opinion, there are other addictions that seem harder to break in an individual, one of which is pain killers. I feel most often many of these drugs are initially taken for legitimate reasons; however, a person prone to addiction believes they need them above and beyond the time prescribed by their physician. No fault of the doctor; no one can readily identify one’s potential for abuse and/or other related factors that contribute to the abusive nature of a person.

I think you covered it; clients are hopeful, feel guilty and a shamed, and are scared and confused about “this whole idea of this treatment stuff”, and the process involved.

Approaches are as varied as the person themselves. From a theoretical perspective, most therapeutic communities operate from a Cognitive Behavioral Therapy modality. Briefly defined, it helps the clients to understand the thoughts and feelings that influence behaviors. They learn how to identify and change destructive or disturbing thought patterns that have a negative influence or behavior. The individualization enters when the counselor is examining the root of the addictive behavior and the multitude of underlying issues that have permitted the development of addiction as a coping strategy.

Good question and there is not one answer I can give. Addiction is an individualized problem and what may be easy for one person to change may be the most difficult for another.

Readiness is as individualized as the approach the counselor will employ to facilitate change. For some, it’s the estrangement from family, friends, and supports, for others it’s the consequences that occur over and over. Still others have witnessed the death of loved ones, and/or overdosed themselves, while some want to change in order to become a better parent, son/daughter, husband/wife, etc. Prochaska and DiClemente (who wrote the book Changing for Good) describe quite accurately the “Stages of Change.” The clients we see are usually somewhere between, “Pre-contemplative and contemplative stages of change.” However, they may vacillate between all of the phases until they become truly committed to the change process.

Most definitely. Don’t allow the elephant to live in the middle of the living room without someone, asking if someone else sees the elephant! Let the other old adage continue to stand the test of time too, “You can lead the horse to water, but you can’t make him drink”.

Currently, we treat more individuals with drug addiction. However, a large percentage of our population is poly-substance abusers. Simply meaning that they will use more than one substance abusively; “If I can’t have my drug of choice, then I’ll use what’s available”. Alcohol removes inhibitions, and often the use of alcohol will allow a person to become more aggressive in drug-seeking behavior, which can sometimes account for the criminal activity piece in addiction. This works both ways; you can see the alcoholic begin to use another drug when their drug of choice is unavailable to them.

Again, I believe treatment must be as varied as the client. Not all persons can adapt to a large institutional type settings (albeit they have their place), not all people can cognitively comprehend the volumes of literature available, can communicate their story and receive unconditional support from staff, (once again setting, volume, staffing, etc. can be deterrents to this happening). That being said, a small, communal setting has its advantages. At Alpha House, we offer a firm, caring therapeutic community. It permits clients to have issues with each other, confront/address the issue without mood/mind-altering substances, and learn/relearn strategies of resolution. Clients learn appropriate interaction with their peers, the staff, and as they develop, the community at large again. Clients are reinstituted to the activities of daily living that most of us go about without giving them a second thought. If most of your day was spent on how to procure drugs, then you need to readjust to getting up, personal hygiene, going to work, making your dinner, catching a T.V. show or two, doing your dishes, (don’t forget that load of clothes, needing washed), getting ready for tomorrow, (did you walk the dog, go to the gym?) and exhaustedly going to bed for tomorrow. What about those friends, family members I haven’t connected with in a while that wants to hear about what’s going on in my life and share theirs with me? Can I save that money for the vacation I want to take? Who wants to come with me and can they pay their way? This scenario doesn’t begin to reintroduce them to the wonderful, world of work. I’ve always reminded myself when I wanted to throw in the towel on a job. “There’s not a job out there that doesn’t come with its fair share of stuff.” The staff are role models for the clients, because we are in an environment where the client resides; they observe our “good days” and the “not so good days.” However, we must also practice what is preached and simply say, “We have those kinds of days too” so there is a mutual respect that is demonstrated for them. The length of stay permits us a deeper understanding of the issues of their addiction. It allows us to personalize the treatment strategies and ways of coping with their ongoing issues as they return into the community. We have an opportunity to observe their interaction with family and children. We can offer couples, family, and parenting interventions. Their families can observe our staff, develop relationships, and communicate their concerns. They give us information that sometimes helps in the therapeutic process, speeding the recovery time. Alpha House offers ongoing support; clients are welcome to come back, “hang out” at the house, support newer residents who may be unsure of the program, and see the potential for success. The support extends to the successful client as well; once again, I tell the clients, if given a choice of being out at 3:00 a.m. in the morning on the corner, or coming here, you can come here! We’re a 24-hour operation; we are a “safe house.” No one has ever tried to “break in” to treatment! In my 26 years, I’ve been privileged to have the protection they offer the staff as well, e.g. “I’ll walk you to your car, let me carry that for you” and yet, I’ve also had to set firm boundaries, terminating some from the program, not allowing some to return due to the nature of their departure. I hope I’ve described the many ways in which Alpha House is different from other facilities. Let me reiterate, we are all in this together. I’m a firm believer in whatever way it takes to achieve the goal, and we (treatment facilities) all have one goal: sobriety and recovery to the person we serve.

Unfortunately, smaller facilities don’t readily have the capacity to offer statistics; however, we are also evolving in this area as well. Most recently, we initiated an in-house statistical data collection with the clients. We are tracking the depression and anxiety of clients while receiving treatment. This will enable us to provide more intense treatment at given stages in the program, hopefully enhancing the treatment experience and outcomes for the client. This is done in part with Allegheny Health Choices Inc. (AHCI) and the Training Center for Outcomes-Based Integration (TCOBI) whose willingness to support small facilities in their need to have this type of information, is instrumental to their sustainability.