Outpatient treatment key to addiction recovery

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Since her early teens, Felicia* used alcohol to cope with her anxiety, depression and trauma from childhood abuse. At 28, the single mother was admitted to North York General (NYGH) after a suicide attempt involving prescription drugs and alcohol. As an inpatient, Felicia met with the hospital’s addiction consultant, and within a few days had physically recovered from her overdose, was alcohol-free and no longer suicidal.

With the consultant’s help, Felicia realized that alcohol dependency was keeping her from addressing mental health issues. She was discharged to the hospital’s outpatient Addiction Program, and within a week, began a daily 10-week intensive outpatient treatment program.

After successfully completing the treatment, Felicia followed up with six months in the once-weekly Aftercare Group, supplemented by one-to-one consultations with the program’s multidisciplinary team.  Felicia is sustaining her abstinence from alcohol, and with help from medication and counselling, feels hopeful about her future.

“Felicia was grateful she didn’t have to be separated from her school-age child while in treatment,” says Genevieve McMath, the Program’s Team Leader. According to McMath, outpatient delivery works because patients can integrate reality and relationships of everyday life into their new lifestyle of abstinence and recovery. “If something happens during the week to trigger a desire to ‘use’,” she says, they come and talk to us in the next day or two, explore the problem, and look at strategies to implement the next time a similar situation arises.”

Since opening in 1968, NYGH has maintained a substance abuse program which has evolved and grown to meet the needs of patients. Today, as many as 125 people each week receive treatment through the Addiction Program, which provides outpatient treatment for people facing problems with alcohol, street or prescription drugs, as well as addictive behaviours such as gambling, compulsive overeating, shopping and internet/video game addiction.

Addiction Medicine specialist Dr. Bonnie Madonik is Medical Director of the Addiction Program. Other team members include the program manager, a nurse with expertise in addiction, a psychologist, an occupational therapist, two social workers, and consultant psychiatrists.

The program’s various components include assessments, consultation and referrals; daytime, three times weekly group sessions in an outpatient Harm Reduction program; a 10-week half-day Abstinence-Based outpatient program; and an Aftercare program for people who have completed the Abstinence-Based program. The team also offers support for family members and significant others, is open to people with mental health as well as addiction problems, and accepts self-referrals.

While individual recovery goals may range from total abstinence to harm reduction, addiction is a chronic brain disease, says McMath, and most people need total abstinence to achieve health – whether physical, emotional, mental or spiritual. “That said, we want to meet people ‘where they are’,” she adds, acknowledging that a very small percentage of people, who come to addiction treatment, may be capable of keeping to the low risk drinking guidelines, or to have the odd joint per year.

Rubin*, a 45-year old patient, came to the Addiction Program because of problems with alcohol and cocaine. “My wife said my use has to stop or she’s taking the kids and leaving.” Rubin thought he could quit on his own and drink the occasional beer, but after unsuccessfully trying for a couple of weeks, he agreed to attend the program for four weeks to satisfy his wife. With encouragement from staff and co-patients, he achieved complete abstinence from all mood-altering substances and behaviours for 10 consecutive weeks. He felt better physically and was enjoying improved family relationships. Proud for the first time in years, Rubin agreed to continue his abstinence and attend Aftercare.

Like Felicia, outpatient treatment was key for Rubin, who continued to operate his business and support his family while in the Program. “When patients are cocooned in residential treatment settings,” says McMath, “they live and breathe recovery but don’t have opportunities to practice what they’re learning.” During treatment, Rubin wasn’t completely able to avoid people with whom he formerly drank and used cocaine. But each time he encountered a trigger, whether a person, place or stressor, “he returned to the program to strategize about what he could do to prevent relapse.”

McMath admits that it can take months or years to achieve abstinence, noting that some patients have been connected to the program, in one way or another, for over 10 years. “Relapse is about learning. It may take a long time to sustain recovery. We encourage patients to come back, no matter how many times. The next try may be the one that works.”

* not his/her real name

*with notes from Genevieve McMath, Dr. Bonnie Madonik