The First 90 Days Sober
What to expect on the initial journey to getting clean
a story from Kristie Elias, LCSW, Vice President of Behavioral Heath at Catholic Family Center, as told to D-D Flannery
Alcohol and substance use, overdoses and the demand for addiction treatment continue to rise. The stress, financial hardships and isolation of the COVID-19 pandemic has led to heavier drinking habits and increased drug use. This is presenting enormous challenges for individuals and their families, while robbing many of treatment options and support systems.
The Life Changing Event
Game changing events such as a sudden unfortunate circumstance, trauma, significant loss and mental illness all can lead to a dependency and addiction on alcohol and substances. Ultimately, the desire and commitment to make necessary lifestyle changes to overcome addiction has to be stronger than the desire to keep up with the habit of using, for addiction recovery to even be an option.
“Addiction represents some of the most devastating losses, shame and regrets,” said Kristie Elias, LCSW, Vice President of Behavioral Heath at Catholic Family Center. “It can lead to voluntary or involuntary institutionalization (such as admittance to emergency department, hospital or rehab facility), incarceration or death, if untreated.”
Martina began using drugs when she was prescribed medications to treat severe back pain. Waking up in the morning and swallowing a handful of pills before getting her three children off to school became her normal routine and only coping mechanism. The morning of April 10th was a day like any other. It wasn’t the first or the second time she or her husband overdosed. The ambulance was called followed by calls to the police and Child Protective Services. Her children were removed from their home and placed into foster care.
The intense sadness and loneliness without her children were not enough to make Martina stop. It fueled her desire her to use more, both day and night. She eventually turned to opioids. The obsession and compulsion to use was so overpowering. She just couldn’t find the will within herself to stop using in order to get her children back and stop hurting everyone who loves her.
Life continued to spiral out of control for Martina. Eventually the court of law caught up with her again and she was facing a felony charge and prison sentence when authorities seized contraband from her home. Shortly after, her husband lost his battle to drug addiction. The impact of these incredibly painful and life changing experiences finally caught up with Martina. She had to do what it took to be there for her children in a real and meaningful way. Time was running out for her to regain parental rights.
The judge gave Martina a ultimatum — to either serve the prison sentence or seek treatment at Hannick Hall, an intensive residential drug treatment program for women with small children. Martina eventually graduated from Hannick Hall, has been reunited with her children, regained full custody of them, lives a sober life free of alcohol and drugs and is employed fulltime.
Detox: What happens during an alcohol or drug detox?
The goal is to address and manage the physical withdrawals immediately and safely and encourage follow up treatment. During the first seven days, the withdrawals are the most pronounced and dangerous, if not managed properly.
“It is critical to seek advice from a medical professional to determine whether or not detox should be conducted under medical supervision or at home,” said Elias. “Detoxing from alcohol and benzodiazepines can lead to death. Detox from other drugs can be uncomfortable, but not deadly, and may not need to be monitored medically.”
Medications are available to ease the physical withdrawals, lesson the tremors, prevent the highs and cravings, or will make you sick if you consume alcohol. Family members and love ones can help by advocating for medication-assisted treatment (MAT). MAT is not a “substitute with another substance” approach to addiction treatment. It has been proven to be extremely successful in managing addictions long-term.
Substance use evaluations can be conducted by finding an open access resources that offer walk-in appointments or through a referral to an addiction treatment provider. The evaluation is an information intake process that is necessary to assess the extent and level of addition, determine an individualized treatment plan and provide guidance on how to enroll into a program and pay for it. Hospital emergency departments can make referrals.
The evaluation process is broken down into two steps: screening and assessment. Common screening and assessment questions include the following:
What got you here?
Describe your current family situation.
Are you facing any legal troubles / offenses?
What caused you to use?
What are you using?
How much are you using and for how long?
Describe your current substance use including any prescription, street drugs and alcohol.
How do you feel emotionally, mentally?
Are you experiencing any delusions?
Do you want to cause any harm to yourself or others?
Have you recently experienced any significant loss?
“Telling secrets to a stranger is scary and shameful. However, honesty is key to obtain the best individualize treatment recommendation,” added Elias.
The window of opportunity, from the time an individual is really ready to take the step towards seeking treatment is typically very short and needs to be capitalized upon immediately. Families and friends, however, should be aware that there is generally a lag time between the evaluation and actually being accepted into a treatment program. There is a high demand for addiction treatment. With a limited amount of treatment resources available at a given time, often family members find themselves completely unprepared on how to bridge the gap from detox to treatment. Sometimes referrals out of the local area are made, if there is greater availability elsewhere.
Going through treatment is a lot of work muscling through both the physical and metal compulsion to use after withdrawing safely. Patients struggle the most trying to manage recovery in the beginning stages when they are agitated from not having a substance to help cope with (or mask) the feelings of shame, guilt, and vulnerable.
After the withdrawal process, other factors of the addiction are explored, specifically what are the triggers, how they incite using, and a game plan to manage them. In addition to stressors and life changing events, triggers can also be sounds, smells, anniversary’s, events, holidays, people, etc. Mental health care is often a part of the recommended treatment plan.
After 30 days of sobriety, cognitive changes begin to occur as the brain begins to repair pathways that were impaired with chronic and acute substance use. The brain fog begins to lift, the ability to rationalize comes back and memory improves. With alcohol, sometime there is permanent brain damage, depending on how much was consumed, for how long and how detox process went.
Whether the recommendation is for a residential in-patient or out-patient treatment, being connecting with people and family members who are also challenged with addiction and want to change behaviors regarding mental and physical addictions is crucial to recovery. Peer connections provide the opportunity to explore, encourage and validate feelings. Addiction evaluators can make warm connections to peers in recovery and local recovery programs.
Programs are opening up more and more since the Covid-19 pandemic hit. Today, there are hybrid models with both virtual telehealth visits and in-person sessions. Urine screenings are more readily available, if people are not doing face-to-face meetings. Group peer sessions have resumed.
The Linear Process
Addiction recovery is a linear process and relapse is a part of this process. It’s important to learn what led to the relapse and any triggers that you may not have been aware of leading up to it. The focus should be on getting back into recovery and less on the disappointment of the relapse.
Behavioral indicators can be signs of a relapse such as avoiding to answer questions around the last use and how are you avoiding triggers, becoming more argumentative or passive than the last encounter, fidgety, speech is faster or slurred and falling asleep at inappropriate times or places. A family member or friend who is knowledgeable about the situation and is supportive makes a great collateral contact, especially if relapse is suspected.
Group process is really important with any addiction recovery treatment plan. Group members will call out any behaviors that seem questionable or risky. This is often more effective than the medical professional point them out.
Reconnecting with peers pursuing recovery from drug and alcohol addiction, and regularly attending meetings and programs that treat substance use disorders such as Narcotics Anonymous, Alcoholics Anonymous, and Restart Your Life is imperative to prevent and recover from relapsing. Getting involved in other nontraditional recovery oriented programs, whether it be finding and maintaining a job or attending an exercise class or an outdoor excursion through outlets like ROCovery Fitness, provide sober experiences and connections to other individuals in recovery.
Sometimes individuals need to be referred outside of the area for additional treatment. Changing the geographical location can be super helpful if you’re tempted to leave the program early against clinical advice to do. Or sometimes, there’s the need for a different curriculum in order for the message to hit home.
The Path to Recovery
Addiction is referred to as “a family disease” because it affects the entire family unit and is not limited to the individual suffering from substance use disorder. For this reason, recovery needs to focus on rebuilding relationships, developing conflict management skills and working through the guilt and shame of what occurred while using.
Everyone follows a different path. There is no one path to recovery. Fortunately, Rochester, New York is resource rich in alcohol and drug treatment and recovery options and with few waiting lists. Learn more Catholic Family Center’s out-patient and residential inpatient services for people — including mothers — struggling to recover from drug and alcohol addictions. Find your path, because you are worth it.
Drinking, coping, and COVID-19- https://www.apa.org/monitor/2021/01/alcohol-covid
Substance use during the pandemic- https://www.apa.org/monitor/2021/03/substance-use-pandemic
Cathplic Charities outpatient clinic - Our Outpatient Services | Family and Community Services (fcscharities.org)
Catholic Charities residential Restart program - Residential Residences | Family and Community Services (fcscharities.org)
Restart Your Life- https://www.restartmylifetoday.org
ROCovery Fitness https://www.rocoveryfitness.org/calendar-of-events.html