The first step is always hard, but what about all of the steps afterward? Once someone has begun opioid or alcohol detox treatment and completed a medically assisted detoxification, where do they go from there? Clare Waismann, RAS/SUDCC, and Dwight Hurst, CMHC, discuss issues with providing general recommendations for aftercare and how important it is to individualize each treatment.
Episode 5: Why Is Individualized Aftercare Important for Opioid or Alcohol Detoxification Treatment?
Dwight Hurst, CMHC: They say a journey of a thousand miles starts with a single step. The same thing is true about jumping in the water. If you’re using a diving board, it just takes that one step and, well, you’re going to hit the water. The question is, then what do you do when you hit the water, or what do you do if you’re walking that thousand-mile journey and you discover you’re on mile eight? It’s a little intimidating to think about all those steps that come afterward.
Dwight Hurst, CMHC: There’s excitement at starting something and a sense of accomplishment and a plan, but sometimes it’s not so clear what is supposed to happen next. This is Dwight Hurst here, Waismann Method® podcast. And Clare Waismann and I will be addressing that exact topic today when it comes to sobriety and treatment from opioid dependence. You can apply this to all kinds of addictive and compulsive things, though starting in and of itself is a huge task. We were able to talk about that a couple of weeks ago when we talked about how complicated it is medically and emotionally, and psychologically, even to take the first steps of getting sober and just stopping, using, and getting into treatment. This is one of the most fun and passionate discussions that we’ve had on the podcast so far. Oh, I was really grateful for all those of you who reached out over social media and shared some questions. We had some of those come up in our discussion, and I’ve struggled to make sure that I wrote my notes down correctly and got your names right. Get your names associated with the correct question. Unfortunately, we weren’t able to address every single question in this episode. But that’s great because many of your questions actually fit some of the topics that are coming up that we’re going to be discussing some of the definitions of treatment and what we’re looking for, particularly when you’re going through the detoxification part of treatment.
Dwight Hurst, CMHC: But then, as you’ve already found out, we talk a lot about wellness and counseling and a real well-rounded approach. And that’s what we’re going to get into today.
Clare Waismann, CATC: So what are we talking about today?
Dwight Hurst, CMHC: Talking about a post-game. Post-care after coming out of detox, right?
Clare Waismann, CATC: Of course. Of course. Let’s do it.
Dwight Hurst, CMHC: So, you know, we talked before about when somebody walks into the clinic that goes through this detox process. We talked to the doc and all of that. Now, let’s say somebody is through that process. They’ve done the medical detox. Where do they walk next?
Clare Waismann, CATC: I think the best solutions are found based on the best assessment. So it is very, very difficult to direct somebody in a sober path or a recovery path. Whatever you like to call it, for me, is more like a “healthy path.” If you have not had a thorough assessment of patient’s health issues, including physical and emotional issues, there are patients that, after the medically assisted detox, they need to follow with your pain doctors because they do have chronic pain. More often than not, some patients have misdiagnosed emotional issues or undiagnosed emotional issues like anxiety, depression, or even other mental health issues that are more severe.
Dwight Hurst, CMHC: And a lot of those are after getting free of a substance. Many of those do rise to the surface and are a more accurate, more accurate diagnosis course.
Clare Waismann, CATC: Correct.
Clare Waismann, CATC: So it’s tough to make an accurate, accurate diagnosis when you are using other devices because emotionally you’re not present enough to have that accuracy you need to, you know, decide what path to go.
Dwight Hurst, CMHC: When I’ve known people on opiates or methamphetamines to have seen where they’ll get a diagnosis of personality disorder or bipolar disorder. Sometimes, those are accurate, and sometimes you find out when they are chemically stabilized, it’s not accurate at all, that some of the mood swings and the behaviors are exacerbated or triggered by the drug use.
Clare Waismann, CATC: Correct. Correct. But I think it’s not just substance abuse. This is with any physiological condition. You know, if I use a substance that, you know, would raise my heart-rate is and go to a cardiologist, if he does an EKG, he’s probably gonna think I’m having a heart attack. The same with blood pressure, if I jog, you know, and get very anxious as I’m driving to the doctor and checks my blood pressure, it will be high up there.
Clare Waismann, CATC: So you can’t make a proper emotional diagnosis on a patient emotionally influenced by the substance you are using.
Dwight Hurst, CMHC: It’s interesting because as I put out the questions online, a lot of the questions people had revolved around using counseling and other diagnosis and things in the treatment. And I had to chuckle when I read that because I knew why they were asking it because of some of the reputations that detox facilities have. But I also chuckle because I knew what you would say. I know that you’re very much plugged into that, getting accurate psychological evaluations and heavily recommending, if not even enrolling into counseling as part of their health management.
Clare Waismann, CATC: Of course, of course, especially if you don’t come from the point that, you know, substance abuse is not the issue. But the consequence of, you know, mostly emotional conditions that were not treated. So that is so incredibly important, like when patients say, you know, well, what is your success rate in a year? I just got that question like an hour ago, saying we allow you to be emotionally present to get the treatment you needed in the first place before you start using drugs.
Dwight Hurst, CMHC: And that’s it. They’re thinking because they’re a couple of people. I know that Erica was one of them who made this question.
Dwight Hurst, CMHC: There was someone named Lewis who also brought this up, which the question comes up of the long-term results? And then I think someone else nailed this question. I don’t have their name right here, which I think is the first thing to answer: what is the definition of success when it comes to detox? Because I think detox is a step in a greater treatment process and things we are looking to do. And so you have to define that, like, what are we looking for? If someone says the long term effects of detox, I guess what they’re saying is, does it help people as they go through health management and sobriety? Does it give them a leg up that is significant? And how do we know that I guess, is what they’re really asking?
Clare Waismann, CATC: Well, again, detox is a necessary part of anybody’s treatment of substance abuse to get healthy. Period.
Clare Waismann, CATC: So medical detox. I think it should be available for everybody’s period. Let me give you, Dwight, an example. So this week, we received this patient, around 40 years of age. Using opioids with zero symptoms. He had pneumonia in both lungs. And you know – severe pneumonia in both lungs. If this is a patient that went to detox in rehab, he would not have made it. His oxygen level was already low. So he’s been in the hospital with us for five days. Not just getting detoxed slowly but taking care of his pneumonia that he wasn’t even aware of, it was tested, obviously, for COVID. And, thank God, he is negative for COVID.
So he needed to say is stabilized first, right? Pneumonia would have to stabilize before you could safely do a detox.
Clare Waismann, CATC: Correct. But my point here is opiates. No. Several different conditions, physical and emotional conditions. So unless you treat and assess those conditions, the physical condition we can treat in the hospital. Thank God we work in a full service accredited hospital where we have several specialists. So, you know, pulmonologists come. They’re able to treat his medical issues over there. Well, Dr. Lowenstein can work with his, you know, opioid dependence. But mental health issues, sadly enough, is not something that we can treat. And three days a week, 30 days, 60 days, or 90 days.
Dwight Hurst, CMHC: Well, it depends what you’re looking for. Well, one of the things I run into is the same thing with inpatient psychiatric treatment. Often is you go into that, and there’s a danger that if people don’t know what they’re shooting for, they might come out thinking that nothing’s been done. When in reality, it’s simply making sure you don’t kill yourself. Stabilize. Get some med recommendations and make sure you have a therapy plan. If you get the, you go. If you get those things from inpatient hospitalization, that’s that’s a goal met. And so there has to be more if they’re.
Clare Waismann, CATC: The issue is not solved. So you have your right foot forward to start reaching a healthy state, right? So you’ve got your meds. Now you’re going to start therapy and, you know, finding ways to cope with issues. Hopefully, the meds will stabilize your mood and make you able to wake up in the morning to fight for your health. So it’s a combination. I mean, we are as human beings; we are complex. We have a brain, and we have a heart. We have a lung. There are so many organs tried to work at the same time. You can’t expect to go to one specialist and have everything fixed. And I think that’s what people expect of rehab.
Dwight Hurst, CMHC: And I think it’s good to be aware that it sounds like one of the mistakes people can make is going through a detox procedure and thinking that they have arrived at some kind of a stable location. That isn’t just it’s a stepping stone.
Dwight Hurst, CMHC: When we talked to Dr. Lowenstein, one of the things I found very interesting was how nuanced, even just the safe medical detox procedure can be. And so the first step is complicated. And then we’re talking about how we’ve gotten through that. We’re going to these next steps. And it sounds like you’re saying one of the big risks is that we don’t think about the next steps. If someone just goes through that and there’s a lot of programs out there that just offer, you know, some clinics or they just do a detox and then it’s like, OK, you’ve got it out of your system.
Clare Waismann, CATC: I don’t think I don’t. I don’t think it’s some; I think it is most. I think most people’s programs out there promise, especially family, loved ones. “Oh, yes. You will come here, and we’re going to work with him and his emotional issues, attitude, and honesty with his going balance. Yes. We have a psychiatrist, and we have a doctor. We have meetings. And they promised the family, send your kid here for 30 days, 60 days, and we’ll send you a brand new perfect human being. It’s a lose-lose situation for everybody involved.
Dwight Hurst, CMHC: Yeah, I mean, I even think I chuckled just because of seeing it so much. But it really is a sad thing to invest in because I think there is a real danger there. And when someone has detoxed, they are in more danger of overdose, too, aren’t they? I mean, right away, their system is what they used to use. Yes.
Clare Waismann, CATC: Yes, I agree with you. But this is, you know, actually something that is constantly brought up, medically assisted detox. But afterward, they are at a bigger risk of overdosing, of course, because they’ve been detoxed. So not to risk them overdosing.
Clare Waismann, CATC: Should we just not stop, stop and let them stay on opioids forever?
Clare Waismann, CATC: Of course, they can relapse! They never got off opioids.
Dwight Hurst, CMHC: Yeah, it brings up an interesting question that some people put out there. We had a listener, Sarah, and also Lewis. We wrote two people who put forth this question about the attitude or feelings you have about drugs intended to cut down on cravings. Because I know Dr. Lowenstein said that he is in favor of some of those types of things. But then I think of, as you put it, Suboxone and some of those drugs that are actually there to treat withdrawal as an alternative to detox. So I guess it depends on what kind of meds we’re talking about.
Clare Waismann, CATC: Again, they’re not there to treat withdrawal. They are substitute drugs where if you take them, you don’t withdraw because you’re still taking the drug. Again, the same idea as you know is if you came to me because you’re drinking a liter of whiskey today. So I’m going to give you vodka instead. Of course, you’re not going to withdraw, or you’re still taking opioids. Oh, you’re still drinking alcohol. So, yes, you’re off your whiskey, but you’re still on alcohol. Now, what is my thoughts about it is there is no one solution for everybody. There are people that for one reason or another, and those are very few. They are not ready to come off opioids. Their reality, you know, is not one that they can’t be without a numbing device. Maybe they could have all the emotional support and social support, and financial support that one needs. But that’s, sadly enough, is not the case for all society.
Dwight Hurst, CMHC: From our conversations, one thing I really picked up is this individualization that comes up in every one of our topics, really. As you say, there are four overall feeling and the feeling that that’s definitely fewer patients who will benefit from that, as you put it. But also, not having a closed mind is also very important, it seems like.
Clare Waismann, CATC: I have a “zero” closed mind. I am, you know, I believe that whatever gives you the best quality of life is the path you should take rather than the path that you’re taking this year. Maybe it’s going to be a different one next year, but I think options should be available. Doctor supervision should not be a rarity. It should be accessible to anybody that needs it. Period.
Dwight Hurst, CMHC: There was one comment that someone made about that. Of how often price can be something that makes it very difficult. There was one question I really felt for the asking her post said, “Wow, you know, if, if I’m not wealthy enough, how do I help my family? I would just really…
Clare Waismann, CATC: I hear that we have tried to bring the costs as low as possible without compromising the quality of the services we offer. But with that said, there is no insurance coverage.
Clare Waismann, CATC: I’m trying to get the insurance coverage right now for the recovery center so we can lower a bit of the cost. But again, insurance is still covering drug treatment as behavioral health.
Dwight Hurst, CMHC: It’s very, very complicated with that kind of stuff. It goes back to the whole medical system. I have been amazed at how many treatments are getting some really good research around them and are being turned down by insurance companies. Yeah, a lot of times. And sometimes it just has to do with whether or not it’s back or whatever. So that’s an ongoing battle that you mentioned, is trying to get detoxification and insurance working together.
Clare Waismann, CATC: You know, it’s it again, you’ll go back to the drug treatment group. Drug treatments are still being controlled by counselors, social workers, and I would add the legal system.
Clare Waismann, CATC: Well, a lot of the legal system and not by medical science. So, Dwight, not well, you ask about the drugs to control cravings. We use Naltrexone and Vivitrol. OK. Those are antagonists that have zero opioids in it. They are not opiates. They do not cause withdrawal. They do not cause dependence—any of the above. The only thing is those medications can only be taken when you’re opioids free. So you have to have you have to be completely detoxed to use those medications. And they are wonderful medications to control physical craving. OK, we’ve been using this for over twenty years. And the biggest issue that we had initially was one of the reasons we created Domus. Nobody would allow a patient to take Naltrexone in a treatment center. It would not be considered in recovery. And we used to fight them and say, please, our patient got to detox. He’s going to your treatment center. Please allow him to have Naltrexone. It’s a non-narcotic non-mood-alternating; it is not addictive. “No, no, no. No drugs.”
Clare Waismann, CATC: The same thing with anti-depressants. No, they cannot take any mood alternating medication.
Dwight Hurst, CMHC: That was something that blew me away when I first learned that the antidepressants were considered to be altering. In a sense that there is a shame and discouragement around that, which is treatment, actually.
Clare Waismann, CATC: So this is what I’m saying to you. So we’ve been fighting for, you know, near a quarter of a century, for a medical solution for opioid dependence.
Clare Waismann, CATC: We have been criticized because. It’s not the medical community that is researching us and deciding if this is good or not. Is the recovery community, people that do not understand the physiology of dependence.
Dwight Hurst, CMHC: Yeah. We had a respondent to one of the questions which works in symbolism rehab and is witness detox processes. And that was one of her first questions was what kind of qualifications?
Dwight Hurst, CMHC: And you’re talking about like medically trained, obviously, doctors and nurses. And unfortunately, that’s not always the case. That you find it in most places is not.
Clare Waismann, CATC: People have seizures in rehab centers. You know, they die from dehydration, from vomiting and diarrhea. As I told you, this 40-year-old that we treated this week would not have made it for a week detoxing from opioids.
Dwight Hurst, CMHC: Wow. Wow. And it’s scary to think about it like that.
Clare Waismann, CATC: Exactly. No, we see patients with severe issues of hypertension.
Clare Waismann, CATC: They know 56-year-old man, that they got two different blood pressure medications once we removed the opioid, sometimes it’s hard to control their blood pressure because they know it. So now you remove the opioids, and they have to readjust. Who is checking all that in a rehab?
Dwight Hurst, CMHC: One of the things that it sounds to me that is very important is not only there’s the counseling side for psychological health. And then there’s also getting whatever check ends, whether you’re in a wraparound medical program like yours or, well, even even if the only resources they’re their doctor, getting some general physiological checkups would be very important after detox. It sounds like.
Clare Waismann, CATC: It sounds like what I’m trying to say is detoxification, OK, is a physiological event that needs to be managed by physicians. Period. Whatever emotional care, recovery, care, support. Peer support. You decide to follow after. It is a different story altogether. Some patients can do well by doing individualized psychotherapy and maybe a psychiatrist. Some people. Their environment is so tainted that they do need to be, you know, in a treatment center where they know they are in a safer environment. That wouldn’t even say safe. Let’s say safer. But again. Physical issues and emotional issues. They are different issues, but they’re always connected because we are ONE; our heads are stuck to our body. But you can not promise somebody that you’re going to be with me 30 days, 60 days or whatever, six months. And I’m going to fix all of your life.
Dwight Hurst, CMHC: Yeah. No, know, that’s a big, big part because it’s ongoing health management. I really like how you refer to that oftentimes as health management health building rather than it is causing only on the sobriety.
Dwight Hurst, CMHC: I think that. Correct. Abstaining from alcohol or opiates or many people who have not fought with addiction or struggle with it on their own. And unfortunately, many who do struggle with it are under that impression that if I can get the substance out of my body and don’t ingest it anymore, that’s it. Everything should be great. And that’s only a small part of really living a healthy life.
Dwight Hurst, CMHC: I wanted to, one of the issues that were brought up by it was the same responded to our questions which works in a related industry? Her name is Carly. She mentioned having worked in some facilities where they would see actual involuntary admissions that would come in. And the question of what, you know, how does it waking up after going through an involuntary detox program affects kind of the outcome of how successful someone’s life would be. You know, you’re Waismann Method always works as voluntary admissions, I believe.
Clare Waismann, CATC: Correct. So we won’t take any patients mandated by courts, or that really do not want to be here because we are not a locked facility, not a psychiatric facility. And it’s usually a lose-lose situation, you know. So we don’t work with and with involuntary patients. Although sometimes they know their bottom has gone to such a low place, they need to almost be resuscitated where they are.
Dwight Hurst, CMHC: It is an interesting process, having seen some people go through that. And I’ll say I’ve seen some people who have done well going through that process. But in general, there’s a lot of disadvantages to not being at that point, two, involuntarily being pushed into treatment.
Clare Waismann, CATC: Correct. And again, it is what treatment is, is what treatment they receive. You know, I have seen patients that just gave up because they believe they have failed so many times that they are not willing to go through all the emotional and physical suffering to fail again, where most of the time they didn’t fail – the treatment center failed them because they did not receive. Treatment is based on their needs; they receive treatment based on a preset protocol.
Dwight Hurst, CMHC: Yeah. Meeting the program’s needs instead of the program trying to meet their needs.
Clare Waismann, CATC: Correct. That’s the difference between treating the patient and treating addiction. When you focus on addiction, often, the patient becomes invisible. So when he leaves over there, he leaves actually more depressed and more hopeless than he did when he came in. Supposedly, he got the treatment that everybody said is what he needed and still leaves there to use drugs.
Clare Waismann, CATC: And the reason most of the time he wanted to use drugs is because the emotional health of that patient was not properly assessed. And he did not receive the emotional help he needed.
Dwight Hurst, CMHC: And then the proper aftercare plan is important, too. And you can’t do that without that assessment. I’m realizing how…
Clare Waismann, CATC: Correct. So when they say to me, “Well, but they were at Domus Retreat for such a small amount of time.” Yes, they were at Domus for a very, very small amount of time because we are not a long term rehab. But with that said, I think Dwight. And I can’t say for all patients, but I can say for most patients that we see there once we medically detox them, OK, where they don’t have to hold the toilet or know for days on end. So once they’re medically detoxed, and they come into the hospital as they would come in for any other medical issue. They are received as a patient, not as a drug addict. They are physically, physically well taken care of. They are respected as individuals. And then they go to Domus. What do I try to do at Domus. Domus is a six-thousand square foot home with six suits. I try to have everyday baking goods, so the smells are good. I try to have at home lavender smells.
Clare Waismann, CATC: I try to have them in the sun, try to show them that every hour they will feel better regardless of where they started from. By the time they leave, they know they can feel good without drugs, even if they relapse. Even if, you know, things don’t work out when they get home, you give them hope.
Dwight Hurst, CMHC: That’s a powerful message of hope to really look at. What are some of the things that you can enjoy and feel good in a life that is without drugs?
Clare Waismann, CATC: Let’s say that they start craving again after a month or two months. They feel they’re going to relapse. They can call, and they can come back for three days, five days, seven days. They don’t need to relapse to come back.
Clare Waismann, CATC: But sometimes you just need a little more support when you get home or after a month. Also, you found out the things that trigger you. I doubt that every time I go to visit my parents, I get extremely anxious. By the time I leave there, again, I think of using drugs. So they come to Domus for a week. Then see the therapist, David Livingston, that we spoke to on one. No groups. And they talk about that. You know, “What happens when you get your parents? What are the things you’re concerned about again, trying to assess “What are the triggers?” and then going from there.
Dwight Hurst, CMHC: You guys don’t do the group therapy.
Clare Waismann, CATC: We don’t, we don’t. Yes and no. So they see David Livingston for therapy only. First, because patients are at very different places when they come to Domus Retreat. You have patients that got treated on Monday, have patients that got through it on Friday. So physically, they feel very differently. And we have a concise window with them. And we really want to get to know them, you know, as much as we can. So David can work whatever path of emotional health, you know.
Dwight Hurst, CMHC: So it’s an issue of budgeting, budgeting for time, and making it practically effective for them.
Clare Waismann, CATC: It is not just time; once you remove all the opioids or alcohol from somebody, they are raw. You know, there there’s no blanket between them and reality. It’s hard enough for them to deal with their own issues if they have to hear everybody’s war stories and issues. It can become overwhelming.
Dwight Hurst, CMHC: That is one thing that can happen in a group is it can deteriorate into different ways. What I’m saying to you, a different experience or story.
Clare Waismann, CATC: Exactly. And because we have very, very few patients at one time, we try to individualize their treatment as much as possible. Like a patient with severe sleeping issues, if they sleep until 10 in the morning, God bless them. Nobody is going to wake them up. I’m saying. But if a patient and a young person is sleeping all day, I want them to be woken up. I want them to go for a walk. Play some basketball. Do something. So every patient is different. Again, we treat patients 22 years old and a patient 82 years old.
Dwight Hurst, CMHC: Yeah, when they leave that that program, the Domus program. What kind of recommendations? I’m sure that is very individualized. But in general, do they go out with recommendations as far as you are to make sure that you’re talking to your doctor? You ought to have some kind of therapy…
Clare Waismann, CATC: Correct. So if we in the hospital find something, OK, their sugar is too high. You know, we saw something in the EKG like this patient this week. You know, he will have to follow with his physician because, you know, there are pulmonary issues. Then Dr. Lowenstein will speak to them to speak to their doctors if they need or want.
Clare Waismann, CATC: Dr. Lowenstein can speak to their doctors and explain more of what we found. With emotionally, David Livingston, and then we’ll discuss what’s the best foot forward, not just what David believes, but something that will fit with their life. And they accept. I mean, sometimes you can be blue in the face to say what you should do, and they won’t do it.
Dwight Hurst, CMHC: Well, and I like that because you’re getting their buy-in also strikes me as a way of showing respect to the person to manage their own health.
Clare Waismann, CATC: Now, David will speak to them for the first two, three weeks when they get home just to make sure that they are, you know, establishing well and they’re following through whatever they need to keep. And that’s what we talked about the other day. We all have to work for our health daily, regardless if you had a substance abuse issue, sugar issue, or obesity issues, whatever it is, we all need to fight for our health. And that’s that’s the goal. So there is no preset protocol for detox. There is no preset protocol for emotional care.
Dwight Hurst, CMHC: Well, I can’t think of anything we could possibly add to that. So we’re gonna go ahead and call it there.
Dwight Hurst, CMHC: Thanks so much to all of you who submitted questions. If you have questions that you’d like to include, we would love to have them. The whole point of this whole podcast really is to increase information, education and help people to be able to make good decisions about how to deal with opiate dependence and anything that you may be dealing with.
Dwight Hurst, CMHC: And those questions are very important. You can hit us up on Twitter @opiates, or you can e-mail us at [email protected] As always, if you’d like to learn more about Waismann Method® and approach to detox and treatment, you can go to the web site, opiate.com as simple as that. This podcast is a production of the Waismann Method Treatment Center. Our music is the song Medical by Clean Mind Sounds. And for Clare Waismann and myself – thanks so much for listening! We’ll talk to you again soon.
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