Coming out on the other side of addiction is something of which one can feel very proud, says Shalu Gugnani, M.D., Medical Director of Addiction Services at Northwest Community Healthcare (NCH) Behavioral Health in Arlington Heights, when reflecting on her patient “Albert” (not his actual name), who successfully conquered alcohol addiction.
“Beyond residential treatment, Albert now makes the decision to be well each and every day,” Dr. Gugnani says.
For a long time, through the example of his peers, Albert thought he was using substances appropriately. This was a normalized lifestyle for him, until he started experiencing consequences that affected him medically, financially and negatively impacted his family.
On his own, Albert navigated the difficulties of his disease for years. It was only after a second alcohol withdrawal seizure that he saw the fear in his mother’s eyes and decided to seek help.
At the start
“When Albert came in, he was entirely motivated for treatment. He was dealing with a mood disorder and a high anxiety level. He was down on himself due to shame and guilt over his continued use, and how his addiction was affecting the people he loved,” said Dr. Gugnani. “We took all of that apart, piece by piece.”
At the start, Dr. Gugnani treated Albert’s alcohol use disorder with anti-craving medications. Albert’s brain chemistry had been dependent on high amounts of substances for so long. Dr. Gugnani treated the symptoms of depression and anxiety as primary disorders in anticipation of how his brain would respond when the substances were taken away.
The NCH Behavioral Health Adult Residential Addictions Center team reassured Albert that once his brain started healing, his neurochemistry would start restoring itself to baseline, and he would start feeling better.
Dr. Gugnani explained that Albert applied himself to a comprehensive recovery. “He understood that his substance use disorder didn’t develop overnight and it wasn’t going to be fixed overnight,” she said.
Assisted by medication management, Albert immersed himself in the various therapies offered at NCH Behavioral Health and regularly practiced coping skills he learned in the program.
Repetition, structure and redirection
According to Dr. Gugnani, aspects of the program include repetition, structure, and redirection. The goal of “redirection” is to help patients reframe negative behaviors regarding recovery, lifestyle, or family interactions.
When people are using a substance, the substance becomes the center of how they function: How are they going to get the substance? When are they going to use the substance? How long will it take for them to recover? – Healthy daily routines fall to the wayside.
NCH Behavioral Health Adult Residential Addictions Center provides a highly structured program for patients to be busy the entire day. Before treatment, Albert was somewhat functional in his use disorder, maintaining two jobs for most of his life. In treatment, he continued to work at a new job as he battled substance use.
“Our program is repetitive because when a patient’s brain is coming off of a high substance use, long-term, they forget things,” says Dr. Gugnani. “They feel like they’re in the clouds sometimes and often experience mood swings.”
Patients also need repetition because of an occurrence known as Post-Acute Withdrawal Symptoms (PAWS). “It is not uncommon for a patient to say, ‘Oh, I’m having a PAWS moment,” says Dr. Gugnani. These moments occur after the acute withdrawal of a substance.
“During a PAWS moment a patient may ask: Why is my memory so bad? Why am I so irritable for no reason? Why was I happy two minutes ago and now I’m crying? This is actually the brain trying to restore itself to its baseline neurochemistry,” says Dr. Gugnani.
It is important that patients learn to recognize an intermittent PAWS moment, which can occur up to two years after the last use of a mood altering substance. Dr. Gugnani adds, “The more knowledge patients have about their symptoms, the less control the symptoms have over them.”
Repetition and structure also supports patients struggling with memory. Recovering patients may say, “I don’t know what I am supposed to do next.” Repetition and structure help shape healthier behavior patterns that patients may use for the rest of their lives.
A way for family to heal
Substance use impacts both the patient and their family. Often, family dynamics become dysfunctional. The NCH Behavioral Health Adult Residential Addictions Center is a place where both patients and families can heal.
“Albert’s story was profound in that he had lost a brother to substance use, and now his family was reliving this trauma in nearly losing Albert to his alcohol use disorder,” says Dr. Gugnani. “Albert’s original motivation to seek treatment was that he couldn’t continue to watch what he was doing to his mother. Later, in treatment, he realized that he couldn’t keep doing this to himself.”
Often, a family doesn’t know how to communicate or help a family member with a substance use disorder and it manifests in unhealthy ways. “Some might think to monitor an individual and keep them on lock down. Others may think to let them do what they want, never voicing their concern,” says Dr. Gugnani. There is often a communication breakdown, and resentments develop.
The NCH Behavioral Health Adult Residential Additions Center offers family programs. Dr. Gugnani explains that Albert’s mother attended several family sessions and was able to get past the hurt, anger, and resentment. Through this therapeutic process, Albert and his mother were able to communicate more effectively and she became an essential support person in his recovery.
“Through the program, Albert’s mother became better educated about her son’s disease and started attending Al-Anon meetings herself,” Dr. Gugnani says.
A model for success
One of the American Society of Addiction Medicine (ASAM) criteria for admission into our immersive program is a patient’s level of motivation. A patient is more likely to do well if they are motivated to get better—that’s the turning point, according to Dr. Gugnani.
The NCH Behavioral Health Adult Residential Addictions Center works on the biopsychosocial model of medication management. Utilizing medications to treat symptoms like depression or anxiety and introducing individual or group therapies.
The staff considers what a patient’s social environment might be like: Is everyone in a patient’s home drinking in an unhealthy way? Is that high risk for the patient? Is a patient’s job something that presents a high risk? And then there is the spiritual aspect which doesn’t necessarily mean religion, but fosters a connectedness to something outside one’s self.
Addiction is a disease of isolation. It pushes people into isolation, allowing them to continue unhealthy behaviors. Being accountable and connected really helps people stay in a state of healthy recovery.
Dr. Gugnani explains that each outpatient discharge plan is individually driven, but planned comprehensively, and is essential to a successful recovery. Treatment is a continuum.
Eighteen months after completing the NCH Behavioral Health Adult Residential Addictions Center program, Albert realizes, “I have a lot more in this world to give.”
The components of life after inpatient treatment include connecting with an individual therapist and addiction provider, medical or psychiatric; and committing to being accountable to others through Alcoholic Anonymous or other program that provides monitoring and support.
Here to help
Are you or is someone you know struggling with a substance use addiction? – “You are not alone,” Dr. Gugnani says.
Exposure through news coverage of the ongoing opioid epidemic and drug crisis has opened doors to a greater number of resources for all who struggle with substance use. “I would encourage anyone struggling with addiction to call their local hospital or health department to seek treatment,” says Dr. Gugnani.
NCH Behavioral Health programs, managed by Linden Oaks, are located on the NCH hospital campus at 901 W. Kirchhoff Road in Arlington Heights. Call 847-HEALING day or night, for a free confidential assessment or to schedule an intake appointment.
Also take our free, confidential online assessment for addiction, depression or anxiety.