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Old 02-10-2017, 08:56 AM
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Default Rehab question

Does anyone know anything about rehab facilities for drug addiction?

Someone I am close to is checking into a rehab facility for opioid addiction. When she told me the name of the place, I — being me — immediately began to investigate it. It was easy enough to start; I just went to their website.

Whereupon all sort of red flags popped right up.

In addition to a curious lack of specific details about the treatment, the posted schedule of daily activities did not exactly encourage me.

Acupuncture? Spirituality workshops? 12-step programs? Meetings with the “Rev.”? (I assume this must mean meeting with a reverend, but the use of this abbreviation without further elaboration, in conjunction with the lack of specificity about the treatment program, is not conducive to confidence in what these people do or confidence in their competency in basic communication skills.)

It should be noted that this person has already been through rehab twice.

I need to know whether there is an effective science-based treatment for drug addiction that does not rely on Christian propaganda (12-step programs that actually have a poor success rate, according to what I have been able to discover), ancient superstitions (acupuncture, the efficacy of which I believe has no evidential support), vaguely worded bullshit about “spirituality” and so on. Thanks in advance for any help.
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Old 02-10-2017, 12:23 PM
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Default Re: Rehab question

I have no, not even indirect, knowledge of addiction or rehab facilities, but I do have some experience of different psychotherapy approaches. And I wonder if some of the difficulties in proving actual differences between different approaches might also apply to rehab.

Which in a nutshell, because I can already feel this might be a long post, are that the methods the facility uses and the philosophy they claim to follow are largely irrelevant (as long as they are not provably harmful, which I get is a concern). What makes the difference is mostly the personal connection between the therapist and the patient, mostly the trust.

The awkward phrase "dodo bird verdict" (all are winners and all must have prizes) summarises the view of some researchers since the 1930s that all therapeutic approaches produce equivalent results.

Of course, there's a lot of pride and money at stake (as with rehab facilities), so lots of talk has gone into proving that one or other school of thought is in fact better. See also Are all psychological therapies equally effective? Don't ask the dodo | Daniel and Jason Freeman | Science | The Guardian, Are All Psychotherapies Created Equal? - Scientific American.

Nevertheless, I believe the success or otherwise of a given therapy depends largely on things other than the formal theoretical methods. Common factors theory - Wikipedia And I suspect the same is true of rehab.

Lot of therapeutic approaches emphasise that the patient ultimately has to take ownership and responsibility, and yet many patients come to therapy because they can't. Isn't this dilemma of willpower also what addiction is all about? So therapy and rehab depend on the patient giving over will and trust to someone else, and then taking it back. The recognition that an addict can't solve their problems themself and needs outside help is the one bit of 12-step programmes that makes any sense to me.

Anyway ... it's a good idea to kick out religious dogma and look for science-based approaches, but I think it unlikely anyone can prove scientifically that one rehab method is significantly better than most others. As long as the place isn't in fact dogmatic and doesn't discard other ideas, and doesn't use guilt and conformity as tools, there might be nothing wrong with it.
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  #3  
Old 02-10-2017, 07:16 PM
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Default Re: Rehab question

Any rehab worth its salt should, at minimum, provide a medically-based detox process and individual counseling. After that, many/most spend the bulk of whatever time is left advocating the addict/alcoholic attend a 12-step program upon release or uses the time to initiate them into some other behavior-modification program, of which there are quite a few.

Depending on where your friend lives, there are atheist/agnostic/freethinker AA meetings and secular 12-step recovery groups that offer the fellowship and support of AA without the heavy-handed Judeo-Christian content found in the typical AA/NA meeting.

It is also possible to, with an open mind, to find and maintain recovery in regular AA as a freethinker; I have been in recovery in AA for almost 25 years; in less than a month I will have 23 years clean and sober.
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  #4  
Old 02-10-2017, 10:55 PM
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Default Re: Rehab question

Perhaps kratom is a temporary solution, if not a permanent one.

Mitragyna speciosa - Wikipedia
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Old 02-10-2017, 10:57 PM
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Default Re: Rehab question

& congrats Kyuss, that's awesome.
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Old 02-10-2017, 11:08 PM
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Default Re: Rehab question

It's a long time since I was involved in the addiction field, and then it was fairly peripheral rather than any sort of expertise, so take the following with fairly large chunks of rock salt:

Addiction treatments have an objectively measurable outcome, namely relapse rates, which can be used to compare treatments, and treatments have been shown to differ on this.

It used to be the case (some twenty years ago) that for opioid addiction the clear treatment leader was methadone substitution. There's a bunch of mostly bullshit objections people have to methadone treatment unfortunately. I don't know about the US, but round here those objections have meant that methadone programmes have been hard to get on and administered with a counter-productively heavy hand.

I occasionally read interesting stuff that suggests the science of addiction is uncovering interesting stuff, but it seems like treatment models are pretty stuck.

With due respect to Kyuss and others (including people I am close to) who have found 12-step programmes to be somewhere from helpful to life-saving, they don't actually come out ahead in measurements of relapse rates compared to several other options. I personally suspect that different treatments might be suitable for different people, and that we aren't able to predict which, so ideally there ought to be a range of options available to addicts.

edit - I guess none of this is actually helpful to you, davidm, sorry and good luck to you and your friend
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  #7  
Old 02-11-2017, 01:03 AM
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Default Re: Rehab question

It can be really hard to tell the quality. Some are revolving door pseudo-science scams, others are serious care facilities. Unfortunately it's hard to tell from brochures as even the serious ones offer an array of 'alternative' therapy, but that is as much to show a hip and progressive vibe, as you first need to convince the user your establishment is even slightly worth it over the drugs.

IMO Rehab fails in one main way, it doesn't break the cycle once people re-enter the normal world. It can be great while people are there, they do well, make progress, and then get dropped back into their old environment and go back to old habits. Making significant changes to their life once back can be key to not revisiting rehab.

What little results AA gets can probably be attributed to breaking the cycle and providing a place to go to change things up. In that regard there are sobriety groups that do all sorts of things, such as different sports, or gaming. Basically the goal is to get a change of environment that can provide a release with a focus on a sober event, say smoothies after instead of shots, etc. There are certainly ones around but they can be harder to find as often centers stay afloat from court appointed attendance, and the court likes to favor god based programs.

You should read up on the rat-park experiments. A lot of things like rehab and AA fail because they use outdated concepts of addiction. We should really see it as more of a coping mechanism than a disease.

An alt therapy that does show promise is psychedelic therapy.
Now this isn't like dropping acid at a grateful dead show, or whatever Rock and Roll the kids listen to these days. It's generally doing a high dose of LSD or psilocybin with a therapist in a calm environment. Not only does it refresh ground in patterns/pathways, it also allows people to evaluate what they are trying to cope with. Of course given the illegal nature of using drugs that have no recognized therapeutic use, for a therapeutic use can make it difficult to find a therapist who does this treatment.
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  #8  
Old 02-11-2017, 01:08 AM
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Default Re: Rehab question

I know almost nothing about the process of recovery firsthand (unless caffeine counts, my use of recreational substances has been limited entirely to marijuana, and while I enjoyed it, the number of times I have used it can be counted on one hand), but I have heard it suggested that a change of surroundings makes it more likely to stick. I suspect this is because a move cuts an addict off from the people associated with their drug abuse, and also forces them into new routines that may be more successful at supplanting the cycle of abuse. Of course, moving is obviously not an option for everyone, and I suspect people with opiate addictions are less likely than the average populace to have the resources for a move.

It also seems that hypnosis can be extremely successful for some people, but that varies widely from person to person. I’m not entirely convinced I’m even actually capable of being hypnotised; apparently some people aren’t. I’ve tried hypnosis for things unrelated to substance addiction, and it didn’t really stick. That said, some people have reported that hypnosis enabled them to stop smoking when nothing else worked, and I believe tobacco is often considered more addictive than opiates, so hypnosis may be an additional avenue worth pursuing in addition to rehab. (Note that it often requires a few follow-up visits after the initial hypnosis to be fully successful.)
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Old 02-11-2017, 10:50 PM
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Default Re: Rehab question

I've been to rehab (i know- surprise, surprise!). I had the time of my life. I was in there for drinking in my early twenties. I was drinking shit like Listerine and vanilla extract by that point. I was the drunkest twenty-something they had ever seen. I was proud of that fact...still kinda am.

Anyhow, I had a great time in rehab. I was fed well. I made good friends with interesting people. I worked out a lot. We got to do art and creative writing. Lots of sports. Fantastic time! The day after I got out I started drinking again.

Rehab removes you from reality and protects you. It seemed destined to fail. The people there do good things and want to help, but it's just not the kind of place to go to clean up. You need to clean up in your life and rehab removes you from that.

What worked for me was going to AA for a while (though i eventually quit because it felt kind of cultish and i don't drink coffee) and being in detox. Detox will wake you the fuck up...though i was there three times, so i'm a heavy sleeper. It puts you down with the lowest of the low and that's the reality of hitting bottom.

I guess rehab works for some and it at least removes you from the situation for a while, but i think NA is the better bet. You have people there to help you and all in the same boat, but you have to rely on yourself mostly to make the change.
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Old 02-12-2017, 04:44 AM
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Default Re: Rehab question

Thanks for the feedback, all. Now I'll have to do a lot of reading.
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Old 02-12-2017, 12:07 PM
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Default Re: Rehab question

I know I'm probably going to get shit for this, but I am an acupuncturist who works in detox at times.
The number one problem of addiction is that it is a coping mechanism for an underlying cause, which can be highly variable.
People released from rehab need a series of supports and coping mechanisms that do not depend on addiction. Rational Recovery and various 12 step programs provide some community (although that community can be other relapsing addicts so may not always be the best, but mentors have good results IIRC).

Acupuncture gets better results with counseling in addiction therapy, after acute detox. I don't see people who aren't getting both, because it's just not effective. People who have been through multiple rehab programs are generally harder to work with, so different approaches become useful. Here is some research by various journals on acupuncture and detox https://www.acudetox.com/phocadownlo...dings_2011.pdf
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Old 02-12-2017, 12:15 PM
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Default Re: Rehab question

Quote:
Originally Posted by Qingdai View Post
I know I'm probably going to get shit for this
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Old 02-12-2017, 12:21 PM
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Default Re: Rehab question

Thanks, man. You always come through.
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Old 02-12-2017, 12:27 PM
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Default Re: Rehab question

I kind of resent my profession being called an ancient superstition, when mostly it's about trigger and motor points of muscles being stimulated. But I also don't hold with the mystical explanations of Qi either. It's more about the ATP/ADP cycle as observed in a living human to me. So my profession isn't always dear to me either.
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Old 02-12-2017, 12:46 PM
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Default Re: Rehab question

Quote:
Originally Posted by Qingdai View Post
Thanks, man. You always come through.
Quote:
Originally Posted by Qingdai View Post
I kind of resent my profession being called an ancient superstition, when mostly it's about trigger and motor points of muscles being stimulated. But I also don't hold with the mystical explanations of Qi either. It's more about the ATP/ADP cycle as observed in a living human to me. So my profession isn't always dear to me either.
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Old 02-12-2017, 09:37 PM
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Default Re: Rehab question

davidm I wanted to write in more detail about my experience with kratom but my mind is constantly occupied lately.

Here is a thread I posted in regards to the considered DEA ban last year where I try to weigh out my experience against what I consider the myths with some examples:

http://commonforecast.boards.net/thread/106/

I took kratom for about 6 months maybe midJuly to a week and a half ago, about 5 grams a day. It helped as a mood stabilizer and pain remedy. I ordered around 300 grams of Balk Bali green extract from mmmspeciosa.com. I would put it in a teaball and boil it with black tea and sugar or more commonly swallow it with water. I had no withdrawals when I ran out. It is something that only works in moderate doses. 3-10 grams a day is all anyone should take for good effects. I was able to take welbutrin (300-450mg a day) and drink any varied amount without bad side effects. I smoked marijuana maybe 1-2 times on average per month. I used pot dependently for a decade before starting kratom. I also quit cigarettes over that time, though occasionally use an ecig. I am not prone to seizures and have never had one unless severe panic attacks count but I haven't had one I'd compare to a seizure in like 8 or 9 years. I have some other thoughts probably but I think the thread I linked is thorough enough about recent events surrounding the substance and it's perception.
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Last edited by Gonzo; 02-12-2017 at 09:59 PM.
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