The family of an alcoholic patient in the UK recently asked me to outline the difference between an alcohol detoxification, a Primary Care alcoholism treatment process, as well as Secondary and Tertiary Care or a Halfway House rehab. They were considering sending their loved one from the UK to South Africa to attend a well known alcohol rehab centre.
Having held the Head of Treatment position in both England and South Africa I feel I’m ideally placed to offer advice on addiction treatment in both countries and also to give them some choices as to which clinic would best meet their alcoholic son’s needs.
Primary Care’s purpose is to deal with the critical issues surrounding addiction. Unless these issues are dealt with and the patient has found a way to move forward and take responsibility for their disease of alcoholism they will continue to drink alcohol.
Alcohol Detox is the first step in the primary care process and the easiest aspect to achieve, a detox may provide sobriety but does not equal recovery. Many patients make this mistake thinking that the drinking is the problem. Alcoholism is much more a thinking and a living problem and the alcohol is but a symptom.
If a patient has had previous treatment episodes and relapses after a period of alcohol recovery, this relapse can be seen as evidence of their need for further primary care treatment. Evidence that their thinking around alcohol is still not accurate.
If I was allergic to strawberries and every time I ingested them I got red blotches on and felt sick, I’d quite simply stop eating strawberries. Why’s the same not true of Alcoholism or drug addiction? Essentially the primary care work is to address the ‘peculiar mental twist’ that takes place once a person has become addicted.
Here’s what the peculiar mental twist is about. I’ve spoken to high functioning patients – doctors, dentists, a high court judge and even Nelson Mandela’s bodyguard – all were bright, of above average intelligence with the potential of good futures if they could just get their addiction to alcohol dealt with. They knew full and well that using alcohol and other drugs was hurting themselves and their loved ones. They knew that it wasn’t benefiting their mental or emotional health, their finances, their careers, etc etc ad infinitum and yet they continued to return to drink & drugs!
What is it that makes it OK for addicted people to continue to return to their substances again and again, despite themselves and their knowledge that doing so doesn’t serve their best interests? These people have exerted substantial will-power, strength of character and intellect to beat their addiction to alcohol and other drugs and yet it appears that they can’t.
Primary Care treatment’s purpose is to assist people addicted to alcohol and other drugs to begin to understand how they rationalise and justify their drug use and minimise the consequences thereof to themselves and those around them. Once we have an understanding of how we delude ourselves into thinking it’s OK for us to drink & use drugs and what we can do differently to begin to take responsibility for our addictions – then we become appropriate for Secondary Care.
It’s a bit like Primary School in that patients aren’t eligible for Secondary or High School until they’ve completed Primary School.
Secondary Care will reinforce the work done in Primary Care and allow more time for consolidation as well as look towards the future and how addicted patients can continue to integrate their new recovery based behaviours once they get back home.
Treatment outcomes for patients with severe dependencies are better with treatment lengths of around 90 days.
I hope some of this makes sense and that you can see that alcohol detox is a necessary first step in the primary care process but by no means equal to primary care’s ability to look at the causes and conditions of addicted people’s illness.
Effective Primary Care treatment is far superior to a physical detoxification when assisting addicted people to rebuild their lives.