An excerpt from Mastering the Addicted Brain: Building a Sane and Meaningful Life to Stay Clean by Walter Ling, MD
Getting off drugs — detoxification, or detox for short — is the first step in overcoming addiction. It is often said to be the first step in the journey of a thousand miles — the long journey of recovery, or living a sane and meaningful life without drugs. Detox is where everyone who tries to overcome addiction begins, and it is the most common addiction “treatment” offered in this country.
The sad truth is that detoxification is also where most people who try to overcome addiction stop. They fail to follow detox with relapse prevention, the necessary next step. Yes, detox is the first step in a journey of a thousand miles, but it is only one step. Alone, detox is not enough to overcome the dangers of relapse. Meanwhile, detoxification repeated over and over is like marching in place; it is not a journey and gets you nowhere. Detoxification may be good for a lot of things, but staying off drugs is not one of them. In my experience, detox almost always ends in relapse to drug use unless it is followed by relapse prevention.
The Difference between a Wedding and a Marriage
Another analogy for how to think of detox — crude perhaps, but not necessarily bad — is to consider the difference between a wedding and a marriage.
Deciding to enter a detox program is the equivalent to becoming engaged — in a real way, the person commits to giving up the life of being single. The wedding ceremony is the detox program itself. Though it’s no party, detox is also one of the biggest events of a person’s life, and this commitment is not made in private. To some extent, it is a public pledge to change forever, one that is typically overseen by professionals and witnessed by the person’s closest friends and family members.
Then what? Well, if you’re getting married, after the wedding remains the rest of your life, and the ceremony doesn’t have much to do with creating a successful marriage. It doesn’t matter whether the wedding is simple or lavish, indoors or out, formal or informal. It doesn’t matter how much money you spend. Your wedding planner, and all the people you hire to get you through the ceremony, will move on to the next wedding, and after a brief honeymoon, you and your new spouse will be left to figure out how to be happy together and remain faithful. In other words, a successful married life depends on everything you do after the wedding. It depends entirely on the work you put in every day to create a satisfying life together. It depends on caring, loving, honest communication, through thick and thin, for better and for worse. The wedding is the promise of a lifelong commitment, but it’s not the commitment itself.
It is the same with detox. During this ceremony, you get off drugs. But that is no guarantee you will stay off. How many people eventually divorce and become single again? Clearly, they were not ready to be married, or marriage was harder than they thought, or they chose the wrong person. To avoid relapse, you have to approach detox with the right attitude, and you’ve got to adopt this attitude before you get yourself to the church on time. Some people think they can have one last fix just before they give it all up and go into detox. That’s like having one last fling before the wedding, and it doesn’t bode well for what’s to follow.
Detox is the first step toward changing your brain and changing your life. But it will take much more than detox to stay off drugs and build a new drug-free life.
The central ceremony of a wedding is the exchange of vows. What are your vows for recovery? Whether or not you’ve already been through detox, take a few moments and consider what you have pledged to yourself. If you wish, write this down and keep it as a reminder.
Detox Treatment and Medications
Detoxification, with or without medications, is the most common treatment for addiction offered and received in the United States. People can undergo detox almost anywhere: in an inpatient facility or outpatient clinic, an upscale residence or their own apartment. Whatever the context, the goal is the same: to remove the person from the constant bombardment of drug exposure, to give them some symptomatic relief from the physical and psychological discomfort of not having drugs anymore, and most importantly to give the brain time to recover from the effects of repeated drug exposure.
Detox is physically and mentally painful. It involves suffering, but it’s a finite amount of suffering. It doesn’t go on and on and on indefinitely; eventually it ends, usually lasting a matter of days to maybe a week or two. However, for this reason, it’s almost never accomplished alone. The person going through detox needs physical and emotional support so as not to feel abandoned or have to face the ordeal alone. Misery loves company.
The use of medications in this setting is typically short term and only for relief of temporary symptoms, like physical aches and pains, anxiety, and sleep disturbances. An example of some typical medications are acetaminophen and ibuprofen for aches and pains. These medications are not meant to help you stay off drugs, though doctors might prescribe other medications for relapse prevention, which are continued after detox. See chapter 3 for more on the use of medications to prevent relapse.
Ultimately, however it’s handled, the goal of detox is to bring the person back to “square one,” where they can begin again.
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Walter Ling, MD, author of Mastering the Addicted Brain, is Professor Emeritus of Psychiatry and the founding director of the Integrated Substance Abuse Programs (ISAP) at the University of California, Los Angeles. With board certifications in neurology and psychiatry, Ling has conducted clinical trials of psychiatric medications, acted as a consultant to the World Health Organization, and run a private practice listed in the “Best Doctors in America” directory.
Excerpted from the book Mastering the Addicted Brain. Copyright ©2017 by Walter Ling. Printed with permission from New World Library — www.newworldlibrary.com.