by David Sheff
Residential programs are more intensive and are appropriate for people whose drug use is at a life-threatening level and who are likely to relapse if they’re out on their own during days, nights, and weekends. It’s like going to a hospital for a serious illness. Many of the treatments are similar to those in outpatient programs, including various kinds of therapies, education, life-skills training, anger management, and addiction medications. Patients also practice disciplines like meditation and yoga that help reduce stress. Because they are living at the program, there’s more time for patients to work with addiction specialists. Sometimes when they are discharged from a residential program, they transition to an outpatient program. As in outpatient treatment, patients in residential programs should also be assessed by doctors to determine whether they have psychiatric problems. If they do, those must be treated, too—often with medication and therapy.
Nic
It took years before I saw a psychiatrist who gave me a bunch of tests that showed that I have bipolar disorder and depression. People think it would be the worst thing to be diagnosed with mental illnesses, but to me it was a huge relief—I thought, So that’s why I’ve felt so bad for so long. That’s why I’ve used so many drugs—I have mental illnesses that have never been treated. I’ve been trying to feel better. I thought, It’s not just my imagination that there’s something wrong inside my head. And not only that. The best news was that these mental illnesses could be treated. You mean I don’t have to feel this way? I can feel normal?
It was a relief, but still, for me, being diagnosed with bipolar disorder and depression didn’t mean I was going to comply with treatment, at least at first. I mean, I could recognize the symptoms the doctor described, but I also remember feeling wary of the way doctors in our society seem so quick to prescribe medication. Not just that, but I also had the feeling that somehow there was something weak about taking pills. I know that doesn’t make any sense, considering I was addicted to taking illegal drugs, but still.
So at first I refused to accept the diagnosis and wouldn’t take my meds.
I thought I was better than other people who needed help. But while my friends who were in rehab and treating their disorders managed to stay sober, I kept on relapsing over and over again. And I began having to admit that maybe one of the reasons I couldn’t stay sober was that these mental illnesses I “didn’t have” were making my life completely unmanageable.
Because even when I was sober, I kept going through these manic periods where I’d have obsessive thoughts and even delusions.
I’d go days without sleeping. It felt like I was in a car with the gas pedal pushed down to the floor so I couldn’t sit still.
Or I’d feel so depressed that I wanted to die.
Not that I’m saying me being bipolar and having depression were the only reasons I kept relapsing. But it definitely made staying sober a whole lot harder. And I’m honestly not sure what made me finally give in and start taking my medication.
I just got fed up, I guess. When I got sober this last time, I made a commitment to do whatever my doctor suggested, and that included starting on a regimen of antidepressants, mood stabilizers, and antipsychotic medication. Slowly, the meds started working for me, and gradually, things started to get better. I also took an addiction medication that helped with cravings.
It wasn’t just the medication, of course. It was therapy, meds, twelve-step stuff, and my outpatient program, too. I’ve come to realize that bipolar disorder and depression are very real for me, but they’re treatable, and treatment hasn’t only helped me stay sober. It’s helped me feel sane and have the kind of life I’ve always wanted.
RELAPSE
For some, treatment works the first time. Others are treated, do well for a while, and relapse—that is, they start using again. Drug addiction is a complicated problem, and it doesn’t go away overnight. People relapse for many reasons. They may relapse because they stopped whatever treatment was helping them. Maybe they stopped going to therapy or taking their medication. Maybe they were super stressed and thought one drink or joint would be okay. Maybe after being sober for a time, they felt as if they’d never really been addicted in the first place.
Many of the same things that drive a person to drugs in the first place can drive them back again: depression or anxiety, feeling insecure and being with kids who are getting high, experiencing problems at home or confusion about their lives.
People may relapse no matter how committed they are to staying sober. It’s not their fault; addiction is a disease that can come with relapse, and though a relapse is incredibly dangerous, it isn’t a sign that someone is a bad person or they didn’t try hard enough, it’s a sign that they’re ill and need more treatment.
While every relapse is potentially life-threatening, the heartening fact is that relapses can be progressively less severe, and those with addiction who relapse can return to recovery. Treatment professionals work with them to figure out what went wrong. What were they frustrated about? Why were they more anxious than usual? Were they bored? Were there problems with family, friends, coworkers, or others? Was there a crisis—a death in the family, the loss of a job? Did a psychiatric illness worsen? When the therapists or psychiatrists figure out what’s wrong, they can treat it, further protecting a person from relapsing in the future.
Nic got sober in a series of treatment programs, but it took many programs before he stayed sober. What finally helped him?
Nic
When I first went to rehab, back when I was just eighteen, I assumed that I’d graduate from my twenty-eight days of inpatient treatment and be free of my addiction permanently so I could then go back to drinking and smoking pot like a normal teenager. I never for a second imagined that the counselors at rehab would tell me that because I was an addict, I would never be able to drink or use anything again.
The counselors explained that addiction is a brain disease, and I had it. This meant my body processed drugs and alcohol differently from the way “normal” people do. My problem, they said, wasn’t specifically crystal meth—that was one of the most destructive drugs, but it could be any drug. My problem was my brain. I had a mental illness. When I took a drug, my brain responded with a craving that was nearly impossible to fight. And when I finally did get sober, my brain would trick me into thinking that I needed to get high again. My brain would also tell me, each time, that I’d be able to control my using, but I couldn’t really.
I didn’t believe I had a disease. Cancer is a disease. Diabetes is a disease. But addiction? That made no sense to me. I was just using to get high. I wasn’t sick.
I really believed I could stop whenever I wanted—I just didn’t want to. So I decided to test it out. I tried just drinking. I tried just smoking pot. I tried just doing pills. I also tried just using various combinations of all of the above. It never worked out too well. I thought I could use in moderation, but I couldn’t. The craving would start. The invisible switch was flipped inside me. I couldn’t stop, no matter what mind-altering substance I put in my body.
It was hard to admit that those counselors had been right, that addiction as a disease was real. It took me a long time to learn. That first rehab wasn’t enough. First I thought it was my fault that I’d relapse—I just didn’t have the willpower or whatever.
In order for me to finally get and stay sober, I ended up going to six or seven different rehab programs and halfway houses. It might be logical to assume that the last program I went into was the one that helped me the most, since it was the one that led to this period of nearly eight years of continual sobriety. But truthfully, I think that every program I went to added pieces to the puzzle that ultimately made it possible for me to stay sober. Still, some programs definitely gave me more “pieces” than others. And some places seemed to teach me more what not to do instead of what to do.
The programs I found unhelpful—they made my problem worse—were the ones built around punishment, and a lot of them wer
e. Making my life more miserable and depressing and hopeless-seeming than it already was didn’t encourage me to get sober. If anything, those kinds of places just made me want to run away and use, and sometimes I did.
The treatment program that finally worked was what is called dual diagnosis treatment. I saw doctors and therapists who focused not just on my addiction, but also on the psychiatric problems that led to my drug use and worsened my addiction. It was critical for me to be assessed by a psychiatrist to get my diagnosis. I didn’t know it at the time, of course, but as we’ve explained, a lot of drug use is people trying to fix themselves because of how bad and confused they feel. That was me. Once I was diagnosed with those mental illnesses, the doctor began treating me with medication and therapy. Everything changed at that point.
In addition to working with a psychiatrist (I still do), I worked with counselors who helped me believe that I could live a happy, complete, successful life without drugs.
The programs also helped me to be myself—to discover who that “self” actually is. They helped me learn about the people, places, and things that could trigger impulses that might lead to relapse, and, more important, the moods that could lead to relapse—feeling super anxious or depressed.
Treatment that helped also helped me focus on goals. My writing was encouraged. I also learned that it was possible to have relationships, and fun, sober. When you grow up high, you don’t know, because you’ve never truly experienced these things, and you believe that drugs are essential if you want to have a good time.
The other patients and I watched movies all together at night and sat out on the patio talking—it was very supportive and nonjudgmental, and it helped all of us discover how happy life can be sober. I was allowed to take my dog on hikes during the day and to get passes to go out at night with others in the programs to movies and concerts to feel as if I had a life outside rehab.
This all was coupled with continuing therapy and medication. Treatment happened in residential programs, followed by outpatient programs I went to three or four nights a week. The outpatient was coed and was kind of like group therapy. What was really cool was that I’d go into the outpatient group thinking about all the problems in my life and how much of a mess I was, but then I’d hear someone else in the group talking about their problems, and I’d think, “Man, I’m not so messed up. That guy, he’s really messed up.” Then I’d spend the whole time trying to help him with his problems instead of being focused on my own, and it totally changed my perspective. By helping others, I was, of course, helping myself. I made some great friends in the outpatient group.
So I guess the bottom line is, I finally responded to treatment programs that (1) included psychological testing with a psychiatrist who diagnosed me, (2) offered regular and intensive one-on-one therapy with amazing therapists, (3) offered group therapy, (4) encouraged individuality, (5) taught real life skills, and (6) showed me that it was possible to have a life—a better life, a wonderful life—sober.
It took time. I kept falling, but eventually I started to learn how to not fall so far down and how to pick myself up a little sooner. It was a lot of trial and error. I had to find out what worked for me and what didn’t.
Because there is no one answer for anyone. We are all different. I guess I just had to be open to trying—and then trying again.
LIVING THE LIFE
After primary treatment, while in outpatient treatment, or after a relapse, people are occasionally advised to move into what’s called a “sober living” environment—maybe a house or apartment where they’ll be supported by peers in recovery. These environments often offer counseling, twelve-step meetings, and a variety of treatments. They may have groups on anger management, maintaining healthy relationships, and other therapies. They may monitor those who require psychiatric treatment as they work with their doctors on ongoing treatment of their depression, anxiety disorder, or other mental illness.
In a good sober home, addicts have professionals who are watching out for them and who are there when they need help. Not only is it safer to be around people who aren’t using, but it can be a positive experience, a place to learn to have healthy relationships and learn that people can have fun without being high.
A boy named Luke told us that he spent his middle school and high school years getting high. He’d never learned to have friends when he was sober. He associated fun with partying. His drug use continued and he became addicted. He finally went into treatment.
In a program Luke attended, besides a range of treatments for addiction, counselors focused on teaching kids that they could have fun without drugs. “I didn’t know that it was possible to have a life without being stoned, but I saw kids who [were doing it],” he says. “Not only did I learn that you could have fun without being stoned, but that you had more fun not being stoned. I’d never have believed that, but it was true.”
Staying sober after treatment presents challenges for anyone, but it can be particularly tricky for teenagers. Those who leave residential treatment and return to the communities, schools, and friends that surrounded them when they were using may be vulnerable. Those emerging from the relatively safe confines of residential treatment may return to a stressful world where there are people, places, or things that can “trigger” a person and lead to relapse. In addition, drugs are probably easy to find. Temptations to relapse take many forms.
Some kids thrive sober, even in environments that would be dangerous to others, but many struggle. They face intense challenges, which can lead to stress, and stress can lead to relapse. That’s why experts believe that kids heading home after rehab should continue in some form of treatment whether or not they’re in a sober house.
Everyone is different. (Dr. Shoptaw says, “Addiction is the place where science meets people.”) Because of that, treatment that works for one person may not work for another; some kids require more intensive treatment and some less; some are fine returning to their homes, schools, and neighborhoods, and some shouldn’t. Some communities have what are called sober high schools, and some have APGs (adolescent peer groups). In these groups, kids meet with counselors and attend support groups and social events together. The most effective relapse-prevention strategies for teenagers are multisystemic. These strategies involve as many people in a kid’s life as possible working together—for example, parents and other family members, physicians, counselors, teachers, coaches, and other adults, as well as friends and peers.
LIFE AFTER ADDICTION
Addiction is a serious illness, and treating it is challenging. But those who continue in treatment and stay off drugs describe changes in their lives that they never anticipated. No, their lives aren’t perfect—life is never perfect for anyone—but sober, kids learn to deal with the ups and downs of life and as a result become happier and more independent and secure. They experience what it feels like to have close friendships that aren’t based on being high but instead on “being real,” as a boy who wrote us said. It’s often possible for people who’ve never had meaningful relationships—intimate friendships and romantic relationships—because of their addictions and other psychological problems to develop deep, trusting, and nurturing connections.
Often, the addict has betrayed, lied to, stolen from, and otherwise tormented his loved ones, making it difficult to mend relationships. Just as it takes time for an addict’s nervous system to heal, it takes time for relationships to heal, but most can.
The kids in recovery we’ve met describe many changes in their lives. Some have said they were doing better in school or work, and some have discovered passions they never had—art, music, nature, sports, movies, volunteering, a million different things—that fulfill them. Some said they were finally facing problems they’d run from their entire lives, problems that had scared them, made them feel like bad people, gotten them into trouble, alienated them from their family and friends, and made them feel ashamed and angry and guilty.
They discover things they
never knew: They didn’t have to suffer in ways they’d suffered their whole lives. They could have close relationships that weren’t dependent on drugs. They could experience lives filled with joy.
Afterword
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Our greatest glory is not in never falling, but in rising every time we fall. —RALPH WALDO EMERSON
Father and Son:
A Conversation
DAVID: What would you say to a kid who’s where you were when you were in school?
NIC: I look back and realize that I was trying so hard to be the “perfect” kid—getting good grades, doing sports, all that—I wasn’t aware of what was going on inside me. The feelings of self-hatred and anxiety. Feeling so bad, insecure, and also just feeling so discontented with everything, I really didn’t know anything could help because I didn’t know I needed help. If a kid grows up with these feelings, how can he or she know it’s not that way for everyone?
Now I know there were things I could have done—well, things my parents and the other adults in my life could have done. I didn’t think anything could ever change the way I felt inside. Drugs and alcohol seemed like the only things that could help in any way. But, of course, they only served to make everything worse. What I know now, however, is that there’s help out there. I’d suggest to kids that they pay a lot of attention to how they’re feeling. Everyone feels sad sometimes. Angry. Insecure. But intense and persistent feelings of anxiety, sadness, insecurity—or as with me, a sort of self-hatred, as if I deserved to feel bad—aren’t normal, and you don’t have to live with them. If I’d known to pay attention to how I was feeling, maybe I would have asked for help. Parents, doctors, counselors—they can help. And even if they didn’t know exactly how to help, they could’ve directed me to someone who could’ve. I really believe that. If I’d been able to see the right doctor, gotten on the right medication, worked with the right counselor, things could’ve been very different for me—much better.