Addiction: What Glory in the High Recidivism Rate? By Susan Winston, LMFT on 8/5/19 - 4:15 PM

When I began my career as a psychotherapist, I was sure I would focus on addiction recovery. After graduate school, I ran into an amazing professor and took a year of courses with her on dual diagnosis. Thirty-six years sober, she was my guide to a world I hoped I would never enter personally, but would focus on professionally.

I proceeded to work at a number of drug and alcohol rehab clinics, from tony Malibu in-patient programs to down-and-dirty outpatient clinics for people fresh from prison or the streets. I was a “newbie,” one of the few working in these organizations that did not have prior addiction as one of my credentials. I talked my way into the jobs by stating that I could offer an alternative to the way people had been living. I had learned how to talk the talk, from AA to NA to no A’s at all. But I learned that as hard as I worked and as connected as I felt to clients, I was never going to lower that +70% recidivism rate reported by the National Center on Addiction and Substance Abuse. Success stories were rare. Those who emerged from a facility often found their way back in. I treated a 20-year old woman in her 10th rehab program. When asked the first thing she would do when she had completed this stint, she stated she would escape from her home and go straight to her dealer for ‘H.’

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In private practice I continued working in addiction recovery. There was the shopping addict whose addiction not only emptied her pocketbook, but also derailed her marriage. I like to think out of the box, so we made a deal: she could shop till she dropped on Saturday, Saturday night she could try on her bounty, but on Sunday she had to return all of her purchases. This was monitored by mandatory photos sent of the purchases and returns. It became such a tiring process for this client that she eventually gave it up. When she needed something for a special event, she had to call me for permission. When she “graduated” from therapy, it was with a growing bank-account, sadly a divorce, but an understanding of her addiction and the knowledge that she could never go back to that behavior again. You might be saying, oh a shopping addiction is not as life-threatening as drugs or alcohol, but in another way it is. The depression precipitated by being broke and now divorced was mentally debilitating. Take gambling addiction. All you need to do is read former Good Morning America anchor Spencer Christian’s book, You Bet Your Life, about the thirty years of shame he hid and the near ruin he continuously faced, to know that addiction in almost any form is a health threat.

I also began to understand that giving up one addiction often leads to another. Why do you think that during AA breaks, so many people are outside smoking? The hole that created the addiction in the first place needs to be filled. So why not with something healthy? I began to find those “hole-fillers” for my clients. Exercise became the most successful. Hangovers and the day-after partying like a rock star are not feel good moments. Getting your health back, your body back, a clear mind—that became the goal.

One client was a law school student. After two years of Taco Tuesdays, Thirsty Thursdays, Freaky Fridays, Saturated Saturdays—and oh well, Sunday too, she was a full-blown black-out drunk; failing out of law school, sabotaging friendships, avoiding her family. When she came to work with me, eschewing AA, she had to come three times a week. She also had to pick a physical activity; her go-to instead of drinking. It was a long year. It became a long second-year of maintenance and on the anniversary of the completion of year two, her official graduation from therapy, I had baked a cake and had sparkling cider ready. She walked in, and to my shock, was followed by her parents, 2 sisters and her soon-to-be fiancé. There were hugs. There were tears. She was carrying a large wrapped photo.

I looked and said, “What a great picture of you and your Mom.”

“Susan,” she grabbed me. “That is me when I started seeing you and me now. I am sober and 60 lbs. lighter and a rockin’ marathoner.”

Did I move the needle on the overall recidivism rate? Probably not, but small successes are what makes this profession worth practicing.  

File under: Musings and Reflections