For addiction medicine specialist Mark Willenbring, MD, no two cases are exactly alike. There are the middle-aged women who tip back five or six drinks a day; most of the time they’re functional and nobody knows they have a problem. There are the young people hooked on opiates, seeking a swift way to nix their habit in this age of instant gratification. For a growing number of addicted adults, the substance of choice is a prescription drug like Vicodin, often available from ill patients who sell their surplus on the side for easy cash. And then there are those with severe alcohol dependency who will consume a liter of vodka a day, or the equivalent of 24 drinks; if they keep going, they’re headed down a deadly road toward cirrhosis of the liver or pancreatitis.
Once a substance user recognizes that he has a problem and wants to get well—which can take months or years—the route to recovery can be long, bumpy, and riddled with backtracking detours. The risk of relapse looms large: Most in-patient rehab centers in this country report that only about 40 percent of their “graduates” remain clean a year later. There’s a spectrum of severity, but addiction is deadly: Every year in the US, about 120,000 people will die from it. That’s 350 people a day. Recovery, experts agree, isn’t about finding a cookie-cutter, quick-fix solution. Says Willenbring, “There are about as many ways to recover as there are people who need to.”
The (Tough) Love Approach
Jim and Sue Cusack, co-founders of Villa Veritas, an inpatient rehab clinic in Kerhonkson, have been in the business of addiction recovery since the days before it was really a business—and certainly not a money-making one. In his recently self-published memoir, Trouble Is a Gift: A Story of Addiction, Recovery, and Hope (S and J Publishing, 2013), Jim, 85, recounts the rough-and-tumble years of his teens and early 20s as a hard-core alcoholic. He had his first drink at age four at one of his family’s Irish weddings; snuck wine in the sacristy when he was an altar boy; boozed his way through a stint in the Army; and hit bottom when his first wife booted him out. The road to sober took him 12 years. “There wasn’t a field back then; there wasn’t any success with drunks,” says Sue. “Jim vowed that if he could get himself together he would help other alcoholics.” His prayers were answered (both Jim and Sue are devout Catholics) when he was given a 30-bed facility. Sue was one of his early clients—though it was a few years after when they fell in love and married. Later, Jim worked with alcoholic New York City police officers in what was perhaps the city’s first employee-assistance program. Years after, Jim and Sue purchased the Catskills resort that would become Villa Veritas.
Since it opened in the early 1980s, the Villa, as Jim and Sue call it, has grown to an 85-bed rehab facility that draws heavily on the Twelve Steps, the philosophy behind Alcoholics Anonymous (AA). The structure of their 28-day program has changed very little over the past three decades. First patients “dry out” and detox, then they attend Twelve Step meetings and have group and individual therapy. “A lot of fads and trends have come and gone, but it’s the basics that work,” says Sue—though in recent years Villa Veritas has added yoga, arts and crafts, exercise, nutrition, and nicotine reduction. There are also an indoor and an outdoor pool. It might sound like a spa, but to Sue, it’s school. “It’s a very structured daily program that consists of getting discipline back into our lives. It’s kind of like going to college for a month, a crash course on how to live a sober life.” In a way, it’s also a bit like church: An AA brand of love and spirituality is a big component.
Inpatient rehab is infamously expensive, but the Cusacks say they keep their program affordable with insurance coverage and payment plans. “We’ll work with anyone who wants to get well,” says Sue. Since relapse prevention is such a big concern, Villa Veritas sets people up with outpatient programs and alumna in their area, and strongly recommends regular attendance in a Twelve Step program. “Here, people are immersed in a family; they feel the power of the group and they start to like themselves. If they go home and don’t follow up, they go back into the isolation, and the drinking or using can start again,” says Sue. Addiction medicine, or the use of prescription meds to ease withdrawal symptoms, is not something you’ll see at Villa Veritas. (“Abstinence is the way to go, we feel. Chances are they’ll be uncomfortable, but that’s okay. No pain, no gain.”) In the end, it’s people helping people, says Sue. “I’m 45 years recovered and proud to be. No doctor or psychiatrist gave that to me.”
The Science Approach
Mark Willenbring has been on a mission to change addiction care in this country since he was director of the National Institute for Alcohol Abuse and Alcoholism (NIAAA)—and saw a lot of good research about addiction sitting on a shelf, unused. “The most common treatment, which is based on what’s called the Minnesota Model, or Twelve Steps, was developed in the 1950s, when there wasn’t any science and there wasn’t any treatment,” he says. “Because this model is based on people in recovery who are sharing their stories, these folks don’t look to science as a way to advance treatment outcomes.” Willenbring finds the rehab model equally unscientific, comparing it to the 1920s sanatorium “cure” of fresh air and sunshine for people with tuberculosis. Moreover, he says, rehab has become a standard treatment when it’s really meant for extreme cases—the sickest 10 percent, or those with the most refractory addiction. “Saying that everyone [with an addiction] needs rehab is the equivalent of saying that everyone who has asthma needs to be put in the ICU on a ventilator.”
Earlier this year, Willenbring opened Alltyr clinic in St. Paul, Minnesota—”to basically demonstrate what 21st-century addiction treatment looks like.” The goal is to provide a scientifically based model that looks, sounds, and feels like other medical specialties. Designed as an outpatient clinic with low-intensity care that’s individualized and extended over time, Alltyr offers every evidence-based treatment available, says Willenbring. That includes medications for drug or alcohol relapse, which he recommends to just about everyone who comes in—but it’s not just about pharmaceuticals. A team of psychiatrists, psychologists, social workers, counselors, and recovery coaches also offer individual and group therapy, cognitive behavioral therapy (i.e., coping skills), and treatment for coexisting disorders such as anxiety and depression. The program is not authoritarian, but rather all about the patient’s free choice—what Willenbring calls the cafeteria model. “It’s like saying, okay, there’s chicken, there’s pork, there’s tofu—take your pick [of treatments], take what you like. The emphasis is on engagement, retention, and working with people as long as it takes.”
And sometimes it takes a long time. “When abstinence is a goal, it usually isn’t so mystically achieved all of a sudden,” he says. Most often, people need to struggle and make a persistent effort over a protracted period of time, with multiple quit attempts, until they get it. The last thing he wants people to do is stay away from him or his staff if they have a recurrence because they’re embarrassed or ashamed. Because addiction is a brain disease, he explains, there are forces at work beyond sheer will and discipline: The mechanisms that control intake of a particular substance get disregulated. “People literally watch in horror as they behave in a way that’s going to destroy them,” he says. The aim is to catch it at earlier and milder stages of illness—and to address it in primary care. “It turns out that for opiates and alcohol, and tobacco or smoking, we already have medication treatments that are pretty good,” he says. “It really depends on the severity and complexity of the disorder.”
The Spirit Approach
When Kevin Griffin set out to recover from a drug and alcohol addiction three decades ago, he was happy to discover that AA encouraged meditation. Even before he got sober, Griffin had a spiritual side, a longing, which led him to explore Buddhism. So he already had a meditation practice—which is part of AA’s Eleventh Step—under his belt. As his practice progressed, he was eventually asked to teach at Spirit Rock Meditation Center in California’s Marin County. Says Griffin, “My own experience of working a Twelve Step program naturally seeped into my teaching.” He wrote a two books—One Breath at a Time: Buddhism and the Twelve Steps (Rodale, 2004) and A Burning Desire: Dharma God and the Path of Recovery (Hay House, 2010)—and built a following. Some of his students want to learn meditation to help them with recovery, yet Griffin’s views also appeal to many people who struggle with AA’s theistic orientation. “The Twelve Steps obviously talk a lot about God,” he says, “so a lot of people who have those difficulties with the Steps are drawn to my work. They have trouble with the language and want to find an alternative approach to it.”
AA mentions “surrendering to a higher power” in order to recover—but Griffin offers a different take on that, too. “Recovery gets somewhat mystified when it’s, ‘Oh, through the grace of God I got better.’ Okay, how does that work? I don’t accept those kinds of generalities. Because if God got me sober, then God can change his mind, I guess.” In Griffin’s understanding of the Twelve Steps, there’s more agency on the part of the practitioners; rather than waiting around for God to fix things, they’re taking action. “It’s about making choices, moment by moment, to think, speak, and act differently from your addictive tendencies,” he says. “That’s how you recover and that’s how you grow spiritually.”
Connecting the process of recovery with Buddhism and mindfulness is a natural fit for Griffin—and perfectly in line with the Buddha’s teachings about pleasure, attachment, suffering, and letting go. “When you’re letting go of alcohol, it’s not a renunciation in the sense of, ‘I really want to do this, but I’m going to stop because it’s good for me.’ That kind of sobriety won’t last very long. The reason you give up alcohol is because you see the truth of suffering in your addiction. When you see the truth of suffering really clearly, there’s a natural letting go; many people will say their craving for drugs and alcohol has been lifted. That’s what I think needs to happen for long-term or successful recovery.” None of it is easy to achieve, says Griffin—and none of it has to be perfect, either. “Having a meditation practice is hard. Recovery is hard, being human is hard,” he says. “Just keep showing up. It gets better.”
Kevin Griffin Kevingriffin.net
Villa Veritas Foundation, Inc. Villaveritas.org
Mark Willenbring, MD Alltyr.com
This article appears in November 2014.
