Response: addiction, memory, and spirit

Vitka Eisen: The article reinforced some conversations I've had recently with colleagues. We were reflecting on people we've known who had a good 4 or 5 years of recovery under their belt and then relapsed. What appeared to connect these relapses were folks returning to places that were triggering for them. John Wanner: We see this all the time. Right now, we've got 74 patients, and at least eight of them relapsed after between 5 and 15 years of sobriety. The article does a good job of making it clear why this happens. I'm going to send it to my colleagues. If we can explain this to patients, they will give more credence to the recommendations we make in treatment. Eisen: I was left thinking about the challenges related to today's shorter stays in treatment. When Walden House was a therapeutic community, people stayed in the program for 2 years. Now a typical stay is 6 months, with a couple months in outpatient aftercare. That gives us a lot less time to help patients rewire their brain, form new associations, change associations that formerly triggered drug use, learn some stress management skills, and titrate their exposure to the stresses outside the program. Many of our folks need to start new lives from scratch because of the communities they came from and because their friends and family members are all drug-involved. Wanner: Some of the addiction literature today is pointing in the direction of longer stays. I think that Alcoholics Anonymous recognized that, without knowing the science, many years ago when they came up with the idea of 90 AA meetings in 90 days. What we try to do at Father Martin's Ashley is to give our patients some coping skills while they are in residence and then move them on to some additional treatment , whether it's outpatient, extended care, halfway house, or whatever, because they still need to be in an environment that's recovery-based. Stages and models Wanner: We see patients in both of the stages of addiction Dr. Gould describes. Sometimes patients who are still in the earlier stages look at those in the later stages and say, " What am I doing here? I don't belong here. I'm not that bad. " We try to tell them that even though they are not yet using every day, not waking up with the shakes, neither were these other …