Episode 15 – Depression And Addiction
Dr. Ashish Bhatt ❘
It’s very possible you or someone you know has struggled with depression. Those with depression are likely to struggle with substance abuse.
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by Dr. Ashish Bhatt | ❘
The podcast and articles by Dr. Bhatt are intended to be strictly informative, and will not provide any diagnosis, treatment recommendation, or directed medical advice. Unfortunately, not all messages can be addressed, and no message is guaranteed a response. Information provided by Dr. Bhatt in articles and podcasts is intended to address common questions of general applicability, and may not apply to your unique situation. As a result, please do not use the advice or conclusions found in any articles and podcasts on this site as a substitute for professional personal medical advice. If you are looking for treatment, please call.
Hayley: Hi everyone, my name is Hayley and this is Straight Talk With The Doc, a podcast that discusses addiction, mental health, and treatment. I’m here with our medical director Dr. Bhatt and our content director Jeff. How are you two doing today?
Dr. Bhatt: Doing good Hayley, how are you?
Jeff: I’m doing well, today is a good day.
Hayley: I’m doing good, too. On this podcast, we talk a lot about signs of addiction and how to take that step to find treatment. But we haven’t really dove into what happens after treatment. Rehab is a place where your focus is on recovery, and you’re not surrounded by opportunities to drink or use drugs. You also have the support of counselors and your peers who are also focused on their own recovery. But, that’s not the real world and once you leave treatment, you really need to be prepared to face triggers and have a plan. So, I want to get into that today, but let’s back up a little. Dr. Bhatt, how does someone know when they’re ready to leave rehab?
Dr. Bhatt: I think that’s a question that most people are asking themselves when they’re there. When we enter treatment, and when somebody enters treatment they should be working with a treatment team. Hopefully if they’re in a residential rehab which we’ll put in this context where they are physically staying there, usually we start a treatment plan. A treatment plan incorporates achieving certain objectives and meeting certain goals. So, when we follow that road map to recovery, which helps somebody see measurable things occur during their treatment if it is a therapeutic breakthrough, if it is showing additional coping skills, gaining additional insight, getting stabilized on their medications, these are things that are accomplished while we’re in treatment. Also recognizing what is going to be needed for us to be successful in our recovery once we leave treatment and that also needs to be solidified before one is discharged. That entails having a good aftercare plan, and having a good after care road map in place. Addiction being recognized as a chronic illness, something most people are going to live with for the rest of their lives, in terms of trying to maintain staying abstinent from substances, these are things that should be put in place before somebody is discharged. So, you would know once that consensus has come between the treatment team and the patient. And insuring that all of these components have been put together so somebody can maintain long-term recovery. I wish it was so fixed in stone or tangible, concrete, like a check box. It’s not. And many times, people leaving are going to have a healthy level or unhealthy level of apprehension and anxiety because as you mentioned, on the outside- there’s a certain level of buffer or safety of hopeful sterility within a treatment center. It’s natural to be somewhat anxious about leaving it and saying “I’m ready.” But, your goal and your likelihood of being successful is there if you make sure those things that we just mentioned are addressed and in place before you’re discharged.
Hayley: What kind of questions should someone ask their treatment center before leaving?
Dr. Bhatt: It’s important to address and ask the things that I was just talking about in terms of what those components of a proper, safe, healthy recovery environment should look like. And are those biological, psychological, social, and environmental needs met or planned for? In terms of asking a question, it should be not just unilateral, it should be a consensus. Nobody should be engaged in any sort of treatment alone. You’ve got to do it as a team. Obviously if you’ve gone to treatment for any medical, psychological, mental health, addiction issue, you should be working in collaboration with your doctors and therapists. So, it shouldn’t just be just to answer they provide you with something that you all agree on and question as a team. And what I meant biologically is, is somebody on the correct medications that they could be placed on to address any psychiatric or mental health conditions? Or, medications that could help maintain or stay abstinent from illicit substances or alcohol- biological components. Also, their medical condition- are fundamental underlying health care illnesses addressed? And then, from a psychological perspective, in addition to medications, are there therapeutic things that are addressed and at least stabilized, where somebody who might need to continue has those things in place in terms of availability to therapy. Socially, is my environment correct, do I have the right support groups? Are they planned for? Are they coordinated? Do I have a sponsor, if that’s the direction I want to go? And, where am I going to live? That’s the environmental part. Who am I going to be living with? All of these things need to be answered as a team for someone to feel that they have an increased likelihood, a chance to be successful in solid sobriety.
Hayley: I want to talk about sober living homes for a little bit. How do they function and who would they be appropriate for?
Dr. Bhatt: Sober residences, living homes, there’s so many different terms used for a place where somebody may go to, to have a healthy environment in which to stay sober- abstinent from illicit drugs or alcohol. They’re good for people who may be at risk for going back into their original environment that could be one where somebody is using and they need to go to an alternative place which provides pure support, structured living, and a model for somebody to maintain solid sobriety and stay in recovery. This can be different, there’s not one unique individual characteristic people would have. But generally, if you need a safe place, a structured place, people who are around you who can show you and demonstrate sober tools and demonstrate a healthy way of living without using drugs and alcohol and they can be supportive of one another, those people who need that would benefit from a sober living situation.
Hayley: I think it’s important for people to continue counseling or therapy once they leave treatment, but is that something that they have to find on their own, or is that something that a treatment center will help them arrange?
Dr. Bhatt: I would hope in this day and age that treatment centers around the country, around the world are prepared to develop that aftercare program. And for the most part I believe this is happening. People shouldn’t be going to treatment then left to their own account to find these things. A lot of people still haven’t gained proper habits and might not recognize what’s healthy in terms of what’s needed, and that is why we go to treatment, to help direct us, support us, guide us, and help cultivate and prepare us to be successful once we’re discharged. That incorporates having a good after care put in place. An after-care plan should be created and cultivated uniquely, tailored for an individual and a patient, and the treatment center should be providing that.
Hayley: I know it depends on the individual and what substance that they are overcoming, but what kind of medications are often taken after leaving rehab?
Dr. Bhatt: That’s a good question. I think a lot of times there could be some debate on how people perceive medications in terms of helping or enhancing somebody staying abstinent from drugs or alcohol, and when I use the word drugs I’m assuming everyone knows we’re talking about illicit drugs here, we’re not talking about prescribed medications. Aside from medications that are available that can help treat an underlying psychiatric or health condition, see those are things that need to be looked at also, those things that are available like antidepressants, anti-anxiety medications, mood stabilizers to help treat somebody’s underlying maybe depression or anxiety or bipolar disorder, that could be contributing to their use of illicit substances. See, a lot of times people aren’t psychiatrically or mentally stable they often seek out substances to stabilize them. Unfortunately, incorrectly, but they do that. That’s one component. And then there’s many medications available that directly relate to the substances of abuse. There are medications available to help with Opioid use disorders, for example, there are antagonist- anti-craving medications, Opioid blocking agents like Naltrexone. They’re available in oral pill form where you take one pill a day and they’ve shown and demonstrated in research and clinical studies to help decrease someone’s craving and increase the time in between possible relapse, and they help people stay abstinent. Naltrexone is also available to treat alcohol use disorder too. And these are available again orally and in an injectable form that’s given once a month. Alcohol in itself has medications available to remain abstinent. These medications are known as anti-abuse, and these medications can again help with someone staying substance or alcohol free. So, I don’t want to go through the whole laundry list of things that are available, but there are medications that are there and I think it should be incorporated upon part of a comprehensive plan to keep somebody abstinent and healthy.
Hayley: I know obviously relapse is a big concern for people leaving. How do they prepare to face those triggers?
Dr. Bhatt: Putting a good after-care plan in place is usually the proper way to go to help overcome the potential for relapsing. This needs to happen inside while you’re in treatment, hopefully you’ve identified what are those triggers for relapse. And then putting that after-care plan in place to help make that happen, avoiding relapse and being successful. Often times people who are using substances, they have a pattern that’s there of certain persons and places and things, or situations that have led ultimately to substance use behaviors. And in between the persons places things and situations, there’s often certain thoughts and certain feelings and emotions. One of the things I encourage people when they’re in treatment is to explore this in therapy, in groups, and to help recognize within themselves what are those connections? What are those persons places things and situations that might lead to negative thoughts, that might create negative emotions and subsequently cause someone to use. Identifying these things help us recognize triggers when we’re outside of treatment, in the real world so to speak. And then, making that execution through your after-care plan, by making sure that there are proper therapies in place to address those emotional situations, those thoughts that might be ongoing, and creating the proper environment to stay away from those persons or places or things or situations that might provoke somebody to use. These are things that somebody needs to prepare for before and after in order to be successful in their recovery.
Hayley: Okay, I have a question that might be a little tough to answer because I’m sure it depends on the situation. But what if somebody’s family is a negative influence and is something that makes them want to use, does that mean that they should avoid their family?
Dr. Bhatt: I think it’s more not tough to answer it’s tough to execute, because, yeah, they’re your family, and I think the quick answer is you should not be around people that could negatively affect or impact your recovery. And as difficult as it may be, we have to try and not put ourselves in situations where these people can continue to impact and influence us. So, we should not leave this up to the patient alone, the patient shouldn’t have to tackle that situation on their way out of rehabilitation. They need to have that addressed while in treatment, and good treatment programs, comprehensive treatment programs should have addressed this while that patient is in treatment. Engage the family member, bring them in, make sure that these things are spoken about. If I could give an analogy, is if I am in a psychiatric unit and I’m dealing with a suicidal patient and I don’t check to ensure that there’s no firearms in the home, well then, we didn’t do our job to prepare this person to avoid harm. Similarly, if I am treating somebody who is suffering with addiction and they’re going to be going home, and I don’t address what’s in their environment, and that’s including the people. It could be their mother, their father, their wife, whoever- we need to bring them in and we need to identify this and educate them and see if we can solve that problem in advance. That’s really how we should do that. Because the same thing we talk about when we talk to family members of the person suffering from addiction, we talk about setting boundaries and we talk about setting limits, and we ask the family member to make tough decisions. To put somebody with addiction in treatment or encourage them to seek help. Well once that person’s now in early recovery, it’s not fair to them to have to go back into a situation. And that family member might not be an addict suffering with addiction, but just the mere presence of substances and illegal usage of illicit substances is just certain behaviors that can be a huge trigger and we have to decrease that potential as much as possible.
Hayley: From your knowledge of being in this field, what are some of the most common struggles that people face after leaving rehab?
Dr. Bhatt: There’s quite a few, and even though I believe there’s a handful of them, these are things that can be addressed, and we can start out with cravings. Let’s talk about cravings, where people often due to just the physical and psychological habituation of being someone who suffers with a substance use disorder, leaving treatment and then being placed into an environment where they don’t have the same conditions, cravings is a big one. And this is where we help people with medications, if the patients open to it, lower the cravings, diminish cravings. Also help them with cognitive behavioral interventions and therapies to help them diminish craving psychologically. These are things that often are big in terms of what people face when it comes to leaving. And again, the environmental situation, that could lead to cravings. The persons, the habits, the places that they visit, the people that they live with, these are things that often are big ones to have people have triggers. So, again, putting them in a proper environment and that’s where often the recovery residence is, the sober support housing, but these are things that can be there where people can go that can provide a safe environment for them to build on their recovery.
Hayley: Can you talk about the types of support groups that are available?
Dr. Bhatt: This becomes a philosophical thing for many people. Should I follow 12-step? Should I do a faith-based recovery? There are many different ways that people can go, I think 12-step might be the most popular. AA/NA programs, these are things that have led to many people being successful around the world in terms of staying away from drugs and alcohol. And then there are many different modalities that are out there, that often people feel have helped them, and they’re not necessarily 12-step based, so I don’t want to necessarily promote any uniquely, but there are many different support groups that help people focus on things that are important to them that are shared amongst people with similar goals, similar thoughts, and similar outlooks. Usually, the unifying goal is to stay away from things that harm them, to stay away from illicit drugs and alcohol, these are the premises of ultimately the goal for these support groups. Many, many exist around the country and are based on different philosophies, I’ll just leave it at that. I think it’s important though, that people just seek them out. Like-minded people share like-minded goals for the like-minded purpose of staying in recovery.
Hayley: The sense of community I think is so important and that’s also something I wanted to talk about because going through treatment, somebody might realize that all of their friends are just people that they used to use with, and they may come out of treatment realizing that they can’t really be friends with that group anymore. How would somebody go about making new friends, new positive sober friends?
Dr. Bhatt: Often times people develop friendships and supporting cast members while in treatment and in support groups. It’s not an easy journey. It’s not an easy journey when those people who are closest to you could be the ones who are the most dangerous to you. And of course, that takes time. That’s why recovery is a long-term process. When we have become so accustomed to behaving and using and feeling a certain way around certain people, relatives or not, friends, whoever, it’s a difficult thing. So, developing these relationships, often using a sponsor, having a sponsor introduce you to other healthy supportive people. Being in a recovery residence where your peers are having the same goals and are using the same techniques to live healthy and sober lives, these are where friendships are built. Those friendships are built on a common goal, and often people get an introduction to living life and seeking out enjoyment in different ways, and it’s kind of deconditioning what you’ve learned previously, and it often starts with building from within the treatment center. Joining alumni programs, often alumni programs are a great way to network with individuals who have completed treatment, who have completed treatment from the same place and have months to years worth of sobriety, and these people become great support systems for people and great life-long friendships develop from there. It’s definitely difficult, but it’s something that’s necessary and achievable to live in recovery in the long-term.
Hayley: I’d like to talk briefly about health and wellness. Does exercise and eating a healthy diet really matter? Does that really help with recovery?
Dr. Bhatt: That helps with everything. I don’t think we should isolate somebody who suffers with a substance use disorder versus somebody who suffers with a respiratory illness or a cardiac illness. For most individuals that don’t have a contraindication to it, you should be eating healthy. We are what we eat, the nutrition that we provide to our body leads to health, leads to physical health and emotional health. People who are eating badly, who are not providing their bodies with proper nutrition, their bodies become ill. They don’t have energy. Exercise is a great example of discipline and habit. As a result, we look better, we feel better, and it’s proven that those who look better, feel better about themselves, again it doesn’t have to be about aesthetics, it’s about your own goals and achievement and the fact that exercise releases endorphins and makes us feel well and good. It allows people to have transformation observed, which is often something that is extremely gratifying to people. And it’s not necessarily about the way you look, it’s about the feeling that transforms within us, and exercise provides us that- it releases endorphins, it makes us feel good and there’s so much science behind that. When we’re looking for long-term recovery, it shouldn’t just be about the presence or absence of illicit substances or alcohol, but also physically being in proper condition. And that also segways to diet. Diet is the key to our bodies well-being, if we continue to eat badly our body will react badly, and it will develop many illnesses as a result. So, diet and exercise has a huge impact on our physical and mental well-being. It’s highly encouraged. If there’s no underlying medical illnesses that stops you from doing it, you should get physically active and you should eat properly.
Hayley: So, I know I’ve talked about this in previous episodes, but unfortunately relapse is common and it happens. What should somebody do if they relapse?
Dr. Bhatt: I think that’s an important question. People who relapse often feel like there’s a huge moral failing and that’s a reason often to feel guilty and shame, and a trigger to continue to use. And that’s exactly what it isn’t. It is a difficult time for human beings when they put so much time and investment, or not, the fact that they just abused again because it affects us emotionally, psychologically, physically. But, the worst thing that you can do is use that and embellish within it and continue to use. People often times in early recovery, who don’t have the skill sets or let me rephrase that, haven’t solidified their skills, and it’s subconscious, we often use catastrophizing things in order to continue usage. We need a reason to use, and sometimes we are catastrophizing components of our lives, and we use and say okay that’s it. But that can be applied to any sort of behaviors that we are trying to change. It could be somebody who is trying to eat healthy, because they have high cholesterol or diabetes, and they’re like oh I just broke my diet let me continue to eat badly. Obviously sometimes that’s not going to have the same level of significance as somebody whose suffering with addiction, but the premise is the same. If somebody does relapse, if they have an after-care team and an after-care program, support system, sponsor, they need to reach out and activate their rescue mechanisms. If somebody has really done their homework, and invested in themselves, by creating that understanding of the environmental and emotional thinking issues that create usage and promote illicit substance use, hopefully they can catch those things before they happen. But again, once they happen, they need to have before they leave rehab, a plan and that plan should incorporate including supportive members in their lives, and not looking at is as a failure, and getting back on track and often that incorporates reaching out to a loved one, to a clinician, their therapist, their sponsor, a friend. Somebody who is a sober support to help them get back on track. But it should not be a reason to continue to use, even though that’s easier said than done, but the main thing is to activate your support system that you should have in place. Hopefully, again, before you have left treatment.
Hayley: Thank you Dr. Bhatt for going over this with me today. If you want to hear more conversations on addiction and recovery you can listen to more episodes on addictioncenter.com. Don’t forget to check out our other resources while you’re there, and we hope to have you next time for another episode of Straight Talk With The Doc.
Dr. Ashish Bhatt
Addiction Center’s Medical Content Director, Dr. Ashish Bhatt, MD, MRO is an accomplished physician, addiction medicine specialist, and psychiatrist with over 20 years of medical and administrative leadership.
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