[Paul Matwiow, LMHC, CASAC is a therapist and addiction specialist in private practice with an office in Callicoon, NY. Many of his clients face problems directly or indirectly related to issues of addiction from alcohol to other substances.]

The River Reporter (TRR): How powerful is addiction? Why is it so hard to overcome?

Paul Matwiow (PM): Addiction is an obsessive-compulsive disorder—the obsession to use and the actual compulsive use of the substance(s). With treatment, addiction can go into remission. The obsession can go into the back of the mind, if you will, and recovery takes its place in the front of the mind, but there is always the possibility that the obsession can later rear its head. We don’t cure addiction; we hopefully get it into remission and keep it there. A lot of people don’t understand this, that addiction is a chronic condition. A person in recovery might say, “I haven’t drunk for three years,” or “I haven’t used drugs in two years. Life is better. I know the pain of active addiction,” and yet there comes a moment when somehow the person rationalizes picking up a drink or a drug again. Say there’s a celebration, or there’s a tragedy, or it’s a sunny day, and in that moment, there’s a blank spot where all of the pain of active addiction and all of the positive aspects of recovery are pushed aside, and there again is a drink in hand, a pill in the mouth, a needle in the arm. That’s the tremendous power of the obsession to use.

Addiction is a progressive illness. In brain images and scans we see that when somebody uses for a considerable time, changes happen in the brain. In simplistic terms, the brain lays down new wiring. The brain learns to operate in the presence of these substances, and it can adapt so well that eventually your body physically needs it. In fact, if you don’t give the body that particular drug or alcohol, it’s going to go through withdrawal. The body needs it to function.

TRR: With the hard drugs we’re seeing now—heroin and oxycodone—is that physical addiction even more powerful?

PM: The rate of addiction, the body’s cellular adaptation to the presence of drugs varies substance to substance. Yes, the opiates are very addictive—heroin, Vicodin, Percocet and the other opiate derivatives. This may sound odd to say, but on one level I’d rather have a crack addiction than an alcohol addiction because in general I’m going to get addicted much more quickly, I’m going to hit a bottom quicker, and hopefully I’m going to do something about it quicker. Some drugs like alcohol can have a much, much slower progression; it can creep up initially unnoticed, sometimes for years, added in the fact that it’s legal and it’s a cultural norm to drink. So in general yes, some drugs like the opiates can act more quickly in the development of addiction.

TRR: How do you work with people in crisis?

PM: The first thing we do is a comprehensive evaluation in order to make an accurate diagnosis and then to be able to make an appropriate treatment recommendation based on the person’s needs. The next consideration is, what are the available resources for the treatment recommendation? If someone needs to be in-patient detox, what is the best place for this person? If an intensive out-patient program is needed, where would I refer this particular person? Given the extent of the alcohol and drug problem in Sullivan County and the available resources here, we definitely need more services.

TRR: What about a family that’s in crisis? Somebody’s just really falling apart because their loved one’s life is being destroyed.

PM: Yes indeed; it’s not just the person using that has the problem; it affects the whole family. Whole systems— family, co-workers, friends—everybody is affected. One of the first things I recommend to the family is to engage in a self-help group, AlAnon or NarAnon, where they will get support from others going through similar challenges of coping with an addicted family member. There’s something powerful about not being alone in this. Additionally, supportive family counseling can be very helpful. Families need support, and they also need to set boundaries. This is a hard one, but the idea of setting limits, not protecting the person from their addiction (we’ve probably all heard the phrase “don’t enable the addiction”). That’s a tough one. I once worked with a family member of a crack addict and every time they came home, there was something missing—the TV, the microwave—and finally, this was not an easy thing to do, they changed the locks. And that’s not turning your back, that’s protecting yourself and helping that person, whether sooner or later, hit that bottom, when he or she has had enough and sees that “I’ve really got to do something about this.” Interestingly, if a family is taking care of themselves by setting boundaries this often prompts the person to seek help.

TRR: Is there something else you’d like to say to be helpful to our readers?

PM: I would emphasize this: address the addiction sooner rather than later. I would say that about any mental health issue, depression, anxiety, obsessive/compulsive behavior, because they can be progressive over time. All experience and research show that the earlier one addresses a substance-use disorder the greater the likelihood of a positive outcome. I would encourage not only the user, but also the family to get educated both about addiction and the recovery process. The other thing I would emphasize is to remember that addiction is a chronic illness. In recovery, the compulsive use is in remission, the obsession remains, and without on-going attention to that reality, relapse can occur. This is one of the reasons why people with many years recovery continue to attend NA or AA meetings.

And last of all, the good news is recovery is possible; there is help available. I urge people wrestling with addiction issues to seek it out sooner rather than later.