The Importance of Medical Detoxification for Opioid Dependence

Dwight Hurst, CMHC: So, Clare, what are some of the things that make medical detox important?

Clare Waismann, CAODC: I think now that we have finally accepted dependence as a medical condition, a physiological condition. I see no reason why doctors should not be the ones treating it. And also because we have also understood that suffering does not equate, you know, recovery or sobriety by no means. So before people used to say, “Oh, if they don’t suffer, they will not know the value of being sober. But actually, we see that more people do not get sober because of the suffering than the latter.

Dwight Hurst, CMHC: Yeah, I think that there’s some hanging on sort of moralistic thinking there. Right? To where if you’re abusing substances, you’re naughty. If you’re using drugs. Right? So you ought to be punished. I, I feel like that. I want to hang on for a long, long time. It’s like, yeah, there’s that kind of a draconian attitude that sometimes went into that.

Clare Waismann, CAODC: I think it changed a bit. Once we had the issue with the prescription pain opioids. But what I don’t understand is why it happened when there was physical pain involved and why medically assisted detox, what was not an option when there is emotional pain involved.

Dwight Hurst, CMHC: Do you think that’s that was a while going where medical detox was available, but not respected or appreciated yet? I mean, what was the length of time there that before people start to catch on, “Oh, this exists and it is a good thing and not just good, but necessary?

Clare Waismann, CAODC: Listen, I think it’s still the majority of people are against it. The majority of people still believe to allow somebody to withdraw and then I’ll teach them a lesson. Make them get up and tag themselves in a four head as an addict. So I think the old values, you know, judging people and making them pretty much pay the price. It’s still used in a lot of different treatment programs, sadly enough.

Dwight Hurst, CMHC: You’re really against labeling, right? That’s one thing I know about you.

Clare Waismann, CAODC: I am, not just in the addiction field, but in any field whatsoever. I mean, where you are right now, you know, it has nothing to do with who you are. This is just a moment of your life, you can stay in it and become dead or you can change it. But I can’t judge you by the worst time of your life. That’s unfair. That’s actually removing hope from people.

Dwight Hurst, CMHC: And addiction amplifies that, too, because the things going really bad, then you take things that impair judgment and, you know, cause and effect understanding and put people into a crisis mode all the time. Then our worst is going to really be our worst when we’re in that place. Correct?

Clare Waismann, CAODC: And that brings us back to maintenance drugs (MAT) that keep people in that state of not being able to make clear decisions. Right? Not right. Not wrong, but clear decisions.

Dwight Hurst, CMHC: It’s not just medical or non-medical. There’s the kind of the appropriate use and the appropriate application of medical things. You know, there are some of the drugs that treat dependence and withdrawal symptoms. And I know we’ve talked a lot about how some of those are better used short term. And then you have some more health management strategies that seem to go better long term. And but then some people go on a replacement drug for long-term and they know that that’s not something that that is generally something you’d endorse.

Clare Waismann, CAODC: Correct. Generally correct. Nothing is 100 percent. Everybody has a different history and definitely different needs. But generally, yes, I think, you know, people should have the right to be free from anything that holds them hostage of a situation.

Dwight Hurst, CMHC: Even for so many people the original problem originates with a prescription. You get a lot of people who’ve never really been substance users or abusers that then get a prescription that gets out of hand. Yeah. I’ve never really asked you that. Do you have feelings about the general use of opiates?

Clare Waismann, CAODC: I think opiates, like everything else in the medical field, as we learn more and more, I think they’re great drugs for, you know, immediate relief of pain. But they are not really supposed to be long-term drugs because consequences of long-term opiates, including for pain, are very negative and very risky for the person. So it affects every organ. So I think for the short term, it works wonderfully. But, you know, if the patient has a long life to live, if the patient has responsibilities, if the patient will still have pleasure, it’s not a long term drug, it shouldn’t be. It’s living with some kind of discomfort. Listen, we all have discomfort. I mean, if I sit here right now and think about, you know, what hurts me, I can give you 10 different things.

Clare Waismann, CAODC: So it is true. The older we get, you know, the more discomfort we have is how much we concentrate on that. I’m not undermining the people that have, you know, acute, intense pain. Some people really, really have, you know, severe pain. Although opioids are found again, in most cases, not to help that long term as well, because it causes hyperalgesia.

Dwight Hurst, CMHC: And finding different ways to manage it, like you say, a long term use of that. Sometimes they have the opiate-induced analgesia as you say, that actually will cause pain eventually or becomes, as you put it, the suffering will deter people from getting better a lot of times. And people will avoid stopping their usage. And in many cases aren’t actually chasing a high and haven’t been chasing high for a long time. They’re just trying to avoid the pain that’s going to come. And I think sometimes when people look at that and they say, oh, well, they’re just trying to avoid, you know, the consequences their actions are just trying to avoid. I don’t think people quite understand that we’re not talking about just kind of “Ouch! I’m kind of uncomfortable. I have some flu-like symptoms.” It’s much more serious than that, right?

Clare Waismann, CAODC: Oh, yeah. And it’s not just the withdrawal. So you have somebody, you know, suffering through withdrawal. A lot of people say, “Oh, withdrawal is not a big deal down. Five days, seven days. I can get through it.” Not really. By at times if you make it through those five, 10 days of total misery, now you’re depleted of so many nutrients, fluids, your whole body is so dysregulated that it makes just living very, very difficult. You are hypersensitive. You also have no endorphins. So you’ll feel everything very intensely, from light to discomfort to pain patients. They feel like they’re going to crawl out of their skin. And that can take weeks with some opiates, even months, not allowing them to get medical assistance through that period, not just keeps them from looking into treatment, but also scared of failing treatment.

Dwight Hurst, CMHC: That’s a whole emotional perspective for people to have, even beyond some way beyond the physical pain. Do you think that’s in some cases even more important? Do you find the emotional fear of failure, of letting people down?

Clare Waismann, CAODC: Oh, of course, of course, they know by the time they call, they have been through four or five sick treatment centers, and in their words, they “failed”. Where I think most of the time the treatment failed, the patient. Of course, sometimes the patient does fail. And when you say fail, what is fail? They just were not able to complete the path that was written for them.

Dwight Hurst, CMHC: And interesting initialing concept do when you bring that up, it immediately comes to my mind trying to think of any other medical situation where we’re like, well, you know, you failed. I mean, I guess you might have doctors, some kind of diet or something. A cardiologist might tell you to lay off saturated fats and all. You’re not doing the thing. But I don’t know that most of them would sit there and be like, you failed. You just didn’t have the wherewithal. I don’t know if that’s what they would lead with.

Clare Waismann, CAODC: And by the way, if they are, you know, having problems with their knees because they’re overweight and they in parenthesis failed the diet or any other physical issues that cause pain, they don’t tell them, “Deal with it because you eat too much when I told you not to. They still will give them the proper medical care for the symptoms they are having.

Dwight Hurst, CMHC: Yeah, you know, that’s a really good point.

Clare Waismann, CAODC: The punishment is just, you know, in dispute in the addiction field.

Dwight Hurst, CMHC: Yeah, if we reserve that kind of rejection and cruelty for people who have an addiction problem, apparently. Correct? That’s one of the things that I feel reassured and confident after I have conversations with you and we record this show. I’m. It reminds me a little bit of like. Oh, yeah. Right. Look, this is a hospital is a medical environment. It’s. And it helps it. That even helps me when I talk to people that are having addiction problems to say, are you looking at that the right way? Are you characterizing this in your mind as a medical problem or are you just labeling yourself as that failure that I just can’t do life? Well, and so therefore I that’s who I’m destined to be.

Clare Waismann, CAODC: Listen, some people, as you know, they don’t have the tools needed to deal with negative emotions. The tools to deal with stress. For one reason or that or another, because of learned behavior or social environment, whatever it is, it leads them to substance abuse. Not allowing them to be free from the substance doesn’t allow them to start the process of learning how to cope with these behaviors, how to cope with these distress, distressful moments. And it’s not just opioids, you think, it is alcohol, anything. If you’re able to get them off the drug, if you’re able to manage the physical craving, now you have somebody that is emotionally present to participate, whatever therapy or even treatment if needed.

Dwight Hurst, CMHC: You talk about the risk of not having detox available. You know, the obvious risks are the ones we focus on going through the the the withdrawal process. The other is the pain and the observable sickness and even the risk of death. But as we’re talking now, it’s got me thinking about other risks that they’re actually in some ways. I’m going to say they’re at least as important. I mean, I guess, you know, if you die, if your life ends.

Clare Waismann, CAODC:  Overdose, of course. What about the destruction of your life, your personal life? Your wife left you. You know, your kids have no respect for you. You lost your job…

Dwight Hurst, CMHC: A risk to your quality of life it’s in some ways is even worse than the risk to your actual physical existence. You have to be alive to have a real life. But it is not worth living if we aren’t if we don’t have a life worth living.

Clare Waismann, CAODC: You’ll have nothing to come back to. You know, I often get the parents. They say, “Well, they told me to wait until they hit bottom.” And I tell them, “Where is the bottom?” Who decides where the bottom is? And once they get really down to the bottom, it’s gonna take a lot more work to come out of it. So why would you?

Clare Waismann, CAODC: There are certain things that you can’t reverse. There are certain things in life that people go through, that stay with them forever. And then you just might be giving them another reason to self-medicate.

Dwight Hurst, CMHC: Do you find a lot of people contact either family or parents of those that are struggling? Do they contact you guys to find out information about detox and are not necessarily the one using themselves?

Clare Waismann, CAODC: They do. Usually you know, when you’re talking about, you know, the twenty, twenty-eight year-olds. Yes, they do. The parents do. But one of the main questions for me is the patient willing to come? Are they looking for a treatment? Are they looking for a way out? If not, it’s difficult for everybody involved. So we will need to make sure the patient knows what are they going to receive and make sure that they are willing, not always ready, because, again, most of the patients are not ready to deal with life on life’s terms. So that’s up to us to find the appropriate support.

Dwight Hurst, CMHC: Yeah, I always think “Ready” is a really tricky, tricky term with anything, any transition in life. You have to… I think… I don’t think any of us are ready for major transitions in life. I think the goal is to be ready enough to take the risk.

Clare Waismann, CAODC: Absolutely right. I was going to say, if you ask any of us right now, you know, in January, “Are you ready for what’s coming?” I guarantee you 99.9% would say, “God, no! Not a chance. I can’t survive that.”

Dwight Hurst, CMHC: Well, I think that applies to most things in life, too. Right? You say, are you ready to start a life with someone to get married or have kids or even to take an educational or career kind of a step? A lot of times. Sometimes, yeah, we might feel like we’re we’re definitely 100% ready. But I think a lot of those things we have to just say, “You know, when I’m ready enough, I can go and then I’ll see what happens and I’ll deal with it and go with that. I think that, ah, if someone is ready or desiring treatment, it is a much better metric than, “Hey! Has your life fallen apart much, you know, you compare that idea of hitting bottom versus “Are you interested in getting treatment?” Which is much more of a medical outlook. The second question then, “Hey, did your life get jacked up enough that you feel bad?”

Clare Waismann, CAODC: It’s I think it can be compared to the diet story. You know, are you ready to start the diet? So I think when you say are you ready to get treatment, what does that mean? Am I ready to go 30, 60 days, 90 day stays, or am I ready to come off the drugs and then do whatever I need to do to live a healthy life? Think that’s a better way to look at it, like at least a more actual way to look at it then. “Am I ready to get treatment?” “Am I ready to live life as a productive human being?”

Dwight Hurst, CMHC: Yeah. You tend to look at it as what do you want to bring to the table of your life or do you want to add to it instead of just taking away drugs, which is part of the problem? A lot of times people hear this throughout their life is like, just stop it. Stop doing that. Take away the drugs. Take away the alcohol and everything. Be fine. It’s like, well, probably not really, because there are reasons that that that all came up in the first place and need to not only take that away, need to add I need to add some happiness and some health and some skills and you know, all of those things. I kind of wonder when people come to contact you, they pick up the phone and call someone like Waismann Method^®. And are they still gathering data? As far as whether or not detox is something that they should do or whether or not it’s good, or do you find that they’ve decided or are still deciding at that point what to do?

Clare Waismann, CAODC: I would say most of the time they have decided they’re gathering information and what the detox is all about. They’re gathering information on detoxification options, risks, and success. But I think most people really that call us, they are ready to put the dependence behind him. Most people, not all people.

Clare Waismann, CAODC: There are some people that are just so scared to live life on life’s terms that sometimes when they call, they are calling, sadly enough, to prove to somebody else that they can not be without the medication. The good news is sometimes even those who come in order to prove they know that they do need the medication to survive, find out that is not so bad without it. So that’s the hope. You know that even if they do relapse, that they know that that week or 10 days they were with us. It didn’t feel so bad. Amount of hope there where it was everything very dark before there’s treatment packed into it.

Dwight Hurst, CMHC: Well, one of the things that’s really impressed me about the way y’all approach it is that there’s treatment packed into it, that you look at it and say, well, we have a short amount of time with our patient. Instead of saying, oh, here’s the one service you came in for detox. There you go. Like some clinics actually do that. You kind of look at it like, oh, you’re here. This is our time with the patient. We’re going to try to make them healthier when we’re done with them. I think that’s very powerful.

Clare Waismann, CAODC: Is it is I think, you know, physically feeling well and being able to clearly think helps you mentally and emotionally as well and sitting with somebody and discussing, you know, their options, their future. You know, even their dreams, you know, and how they could achieve that. You know, supporting them through that time, I think is extremely important. It’s just a feeling hurt, feeling cared for. So everything we say, everything we call treatment, it creates a certain theory of what’s right and what’s wrong. There is no right. There is no wrong. And there is human beings of different needs. And if you do have a physical issue, you should be treated by a physician. If your physical issue also caused or we don’t know who is the chicken and the egg. Right. All right. Emotional issues. Then you should have a doctor and a therapist. And now if you do want support – by friends, family or other people, that have been in the same situation. That’s great as well. But those are three different things altogether.

Dwight Hurst, CMHC: And none of which are mutually exclusive from the others. I think if people look at it and say, what’s the right way to go or the right way to go is get as much treatment as you can access that you’re willing to do and able to access, you know, whatever is available to you.

Clare Waismann, CAODC: So you would be amazed, you know, how many families put together in order to get their family members treated in the hospital instead of a room.

Dwight Hurst, CMHC: Mm-hmm. So you’ll see people that’ll do even because stereotypically people would think of a program like Waismann Method to be really high cost and so therefore exclusively people with a lot of means. But you’re saying there’s a lot of people that will push together funds and because of the value.

Clare Waismann, CAODC: Absolutely. Yeah, absolutely. Yeah, but there is truly there is too much treatment. There’s always too much of something.

Dwight Hurst, CMHC: Yeah, no, that makes sense. And I’ve seen that too. Or someone becomes a frequent flyer to the treatment culture almost a little bit too much, and that becomes their whole thing.

Clare Waismann, CAODC: Yeah, and of course, I like it, but let’s make it an example. You have a young man. Twenty-five, twenty-six years old, did not have any issues. I mean, any major issues growing up and went to play football in college or whatever. Got hurt. Started taking opioids. Life went upside down. He is a year away from getting his degree. You know, I had great prospects in life. Should he go to treatment, detox, then treatment, then sober living? Then outpatient, or should he get detox, get, you know, emotional assistance and treatment to go back to a productive life and finish his school and become a productive member of society.

Dwight Hurst, CMHC: It’s a good point. There’s a reason where I’ve gravitated to working in outpatient therapy is most of my career because I feel like when I worked in residential and inpatient facilities, they’re really good programs. Many of the ones I worked for and they were necessary. But everybody has to do outpatient medical care at some level before, after or instead of the more intensive. Right. And so that’s going to be there no matter what. And so, yeah, that when you talk about that for me, if it was my son we’re talking about or if it was me, if it’s at all possible to say, let me get some medical stabilization that doesn’t tank all of those things, you said if it’s possible.

Clare Waismann, CAODC: Right. Right. Right. So that’s what I’m saying too much treatment is possible. Too little is often possible, but too much is also possible. Again, there shouldn’t be a preset protocol. There should be a very good health evaluation of the person in front of you. And a detailed plan, an attempt to give them a healthier and happier quality of life if possible. Period! Without any preset judgments or protocol. And that I think is one of the biggest issues in the treatment world is, you know. Oh, we’ll tailor for you. You’re not tailoring. If you’re telling them you have to be here 60 days, it doesn’t matter if your whole life is gonna fall apart. And then you have to do this for 30 days and then you have to go to a meeting with the other hundred people. That’s not tailoring.

Dwight Hurst, CMHC: Well, for the people who’ve never really experienced working in a field like this are seeing it. How would you describe what it’s like to be part of this with somebody? When somebody comes in and you’re part of their treatment and you see them go through the detox? How does that affect you? What does it feel like to you?

Clare Waismann, CAODC: It’s something that I think throughout the years has changed throughout the years. When you get to know people what you see them succeeding or you see them failing, it becomes quite personal. What could we have done better? On the other hand, when they succeed and they’re so hopeful and thankful and grateful? How can we make them feel all those things about themselves and make that victory theirs and not ours? Because truly, we’re just, you know, a tool. But they are the ones doing the work. I guess it gives you a perspective of the idea that we are not that powerful. We are just one person in somebody’s life being there for them and helping them to get where they want to be, period.

Dwight Hurst, CMHC: Waismann Method^® podcast is a product of Waismann Treatment^® specialists, which you can follow on Twitter @opiates to learn more about us. Or emails at info@opiates.com. Please consider going over and giving us a great review on Apple Podcasts or whatever program you use to listen to your shows.

Dwight Hurst, CMHC: Please share this show with a friend if you’re willing to help us to share the good word about treatment for dependence and help people to make good decisions about the treatment. Our music is Medical by Clean Mind Sounds. The show is edited and produced by Poped Collor Productions, a company that specializes in helping health care professionals, nonprofits, and others to find creative solutions through podcasting. Tune in for our next episode. David Livingston and I will be talking about what constitutes therapy and what constitutes moving towards a healthy, happy life. And recovery and treatment. It will be really exciting to have you here, as it always is. Always ask questions, because when you have questions, you can find answers. And when you find answers, you find hope. Thanks for listening. Bye-bye for now.