Staying sober for the long term requires skills to manage recovery

December 17th, 2018

In February of 2014, Erin Henninger was a 35-year-old woman with many identities. She prided herself as a hardworking veterinary tech with a strong drive to succeed. She was a wife and mother of two young children. One identity, though, overshadowed and threatened all of these. Erin Henninger was an alcoholic.

She’d been drinking heavily since she was a 14-year-old in Bismarck, North Dakota. She drank through high school, through a job as a blackjack dealer, through vet tech school in Denver, and through her high-stress job providing emergency and critical care for animals, through having kids and watching her marriage crumble.

Erin Henninger (far left) with sister Lyndsey, daughter Rylan, son Dylan, niece Aubrie, and brother Andrew during a hike in Castlewood Canyon near Parker.
Erin Henninger (far left) with sister Lyndsey, daughter Rylan, son Dylan, niece Aubrie, and brother Andrew during a hike in Castlewood Canyon near Parker. (Photos courtesy Erin Henninger).

Henninger plowed past many warning signs of alcohol abuse: blackouts, drunk driving, memory gaps, and doubts about her ability to adequately care for her kids. At home, laundry piled up and the sink filled with dishes. At work, she began to doubt her ability to do her job. After work, she stopped at the bar, then headed home, grabbing a beer before she went in to hide the fact that she already had alcohol on her breath.

Deep down, she wasn’t surprised by any of it.

“In my early 20s, I knew this would be a problem that I would have for the rest of my life,” she said. “I knew I was always going to be tied to alcohol. I knew I had virtually no control once I started drinking.”

It was a tough thing to admit. “Anything I’ve set my mind to, I’ve always been able to do, but I just couldn’t kick it,” Henninger said. “I thought there must be something wrong with me. Why was I failing at the one thing that could change my life?”

Road to recovery

But one day in February 2014, Henninger did decide that her life depended on making that change. She entered the Center for Dependency, Addiction and Rehabilitation (CeDAR) at UCHealth University of Colorado Hospital on the Anschutz Medical Campus. Henninger completed a 30-day inpatient stay, a 60-day residential stint, and intensive outpatient therapy. She remains involved in CeDAR’s Alumni and Volunteer program.

Now sober more than four years, Henninger realizes her addiction recovery was and is about far more than abstaining from alcohol. Recovery meant she had to look squarely at uncomfortable truths: social anxiety that resulted from bullying and verbal abuse as a child; conflicts between her desire to work and her responsibilities as a mother; guilt that resulted from it; and stress and drama at her job that fed the alcohol-fueled chaos of her life.

Erin and Dylan on Castlewood Canyon hike.
Erin and Dylan on Castlewood Canyon hike.

“I feel like at CeDAR I got all the tools I needed and the awareness that if I solely focused on only one of those areas – drinking, relationships, job – that I wasn’t going to have a happy life,” Henninger said.

30-day illusion

Erin Henninger’s example points to another truth in the world of drug and alcohol rehabilitation, where hundreds of millions of dollars flow each year from people desperate to break themselves or their loved ones from the vise of addiction. It’s a world that often offers hope and promise of a speedy recovery, even as the evidence points to a more complex and uncertain reality.

Until relatively recently, the standard 30-day addiction treatment stint was seen as a way of saving the lives of individuals who had hit rock bottom, said Dr. Patrick Fehling, an attending psychiatrist at CeDAR. That view today is “old-fashioned and archaic,” he said.

“The new way is to look at addiction treatment as chronic disease management,” Fehling said. “It’s not like giving someone antibiotic treatment. It’s more like treating diabetes.”

That means giving people the tools to manage their recovery over the long term, Fehling added, and helping those like Erin Henninger to recognize that “progress is gradual and that they often have to stabilize their lives on a lot of battlefronts.”

CeDAR’s approach to recovery is built on three fundamentals: clinical care for both medical and psychiatric issues; education and training to increase the base of people trained to fight addiction; and research to expand understanding of the disease, said Director of Clinical Quality Harlan Austin.

The multidisciplinary approach, which involves not only clinicians but a growing community of people in recovery who want to help others battling substance use disorders, is necessary for a very basic reason, Austin said.

“Addictive disorders are killing people in large numbers,” he said.

Indeed, drug overdoses claimed 72,000 lives in 2017. Alcohol takes an even greater toll: 88,000 deaths annually. The National Institute on Drug Abuse (NIDA) estimates that substance abuse costs the United States $740 billion annually – a whopping total even when $300 billion related to tobacco use is subtracted. The $78.5 billion attributed to prescription opioids is based on 2013 data. A more recent analysis places that burden at $95 billion.

Small wonder, then, that there are some 14,500 “specialized drug treatment facilities” in the United States, according to NIDA. The Substance Abuse and Mental Health Services Administration (SAMHSA) reports that the number of opioid treatment programs alone grew by 39 percent between 2003 and 2016.

Erin and Rylan on a camping trip outside Keystone.
Erin and Rylan on a camping trip outside Keystone.

Yet NIDA also reports that relapse rates for substance use disorders range from 40 percent to 60 percent, similar to chronic diseases like asthma and hypertension. That statistic alone demonstrates that individuals and their loved ones must think carefully before they commit to treatment that easily runs into tens of thousands of dollars, Austin said.

“Treatment must be something proven to be effective,” he said. “Historically that has not always been a strong point in the industry.”

Fact-based approach

Some facilities, for example, base their claims of effectiveness on the percentage of patients who complete a 30-day inpatient treatment regimen. By contrast, Austin noted, CeDAR uses a variety of evidence-based, five-year outcomes measures of recovery spanning addiction severity, mental health, trauma, social connection and spirituality (see box). In addition, CeDAR maintains and regularly updates a website with a broad collection of educational materials and information about its range of treatment programs.

“There is no ‘secret sauce,’” Austin said. “We are willing to be open and transparent about the services we provide.”

As part of UCH, the Rocky Mountain region’s only academic medical center, CeDAR also approaches addiction treatment as a dynamic field driven by trained specialists and those who learn from them. For example, CeDAR provides medication-assisted treatment (MAT) with Suboxone and other drugs designed to ease withdrawal from opioid addiction. Some treatment facilities insist on abstinence and attach a stigma to MAT, Austin acknowledged, but he noted that the American Psychiatric Association and NIDA both view the therapy as a proven step on the road to recovery.

In battling a “chronic, relapsing disease with multiple entry points” for individuals – genetics, depression, anxiety, trauma of many sources, social pressures, and so on – CeDAR draws extensively on the insights of “new minds and fresh perspectives,” Austin added. It offers fellowships in addiction medicine and addiction psychiatry, as well as psychology internships, rotations for medical students and master’s-level internships.

“More integration of different perspectives and more minds at the treatment table make for a better program,” Austin said.

Integrated care at CeDAR extends to helping individuals build what Austin calls “recovery capital”: a holistic approach to health that includes not only abstaining from substances, but also finding personal spiritual meaning and exercising to restore physical vitality.

Ongoing support

CeDAR also stresses the importance of helping those in recovery build and maintain relationships after they complete their treatment program. The five-person Recovery Management team includes three recovery coaches and alumni and volunteer support.

For Erin Henninger, the Alumni and Volunteer program has provided “a little bit of a home base” and a regular opportunity to share experiences with other people in recovery who have returned to their communities to rebuild their lives.

Erin with Rylan and Dylan at a lacrosse tournament at the Air Force Academy.
Erin with Rylan and Dylan at a lacrosse tournament at the Air Force Academy.

“That’s important because recovery exists really well in a vacuum, where you don’t have any other influences,” Henninger said. “But that’s not real life.”

Meghan White, CeDAR Alumni and Volunteer Coordinator, says her job boils down to helping people in recovery build bridges to others – citing an oft-quoted observation from British author Johann Hari that “the opposite of addiction is not sobriety. It is human connection.”

It’s hardly an abstract belief for White, a recovering alcoholic and CeDAR alumni. After a series of DUIs and a serious auto accident caused when she blacked out at the wheel, her attorney suggested that she seek alcohol treatment, and she willingly complied. She entered CeDAR in the spring of 2012 and completed a 30-day inpatient stay. She then served a six-month jail sentence and emerged in February 2013 frightened but determined to stick with sobriety.

“I had to build my life back from ground zero and get back into life and apply what I had learned,” said White, who is approaching her seventh year of sobriety in December, an anniversary she values as a mark of redemption and positive growth after the DUIs and jail time. She returned to CeDAR, not as a patient but as a staff member, beginning in admissions and moving on to the Alumni position a little less than a year ago.

“I knew early on in treatment that it was a field I wanted to go into,” White said. “A certain responsibility kicks in for those in recovery. I wanted to be a support and a beacon of hope for other people who are trying to navigate their ways through early recovery and for folks who are still ambiguous about it. They know they need to make a change but still have crippling fears about making that change.”

White acknowledges she’s still in the relatively early stages of rebuilding the Alumni program, which has long been an important block in CeDAR’s therapeutic foundation. She began with an open house that drew alumni back to meet, reconnect and share experiences and continues to reach out to her “constituents” through a newly formed Alumni Committee. A longer-term goal is to redevelop a CeDAR Alumni Peer Support (CAPS) program that would offer those who are interested “levels of participation,” including phone outreach, direct support to former patients and peer coaching certification for individuals who want to get into the recovery industry.

Underlying it all is White’s realization – shared by CeDAR colleagues – that those in recovery need “unconditional support and encouragement” as they travel uncertain paths to the future.

“During treatment there is a lot of education into the disease of addiction,” she said. “We learn skills and tools, but eventually it is time to apply everything we have learned. That can be rough because there are so many things you can’t account for. There is always the variable of other people, triggers, and cravings. No matter how much you plan, you can’t take into account those situations that you might be presented with. It’s trial and error, but we’re inclusive no matter what pathway you want to take. There is a place for you.”

Life, rediscovered

With ongoing support from CeDAR, Erin Henninger has found a new place in the world. She helps with the Alumni and Volunteer program, works part-time for the Colorado Crisis and Support Line, is one semester from earning her bachelor’s degree in psychology from Metropolitan State University of Denver, and plans to begin a master’s program in counseling. She understands from her time at CeDAR that recovery is a process, not an end point.

CeDAR outcome measures

CeDAR Director of Clinical Quality Harlan Austin cites the following as a partial list of five-year outcome measures used to assess patients’ treatment success beyond completing a 30-day inpatient stay. Each, he says, has improved over the five-year period, as have measures of improved social connection and spiritual awareness.

  • Addiction severity scores show significant improvement for alcohol and drug use disorders at 30 days and at 6, 9 and 12 months. (Addiction Severity Index)
  • PTSD severity scores move from “Clinically Significant” to “Not-Clinically Significant” during retest at 30 days. (PTSD Checklist)
  • Depression scores are reduced from Moderate to Mild in 30 days, and further reduced to Minimal at 90 days. (Patient health Questionnaire 9; Depression Screen)
  • Anxiety scores are reduced from Moderate to Mild in 30 days, and further reduced to Minimal in 90 days. (Generalized Anxiety screener)

“At 30 days of treatment, I felt like I had been cracked open,” Henninger said. “Some outer layer I had built up over the years had been taken away, but I had barely scratched the surface of what was going on with me.”

She dug deeper with her 60-day residential stay, outpatient therapy, alumni work and education, all the time driven, she said, by a willingness to change.

That, and a commitment to forging “caring and honest relationships” gives the providers at CeDAR a solid foundation for helping people shed the grip of addiction, Fehling said.

“Recovery is about relationships, love, freedom, healing, honesty and becoming a good steward of one’s own health,” he said. “We put power back in the hands of people to choose.

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.