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What to Know About Addiction and Drug Rehab in Hawaii

When you’re in the throes of a substance use disorder, it’s easy to feel that there’s no way out. As your world narrows and revolves more and more around alcohol and/or drugs, you might begin to feel that life is unbearable with or without substances. But if you’re ready to make a change, know that you don’t have to do it alone. If you’re a Hawaiian in search of drug rehab, plenty of help is available in the state.

A Look at Substance Use in Hawaii

Although some drug use trends in Hawaii are similar to those of the mainland United States, there are some key differences that set it apart from other states. For one, while many areas in the country have struggled with opioid abuse, this issue has been less problematic in Hawaii. In fact, according to the 2019 National Survey on Drug Use and Health (NSDUH), Hawaii’s rates of opioid use disorder are lower than the national average. When singling out heroin use, the rate among Hawaiians 12 and older is also lower than the national average.

This is not to say that Hawaii doesn’t have a drug problem, however. The number of people in the state who reported using illicit drugs in the past year was higher than the national average, but many of these people are using methamphetamines. For at least 30 years, Hawaii has been struggling with high rates of meth use. Today, the drug continues to be one of the most prevalent drugs of misuse in the state, second only to alcohol. The recent pandemic has further contributed to the problem and led to an increase in the number of drug users in Hawaii turning to meth to deal with stress.

As mentioned, the rates of meth use in Hawaii are second only to Hawaii’s rates of alcohol abuse. The 2019 NSDUH found that 6.3% of Hawaiians, or approximately 73,000 residents, had an alcohol use disorder (AUD). This is higher than the national average of 5.3%. On a positive note, the rates of AUD in Hawaii are down 1.5% from 2004.

Each year, several thousand people in Hawaii seek treatment for drug and/or alcohol abuse. The majority of these are seeking help for drug use only, but a significant portion struggle with both drug and alcohol use. Regardless of a person’s substance of choice, treatment is quite similar and includes examining the root causes of addiction and finding new coping mechanisms for managing them.

What Causes Substance Use Disorders? Why Seek Treatment?

Contrary to what some people might say, substance use disorders do not develop by choice. Current research indicates that genetics, developmental factors, and environmental factors combine to determine whether someone develops a substance use disorder (SUD).

Some people develop SUDs while trying to cope with mental health diagnoses. This is known as dual diagnosis. For example, bipolar disorder is highly correlated with SUDs. The same is true for many other mental health disorders and drug use. Trauma (with or without an official post-traumatic stress disorder diagnosis) also greatly increases your risk of developing a substance use disorder.

The bottom line is that substance use disorders aren’t as simple as they may seem from the outside. True recovery doesn’t just mean stopping drug or alcohol use; it also involves examining contributing factors and managing them.

When you seek professional treatment, you don’t have to take on this complex problem alone. In drug rehab, a team of professionals can work with you to tackle your substance use disorder from all sides, help you develop healthy coping skills, and enable you to move toward a better life.

Do You Have a Substance Use Disorder?

The Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychiatric Association, includes the diagnostic criteria for every recognized mental disorder. It’s updated periodically to reflect current research.

The current edition, DSM 5, recognizes that substance use disorders fall on a spectrum. There are 11 different criteria that physicians look at when evaluating someone for an SUD:

1. You take more of a substance than you intend to.
2. You want to use less of the substance or stop using it, but you don’t seem to be able to.
3. You spend a lot of time obtaining the substance, using it, or recovering from use.
4. You experience strong cravings to use the substance.
5. You aren’t able to do what you need to in school, at work, or at home because of substance use.
6. You keep using the substance even when it causes trouble in relationships.
7. You find yourself giving up important work, social, or recreational activities to use the substance.
8. You continue to use the substance even when it puts you in danger.
9. You keep using the substance even if you know you have a psychological or physical problem that the substance caused or makes worse.
10. You have built a tolerance to the substance (need to take more to get the same effect).
11. When you don’t use the substance, you experience withdrawals. Those withdrawals prompt you to use more.

Not everyone experiences all of these. When a clinician evaluates someone, they can use how many criteria a person experiences to determine the severity of the substance use disorder:

• Two to three symptoms: mild disorder
• Four to five symptoms: moderate disorder
• Six or more symptoms: severe disorder

Keep in mind that only a qualified clinician can diagnose a substance use disorder. But if you recognize yourself in the symptoms described above and want to stop using, a drug rehab facility will likely be able to help you. Before beginning rehab, however, you’ll need to safely withdraw from substances.

Withdrawal: What You Should Know

Before you begin an inpatient or outpatient treatment program, you will need to undergo the process of detoxification. In detox, you will receive medical attention and supervision while coming off any psychoactive substances.

It may be tempting to taper off drugs and/or alcohol on your own, but this is not a good idea. Withdrawal from some drugs, especially alcohol and benzodiazepines, can be fatal. With a medically assisted detox, you can minimize the painful or unpleasant effects of withdrawal while dramatically reducing your risk of serious complications.

Even if you aren’t able to attend an inpatient treatment program, it may be worth looking into inpatient detox. Once your risk of serious medical complications has passed, you can leave the detox facility and attend outpatient therapy if you prefer.

If inpatient detox is not something you can do, it’s still wise to reach out to your physician. In some cases, a doctor may be able to prescribe medication to prevent some of the dangerous effects of withdrawal.

What Kind of Help Is Available in Hawaii?

Each person’s substance use disorder is different. So, it makes sense that there’s no single solution that’s best for everyone. Depending on the severity of your substance use disorder and other constraints, you can choose from several levels of care.

Inpatient Rehab

This is what most people think of when they imagine drug rehab. In an inpatient program, clients live on the premises and receive 24/7 care. Many residential treatment programs are on a dedicated campus and aim to help you holistically manage your substance use disorder. The most structured programs include a range of different classes and therapies. They might include the following:

• Substance-use education groups
• Group therapy
• Individual counseling
• Management of co-occurring disorders
• Trauma therapy
• Relapse prevention groups/counseling
• Spiritual guidance
• Nutritional counseling
• Vocational counseling
• Recreational therapy
• 12-step programming
• Pain management groups
• Specialized therapy including Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), or Eye Movement Desensitization and Reprocessing (EMDR).

Every residential treatment program is different. If you’re considering drug rehab, it’s a good idea to call around and talk to a few different rehabilitation programs. Learn as much as you can about each one. Recovery is a highly individualized process, and if you can choose the best fit, you will maximize your chances of success.

Partial Hospitalization (PHP) and/or Intensive Outpatient Therapy (IOP)/

Often, these two types of outpatient care are used as step-down options after inpatient treatment. But depending on your needs, you might elect to attend one immediately after detox.

Partial hospitalization is the more intense of the two program types. It’s designed to mimic the intensity of an inpatient program (each program day is usually about four to eight hours), but instead of living at the treatment center, you go home at the end of the day.

If you can’t attend a residential treatment program, PHP offers much of the structure and specific therapeutic options of an inpatient program. If you did attend a residential program, PHP is a good option if you want to ease back into everyday life.

Intensive outpatient programs (IOP) usually only last about two to three hours per day. Some rehabs only offer residential treatment and IOP, while others offer residential, PHP, and IOP. If you want to attend IOP but have issues commuting, some programs offer virtual IOP.

Sober Living Environments

Some Hawaii treatment programs offer sober living accommodations for those who have completed treatment. Depending on the program, these accommodations may have some level of supervision. Often, clients live in a house together (as opposed to the dormitory-style accommodations usually found in inpatient rehab).

They usually will be able to work a regular job and attend outside therapy as needed. In most cases, the program overseeing the house will require drug testing or some other measure to ensure that clients haven’t returned to using.

Continuing Care

Not every treatment program offers options for those who have completed IOP and PHP. But in some cases, you have the option of continuing care.

Sometimes, continuing care includes recovery maintenance programs or extended outpatient programs where you meet with counselors and other members of a treatment team. These meetings might be weekly, monthly, or somewhere in between.

If you are a health professional, you also may be able to attend ongoing groups specifically for health professionals with substance use disorders. These groups can help you discuss industry-specific concerns and help you develop a sense of community.

Especially if you have a co-occurring disorder, your treatment team might recommend seeking out individual counseling and/or medication management. These options can help you continue to cultivate healthy coping skills while maintaining the ability to manage your mental health.

Ready to Change Your Life?

It takes tremendous courage to reach out for help when you’re dealing with a substance use disorder. But when you’re ready to make a change, drug rehab in Hawaii just might be the right next step. The path to a better life is just a call away!

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Reviewed By:

Dr. John Elgin Wilkaitis

Dr. John Elgin Wilkaitis completed medical school at The University of Mississippi Medical Center and residency in general psychiatry in 2003. He completed a fellowship in Child and Adolescent Psychiatry at Cincinnati Children’s Hospital in 2005. Following this, he served as Chief Medical Officer for 10 years of Brentwood Behavioral Healthcare a private health system including a 105-bed hospital, residential treatment, and intensive outpatient services.

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