In what has come all too common for me since I started covering sports, my professional career as a licensed mental health professional once again intersects with my sports writing.
Those who don't know, I have worked in Ohio in the mental health field for the past 14 plus years. During that time I have worked with clients related to substance use for the entire time. That work included criminal justice, outpatient and inpatient settings including working with other disorders, such as depression, anxiety, etc. I've worked with men, women, children and families.
Today, Josh Gordon entered rehab. The media that covers the Cleveland Browns on a day to day basis have come out with statements that make many think his career in Cleveland is over. Many, media and non-media, have pondered whether Gordon has failed another test. It is possible.
What we know about "rehab" is they are not all alike. Many are at least 21 days, most are at least 30. Rehab generally isn't about time, however. It is about a client getting the help they need, showing the skills and understanding required and meeting certain treatment plan goals.
No matter what his long-term future is, Gordon is unlikely to see the field this year.
If Gordon made this decision because he felt like it was what was best for him, rehab will be great. If he made the decision as a preparation step before a positive test is revealed, he still can benefit from rehab but his intentions will be questioned from the outside.
None of that matters. Gordon needs help. No amount of money can beat back addiction. No amount of fame can beat back addiction.
I've decided to put together some information from a couple previous articles that I have written, about both Gordon and Johnny Manziel. The information is still accurate, I've just changed Manziel to Gordon where appropriate and cut out parts that just didn't apply to the situation.
On the Recovery Process - Originally about Manziel
A few key pieces of information before I go forward:
- I have never had any part of Gordon's treatment.
- Nothing that I write should be considered a clinical recommendation for Gordon or anyone else.
- I don't assume to know everything about Gordon situation.
- None of this is in defense or excuse for Gordon.
What is Rehab?
What I have learned throughout the Manziel (Gordon) rehab process is that most believe rehab is a place someone goes to get fixed. Much like taking a car to the mechanics. This is not what rehab is and is an unrealistic expectation.
There are three basic goals of rehabilitation facilities:
- Stability in Medical, Emotional and Behavioral aspects of life.
- Understanding and agreement of root causes and behaviors that led to the need for rehab.
- Distinct plan for aftercare to assist in return to society.
Finally, making the treatment team, along with the client and his support system, create a very distinct aftercare plan (think discharge plan upon release from hospital). This generally includes scheduled appointment with an outpatient therapist, a Relapse Prevention Plan (a lot of details are included in this) and contact information for any and all support client might need upon release.
What is Addiction?
As the coverage of Manziel's issues has been talked through, one thing has become clear: Most believe addiction is a behavior, will power issue. While using does require a behavior, it is a mental health issue.
First, substance addiction is best described as an allergy. Much as my eyes, nose and throat reacts to the presence of cats even though most people don't have that experience, use of substances are similar. Most people can use substances within control because the feeling of being drunk or high doesn't feel good and actually makes them feel ill.
Those with a substance related allergy are the opposite. Without choice, they react positively to the feeling of getting buzzed. For them, it actually feels uncomfortable, unnatural to stop using before getting drunk or high.
Addiction is a mental health disorder that plays out behaviorally. Much like someone with Obsessive-Compulsive Disorder (OCD), where someone either obsesses or feels a compulsion then tends to act out, the behavior is not the issue. Someone with OCD may compulsively wash their hands but it is the compulsion that is the problem, not the washing hands. Just addressing the hand washing or substance use, or blaming the behavior, is accurate or appropriate.
While most believe that someone coming out of rehab, if "they cared, tried, put in the work", should not use again. Those thoughts are based on false assumptions. Going to rehab is a great decision for someone having a big struggle. It is great for resetting the system, understanding the struggle and making plans for a healthy future.
On average, an addict relapses eight (8!) times before their recovery really takes. That starts when a client makes the decision to really work a recovery program. For some it can take right away, for most it is a much longer process.
In treatment, therapists are looking for progress, not perfection. While we hope that clients can quickly move forward in health, we look to help them progress towards that goal instead of focusing on failures. In weight loss treatment, which is also progress oriented, it isn't about your current weight but how far you have come.
Do Consequences Matter?
Manziel could have lost his job in the NFL after last year's behavior, much of which connected to the issues that led to rehab. If the Schefter report is accurate, Manziel is lucky his driving didn't cause an accident as he reportedly was speeding, driving on the shoulder and seemingly reckless. Employment at risk, possibility of jail and the need for rehab seem like they should be enough consequences for Manziel to change his ways.
Except consequences are rarely proven to create change.
Three months later, about 75% of people who have a heart attack are back to eating and exercising the way they were the day they had their heart attack. If having a life threatening event (I'm considering all heart attacks serious) is not a big enough consequence to change behavior, not much is.
Instead, having positive goals, not avoidant related goals, and support people affirming the positive changes are the most important aspects of success.
On the Issue of Marijuana - Originally a Gordon Piece
(Note: The goal of this article is not to promote the use of any substances, encourage the legalization of marijuana nor to convince anyone that the substance should be illegal.)
Diagnostic Information on Marijuana
Diagnosing a client with issues related to use of marijuana is the same as diagnosing one with issues with over the counter medicines, sugar, pain killers, tobacco and alcohol as well as illegal substances like heroine, cocaine and methamphetamine. The fact that marijuana is illegal and alcohol is legal, for example, does not play a direct role in the diagnosing of someone with a substance-related disorder. Said basically, we would diagnose someone with an issue with a substance if the following were true:
- Impairment in social, educational or employment functioning or
- Significant legal issues or
- Use of substances when physically dangerous (driving, using heavy machinery, on ladders/roofs, etc)
- Continued use despite causing problems in social or interpersonal relationships.
We would diagnose someone was dependent on a substance (commonly referred to as an addict or alcoholic) if 3 of the following 7 are true:
- Physical tolerance – Needing to use more of the substance to get the same desired result.
- Withdrawal symptoms – Physical symptoms when the drug is not used.
- Withdrawal rates vary per substance. (Alcohol 8 hours, Opiates 2 days, Marijuana 28 days)
- Using more of the substance then planned/intended.
- Continued attempts to cut down or quit while being unsuccessful.
- Chronic focus on getting, using and/or recovering from the substance.
- Reducing or abandoning social interactions due to substance.
- Continued use of substance in spite of physical or psychological problems being caused by or made worse by the substance.
Understanding the Substance
Marijuana is a hallucinogen. It causes relaxation, craving for foods (specifically fats and sugars), diminishes motivation and causes visual or auditory hallucinations (though most marijuana used is not strong enough for this). The withdrawal symptoms, just like every other substance, is the opposite of the effects of the substance. Withdrawal causes irritation, body aches, lack of patience, lack of appetite, and increased motivation. Withdrawal takes place about 28 days from the last use of the substance and, just like the effects, depends on how long and how much of the substance is used. Many say there is no withdrawal symptoms due to the time lapse before the symptoms and that the symptoms can also be caused by a bad nights sleep, a cold or flu or other common life occurrences.
Why the Concern
The effects aren’t great. The withdrawals are similar to a cold or bad night sleep. Many states have legalized the substance. What is the concern for Gordon, other NFL Players or the normal everyday citizen? As a counselor there are a few reasons to be concerned:
- Motivation – A unmotivated Gordon is less likely to work hard on his craft, whether physically or mentally.
- Social – Most substance users hang out primarily with people who also use the same substance they do. A non-diverse crowd can always be problematic. Especially when substances are involved.
- Legality – Factually it is illegal in many states and is banned in the NFL. Using something that is not allowed is concerning for an athlete who needs to be disciplined as well as the common man who could get in trouble. In states where marijuana is illegal often users limit their job choices to ones where they are not drug tested, often lower paying jobs.
- Emotional Regulation – For me this is the most important issue so I will finish this article expounding on it.
Turning to any substance or behavior to deal with stress, sadness, anger, anxiety, etc is a concern. Whether it is sex, cake, alcohol or marijuana the need for something external to attempt to deal with a problem that is internal is not successful. The internal problem still exists but is masked by the external object/behavior/substance. When the taste of cake finally leaves your mouth or the effects of the alcohol, marijuana, caffeine or other substance wears off the problem is still there. Often times it has grown, like mold in the refrigerator that isn’t cleaned. Anyone using these external ways will continue to do so because they work, they work quickly and the result is guaranteed if short-lived. Their solution to the short-lived part is often to use more and use more often the external solution. In the end, they don’t tend to develop internal skills to cope with their issues and become dependent on the external to solve their internal.
The other side of emotional regulation is fun. If they aren’t using substances as a stress relief they often use it to have fun. Often this tends to lead to the belief, sub-conscious, that a substance, whether that is alcohol, opiates, cocaine, marijuana or sugar, is required to have fun. When these two get connected, substances and fun, the person finds themselves unable to have fun when their substance of choice is not around. They start to crave it, revolve their social life around it and become bored without it. Fun and substances are one in the same.
Josh Gordon may never return to playing for the Cleveland Browns Organization. He may never return to the NFL even. Right now, his health is the most important thing. Hopefully this article provided some information and insight for you as you process once again Gordon not being on the field and maybe provide you more information about substance related issues.