Substance Abuse Recovery
Dr. Gerald Mckenna
Medical director and CEO of McKenna Recovery Center
Where did you receive your schooling/training?
I graduated from Marist College in Poughkeepsie, N.Y., with my B.A. I attended medical school at State University of New York, Health Sciences University, in Syracuse, receiving an M.D. in 1966. I did a rotating internship at the University of California’s San Francisco General Hospital and a three-year residency in psychiatry at Harvard Medical School’s primary psychiatric training facility, Massachusetts Mental Health Center in Boston.
How long have you been in practice?
I have been practicing for 44 years with a focus on addiction medicine, and psychiatry within this focus, for the past 15 years. McKenna Recovery Center has treatment facilities on Oahu, Kauai and in Hilo.
What interested you in the field of addiction and recovery?
From the beginning of my medical and psychiatric training, I gained a lot of experience in addiction. After residency, I spent two years in the Air Force as part of the physicians’ draft during the Vietnam War, first in UTapao, Thailand, serving as the only psychiatrist for the region to the Air Force personnel there, and the second year at the Pentagon in Washington, D.C., in the Air Force Chief of Staff’s office, where I participated in a task force to address the extensive alcoholism and drug addiction problem in the military and among our service personnel during that time.
My own recovery from alcoholism helped me to have empathy for what people go through with this disease and just how complex and elusive it is. Addiction is a disease that we try to hide from others, and we end up living dual lives: the life that may look very normal on the outside and the life of the addict struggling with attempts at controlling their addiction.
Do you treat people only for alcohol addiction, or for any kind of drug recovery?
In our clinics, we treat individuals with any addiction, primarily focusing on those with alcohol and other forms of drug addiction, including opiates (Percocet, Vicodin, OxyContin, Roxicodone, etc.), benzodiazepines, methamphetamine, cocaine and marijuana.
How does the process work?
The process of addiction treatment and recovery involves a number of stages. First, the individual needs to recognize that they need help, and this can be facilitated through an intervention or through the urgings of family, work, health care professionals or the courts. Absent an intervention, recognition that one has a problem can take many years or even a lifetime. Unfortunately, many people with addiction die of their disorder before ever recognizing the need for treatment. Denial in the family and the individual’s circle of community also can hinder the link to recovery.
Once we are linked to the individual, we begin with an evaluation, which involves a complete bio-psychosocial and developmental history, plus substance-use history. We screen for substances that are in the system and do our best to include the family for this initial phase, to get a full picture. We match the individual with the best form of treatment available within their specific picture of resources, from home environment and family supports to insurance benefits and community resources.
The spectrum of treatment options considers a continuum of care model, which ranges from minimal outpatient intervention to hospitalization. Depending on the substance and severity of use and addiction, a detoxification process can be a critical piece of the continuum for treatment considerations.
A program of monitoring, whether in the treatment facility or in an independent monitoring agency, also has been evidenced as a factor in sustained recovery. The lowest rates of recidivism have been found in individuals participating in long-term monitoring programs, such as those for physicians and pilots.
In the McKenna Recovery Center, we focus on outpatient treatment. Most people can be treated on an outpatient basis, which allows them to return to work and be at home during the treatment process. For those requiring higher levels of care, we refer out to existing resources within the scope of an individual’s insurance plan.
Is there a point where someone is considered addiction-free?
Because addiction is a chronic neurological disorder, we treat it as we would any chronic life-threatening medical illness such as diabetes, heart disease, or any of the myriad chronic medical problems, many of which are based on our lifestyle. In this sense, recovery from addiction is a lifelong process, and we strongly encourage people who have graduated from our program to stay involved in a 12-step program, find a sponsor, work the steps and develop a spiritual lifestyle that can continue for lifetime recovery.
While treatment is ongoing, part of the outpatient recovery process is to connect people with community-based recovery, such as Alcoholics Anonymous and Narcotics Anonymous, so that an individual has continuing support once he or she completes our facilitated treatment process. We have found this link to also be key for sustaining long-term recovery.
How difficult is addiction to treat?
Addiction is no more difficult to treat than any other chronic relapsing life-threatening illness. That it remains a shame-based illness both individuals and families hide makes detection and treatment initially more difficult. The problem with all of those chronic illnesses is making sure the patient understands the nature of the illness, is willing to take the steps to treat it, and will recognize the need to continue to focus on recovery for the long term. The relapse rate for those with addiction is no greater or less than the recovery rate for other chronic illnesses. Many people that we see in treatment have a dual diagnosis of depression or some other psychiatric disorder with their addiction. The knowledge of psychiatry, medicine and addiction medicine, and working through the unique cases of each individual are critical in evaluating and determining the right treatment plan, and can be a maze that takes time to resolve as substance use subsides and symptoms are treated in our program. We treat both the psychiatric conditions and addiction simultaneously.
Anything else you’d like to add?
Our understanding of the brain processes involved in addiction is increasing exponentially as neuroscience advances our understanding of brain function. This understanding will help develop new methods of relapse prevention and will allow medicine to make an even greater contribution to the addiction field. The more the individual can take control of their own life and learn how to manage their illness, the more cost-effective any treatment will be. Watching people move from active addiction to recovery is rewarding to me and all our dedicated staff.