On March 20, embattled Alameda County Supervisor Nadia Lockyer tried to act like her troubles were behind her. Fresh out of rehab, reportedly for a substance-abuse problem, she was all business when she showed up unexpectedly for a board of supervisors retreat. It was her first public appearance since news broke in early February that she was seeking treatment for her addiction, along with injuries that she says were inflicted by an ex-lover.
Dressed in a chic but sedate black suit and pearls, the forty-year-old wife of state Treasurer Bill Lockyer wouldn't talk to reporters except to say, "I just want to get work done." She left an aide to release a four-paragraph statement that emphasized her health and readiness to get back into the swing of life and work. "I'm happy to be back on my feet," she stated.
But her troubles were far from over. In the following weeks, more sensational revelations emerged, capped with Lockyer telling a reporter a desperate story about how her ex-lover was allegedly stalking her and had hacked into her email so he could accuse her seventy-year-old husband, the state's former attorney general, of getting her involved in drugs.
Calls for Lockyer to resign escalated, with editorial page writers saying her "serial lying" and erratic behavior were typical of an addict — and not proper for an elected public official with power over hundreds of thousands of people.
Eventually, the pressure became too intense for Lockyer. Last Friday, she resigned from office, saying she needed to concentrate on her recovery and work on being a better mother to her son. "Reality is, I set my personal goals in recovery too high, and too quickly," she said in a statement. "I got myself in a place called addiction all by myself."
Lockyer also admitted to a San Jose Mercury News reporter that she had lied when she said her ex-boyfriend must have hacked into her email account, and said she had sent the email. Lockyer also said that she has 77 days of sobriety, but she likely remains emotionally and physically fragile. She also has a high chance of relapse. That's the picture painted by statistics, drug treatment professionals, and addicts themselves.
Rehab definitely, in short, is not a cure, and that's true even for the person fervently committed to staying clean. Rehab is just the beginning of a life-changing, one-day-at-a-time program of vigilance.
"I was like many people who enter treatment; I thought I would do my 28 days in rehab, and I hoped they would hit me with a magic wand and I would be done," said Odell, 54, who went through detox and a 28-day residential program at Alta Bates Summit Medical Center's MPI Treatment Services in Oakland for alcohol and cocaine addiction. At the end of those 28 days, he opted to continue with MPI's yearlong outpatient "after-care" program. He also got involved in Alcoholics and Narcotics Anonymous. That was in 1995. Nearly 17 years into his recovery, he said, "I'm still a meeting-a-day kind of guy."
As many as 15 percent of Americans have a problem with alcohol, painkillers, or other drugs. In recovery circles, it's estimated that only about 15 percent of those people seek help, and only 15 percent of those people stay sober over the long term, said Nina Ferraris, program director at John Muir Behavioral Health's Center for Recovery in Contra Costa County. In addition, dropout rates for patients in the first 28 days of treatment are as high as 50 percent, according to one study. Relapse happens in people who have been sober two, ten, or twenty years.
We read about celebrities like Whitney Houston drowning in a hotel bathtub with cocaine in her system after vowing to seek treatment. Alcoholics Amy Winehouse and artist Thomas Kinkade both died after they started drinking again. Lockyer's recent stint in rehab is her second time in treatment. She sought treatment after she was elected supervisor in 2010; she met her ex-boyfriend in the program.
The "disease" theory of addiction offers a powerful explanation for why addiction is relentless. Two decades of research led the American Society of Addiction Medicine last summer to officially define addiction as a chronic brain disorder — not a moral or social weakness. Addiction affects the parts of the brain involved in reward circuitry, memory, impulse control, and judgment. It creates cravings that override reason and pushes addicts to risk relationships, jobs, reputation, health, and personal safety to feed their habits.
"I still have cravings all the time," said Chris, 26, who got sober just over a year ago at John Muir's program in Concord. Before that, he was putting away close to a "handle" — almost a half-gallon — of vodka a day. Chris' drinking, which started at age eighteen, cost him his college scholarship.
Besides cravings, other physical and psychological problems plague addicts in the first years of recovery. Withdrawal continues in the form of "post-acute withdrawal" symptoms, which include anxiety, depression, sleep problems, and impaired concentration. And addicts must return to real life after what feels to many like rehab's nurturing cocoon. Before seeking treatment, many have wrecked marriages, lost custody of their kids, jeopardized jobs, or been arrested.
Residential or outpatient rehab inculcates patients with information about addiction and introduces strategies to help them cope with cravings and begin chipping away at personal problems. But rehab won't keep you sober. That's what a John Muir counselor told D.G., a 53-year-old Concord woman who went into rehab last spring for alcoholism. "We're going to give you the tool box to stay sober, but it's going to be AA or LifeRing over the long term that keep you sober," the counselor said.
D.G. committed to going to at least three AA meetings a week. That's a requirement for her to stay in John Muir's after-care program, where, in a weekly process group, she can get feedback on managing situations that could trigger relapse. While research shows addicts should stay in treatment for at least three months, counselors at John Muir and MPI say patients do better when they stay in treatment for a year. An after-care program provides structure and accountability. "We tell patients you're not in treatment for 28 days; it's a 13-month program," said Terry Arnold, manager at MPI Assessment and Clinical Services.
Although relapse is common, Arnold and other treatment specialists believe people can still achieve long-term sobriety after multiple setbacks. As with other chronic illnesses — diabetes, asthma, heart disease — relapse signals a need for addicts to reassess their programs and make adjustments. As drug treatment experts say, addicts can't choose whether to be addicts, but they can choose to get help.
Twelve-step literature talks about "surrender" and "willingness." Addicts must surrender to the fact they have a disease and be willing to commit the time and focus to staying clean. "They have to make recovery their priority," Ferraris said.
Putting recovery first means making all sorts of small and big lifestyle changes: taking time off from a stressful job, abandoning toxic friendships, moving out of a home or neighborhood where family and friends are still drinking or using.
D.G. skipped a recent work party where she would been feted for 35 years of service at her job. "There would have been alcohol," she said. "I didn't need to be there." Odell has rebuilt his social life around friends he has met in AA and NA or through MPI's alumni program. Chris moved out of his parents' home, because they still drink, and into a "sober-living" house. He relies on the support of his recovery friends to stay sober and take steps to find work and go back to school. He accepts he will have to be on his guard the rest of his life, paying close attention to situations — passing the liquor aisle at the grocery store — that trigger cravings. Just taking one sip could plunge him back into a habit that could disable or kill him. "To put it bluntly, you can't get much deeper into the disease than I was. I don't have another relapse in me."