Revealing the Unseen: An In-Depth Look at the Signs of Drug Addiction with a Leading Clinician
Jul 10, 2023
Overlooked, unseen or ignored signs of addiction can lead to devastating consequences for individuals, families and communities. One of CleanSlate’s counselors, George Affonso, knows that firsthand, as his own recovery journey led him into a career of helping others find their own path to health.
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What is your experience in addiction treatment and what inspired your interest in it?
George: I was born in Somerset, Massachusetts, growing up mostly on the South Shore, near Fall River. There are major drug problems in Fall River and New Bedford areas, as there are in so many places now. I then lived in Little Rock, Arkansas for ten years before returning to my roots.
I went to school for marketing and communications, and worked a lot of nonprofit jobs over the years. That led me down a path, and now I’m in recovery myself. I went through various programs, halfway houses, inpatient and outpatient treatment facilities. That sparked the passion and desire in me to help others, which is how I got situated on the right path.
I went back to school and got my master’s degree in developmental psychology. I then studied addiction treatment and became a licensed alcohol and drug counselor. Along the way I’ve learned a lot about the connection between addiction and mental health, and how all of that plays out in everyday living. I’ve been in the field now for almost 10 years. Early on I got good career advice that if you love what you do, you’ll never feel like you work a day in your life. This is a work of passion for me.
Was it early in your recovery journey that you realized you wanted to work in addiction treatment?
George: I went through a halfway house here in Plymouth, the Anchor House, and I used to go back and run the alumni meeting every Tuesday night. One night a director comes up to me and asks, “How happy are you with your job?” At the time I was managing a retail store, and had at most a year and a half in recovery. But I had a lot of management experience in my previous career, and so he hired me as assistant director. That planted the seed, which evolved into a career. I just fell in love with trying to help others get on the right path and change their lives for the better.
What led you to CleanSlate?
George: I always loved one-on-one counseling and guiding people on the recovery journey. I love how CleanSlate is focused on behavioral health and the shift away from medication alone. Plus, all the data shows that the combination of MAT and counseling leads to the best outcomes. That’s exciting to be part of.
On the behavioral health side, are there certain disorders you notice co-occur frequently with addiction?
George: The top two are anxiety and depression, and we also see a lot of trauma and PTSD. Almost everybody starting recovery has anxiety about the future over what’s going to happen, and depression about the past, asking themselves how their lives reached this point. They’re in a limbo stage early on, and some level of anxiety and depression go along with that. But as people get better, anxiety and depression tend to slip away—unless there are deeper clinical causes.
Before people realize they need treatment, are there certain telltale signs of addiction to look for?
George: From the perspective of loved ones, family, friends or co-workers, the biggest thing is behavioral change. Take someone who is active in sports, does well at their job, or is especially outgoing, and then all of sudden they become less active and more withdrawn. They stop engaging in the activities that they’ve historically loved to do. In the work case, if you notice a change in a co-worker, where they’re calling out more and their performance decreases, that is the most significant kind of sign that someone might be struggling with addiction. The behavioral changes of not showing up or participating in life tasks anymore are often accompanied by mental or emotional signs, such as seeming more depressed and anxious. These changes could be purely mental health, but they are also signs that someone’s addiction is getting stronger.
From the individual’s perspective, if you find that you used to go out and be able to have two or three drinks with your friends, but now that’s becoming five or six drinks, you continue to drink after the party’s over, you’re drinking alone, you’re having blackouts, and it’s causing you not to show up for work or other commitments, those are telltale signs that you might have a problem and definitely need to get help.
I tell people from the beginning to get honest. Get honest with yourself first and foremost. If you’re not honest, nobody can help you. When I ran the men’s halfway house, I would tell them: “You can be deceitful. You can check all the boxes, and tell us all the things you think we need to hear. But at the end of the day, who are you fooling? You’re fooling yourself. And the one who’s going to suffer the most is going to be you. And sadly, so are all the people who love and care about you.”
If an addict or an alcoholic picks up, uses, and nothing detrimental happens, one hundred percent they’re going to do it again. When they use or relapse and nothing negative happens, that’s the worst thing in the world for them. No doubt, they’re going to do it again.
When someone recognizes that they have a problem with substance use and comes to you for help, where do you start?
George: First I evaluate what and how much they’ve used. For example, if their consumption of alcohol has become excessive, I’ll probably recommend they do an inpatient detox. Opiate withdrawal is terrible, but technically you don’t die from it. But alcohol can be a grave danger to detox yourself from. You can have a seizure and die. Opiate withdrawal can be extremely painful and uncomfortable, but your life is not at stake as it is with alcohol withdrawal.
I have this stupid analogy, but it works to help us picture the three parts of addiction—physical, mental and spiritual/emotional. Imagine putting a screw into a piece of wood. Spiritually or emotionally, people lose their connection to others and isolate more. So the screw goes into the wood a little bit. Mentally, they’re obsessing over the drug and constantly craving it. The screw goes in deeper. Then you become physically addicted, and have to use to function or prevent the pain of withdrawal. At that point, the screw is in so deep that you’re ‘screwed.’
And so how do we reverse that process? Typically the first thing you address is the physical aspect through inpatient detox. You’re getting comfort meds and withdrawal meds so that you can physically feel better. And now the screw comes back out a little bit and then you start to clear up mentally. You gain focus and clarity, and the screw comes out even more. The spiritual and emotional part comes through connection with others, where you build or rebuild relationships with loved ones, family, friends, support groups, whatever it is. And now the screw is completely out and you’re free.
Given the importance of inpatient detox in various kinds of cases, do you have ways of coordinating that with the patients you see at CleanSlate?
George: There’s a number of detox facilities we work with. It wasn’t that long ago a young guy came in who was visibly impaired. His drug of choice was opiates, but he came in drunk. So we started calling detoxes, and got him in to a local detox in Plymouth called High Point. Making these community connections and partnerships is something that CleanSlate does well.
On the mental health side too, I might realize that someone needs a higher level of care. If I have a patient with severe trauma—physical, sexual, or emotional abuse—there are a number of local trauma specialists I can send them to.
Can you describe your experiences with patients who continue their recovery journey beyond CleanSlate?
George: I talk to them about their goals. If their goal is not to be on a medication, there’s a clinical process to do so safely. But I remind people it’s a process, and needs to be done under the guidance of their medical provider. Many people successfully end their medication assisted treatment and go on to live happy, productive lives.
On the other side of that, some people struggle with the stigma, not wanting others to know they’re taking medication. I remind them that they have a disease. Substance use disorder is a clinical disease. It’s a chronic illness that will kill you if left untreated. It’s no different from diabetes. Diabetics could say, “I don’t want to take my medication anymore.” And then they could potentially die. It’s the same thing with Suboxone. If it’s helping you and you’ve been able to develop, stabilize, and create a good life for yourself—why change anything that’s working? I remind people of their lives prior to MAT. If they can’t sustain recovery on their own, that’s where it’s going to lead them back. It’s a scary thought. And nowadays you’re lucky if you make it back to treatment.
Any final thoughts on the signs of addiction?
George: Communication is key. If you feel that a friend, a loved one or a co-worker is struggling, say something. I will never apologize for confronting somebody if I’m worried about their overall well-being and no one should be. It’s just being honest. If someone is struggling or they question whether they have and issue, honesty is the best policy. It’s such a weight lifted off them. Speaking for myself, when I finally admitted that I needed help, it was like the weight of the world was lifted. Then I could breathe a big sigh of relief, and try to do something about it.
If you or a loved one is struggling with addiction, reach out today for the treatment you deserve
Call (833) 505-4673