09 December 2009

Finding Harmony

Health24 visited Harmony Addictions Clinic, Cape Town's youngest addiction treatment clinic.

Serenity. Wisdom. Courage. These are the first words you read on entering the gates of Harmony Addictions Clinic, Cape Town’s most recently established primary care addiction treatment clinic that opened in Hout Bay a year ago.

 A walk through the peaceful grounds takes you past private suites and semi-private rooms, seminar rooms, a pond, a lake and a small animal farm.

 Very few people who arrive at Harmony Addictions Clinic abuse only one substance – poly-substance users are common. The clinic addresses all forms of addiction, ranging from alcohol and drug dependence, to gambling-, nicotine-, sex addiction and co-dependency. It also runs an eating disorders treatment programme.

 Addiction as an illness

Harmony’s programme was developed with the support of the world-renowned Hazelden Clinic, based in Minnesota, USA. Hazelden Clinic is home to what is known as the Minnesota model. This model of treatment is well researched and has been refined over the years, but the basic tenets remain in place. These are:

  •  Addiction exists - This condition is not merely a symptom of some other underlying disorder. It should be treated as a primary condition.
  • Addiction is a disease - Attempts to chide, shame, or scold an alcoholic into abstinence are essentially useless. Instead, addiction is viewed as an involuntary disability, a disease, and should be treated as such.
  • Addiction is a multi-faceted illness.  Alcoholics and addicts suffer from a disease that affects them physically, mentally and spiritually. Therefore treatment for the disease will be more effective when it takes all three aspects into account.

 “Addiction is not about indulgence or a moral failing,” says Steven Thomson, CEO of the Harmony Group. “These old attitudes entrench the stigmatisation of substance abusers. Instead, it is a disease which follows a disease-pattern.

 “It is a progressive illness. It starts with experimentation, progresses to social use and gradually develops into more compulsive use. The compulsive stage is the start of obsessive thinking around the substance as well as failed attempts to control usage. It is the compulsive and obsessive relationship with substances and behaviours, such as the inability to exert control, which defines the difference between addicts and non-addicts.

 “Roughly 10% of any given population will suffer from an addiction in their lifetime. Whilst there is no conclusive evidence as to the cause of addiction, genetic and physical research supports the medically accepted fact that it is a primary illness. In short, no one wants to be an addict; it would appear that people are born with it,” explains Thomson.

Losing control over anything in life is difficult to admit, for addicts and non-addicts alike. Most people go through very definable stages of acceptance, from denial through anger, through bargaining to acceptance. The addicted individual still believes that the benefits of using outweigh the consequences and develops defense mechanisms which keep that belief in place.

A self-employed business man would sooner blame the recession for his cash-flow problems than admit to himself that he is snorting R100 000 of cocaine each month. A loving mother would convince herself that taking handfuls of tranquilisers has no negative impact on her children, even when she fails to pick them up from school and is regularly passed out.

These examples represent just some of the defense mechanisms regularly used by addicts, in their attempt to convince themselves and others that their lives are not out of control. In so doing.

"It is important to remember that the addict him/herself has unconsciously severed the link between compulsive using and behaviours and its consequences. This is the very psychology that keeps the addictions going. It is often very difficult for someone close to the addict to understand this.

 Hitting rock bottom

During this phase, one sees the beginning of progressively worse “rock bottoms” – any severe experience which marks a challenge as well as an opportunity. If the individual doesn’t take up the challenge, it could lead to irreparable damage such as divorce, cognitive impairment, job losses, accidents and psychiatric disorders, for example psychoses.

Physical consequences also set in. These can include hepatitis, potentially fatal liver disease and kidney damage. Irresponsible “acting out” behaviour can lead to sexually transmitted infections, as can needle sharing amongst intravenous drug users. 

“Primary treatment at Harmony Addictions Clinic is really about helping clients to understand their illness and to learn to live with it. Critical to that is giving them specific techniques for managing difficult feeling states and situations that elicit cravings,” says Thomson.

“We believe that both internal relapse prevention skills and the ability to use the external support structures of 12-step fellowship groups are key elements to a successful recovery.

"Treatment is also about education of how one’s defences work and uncovering the level of delusion. He or she needs to ask the questions: is it bad enough? And do I think a future without it could be better?"

The programme includes grief therapy in their treatment plan as recovery also entails losses: the loss of a “crutch” and in some cases, the loss of friends who enabled the addiction. It is important also that during treatment the addict needs help in working through shame, resolving relationship difficulties and building self-esteem.

Growth, enrichment and a gift

“If you make the decision to get better, there is this wonderful opportunity for growth and for finding freedom from obsessional thinking and denial. The physical addiction is usually gone after 21 to 28 days, and by three months, true healing has started kicking in,” says Nicholas McDiarmid, media liaison and admissions officer.

With help and guidance, relationships and work performance improve and amends get to be made appropriately.

“Most addicts secretly want help; the desire to be 'normal' is there. The disease model helps to remove the shame. Taking responsibility for your disease is different from blaming yourself for having it. At the moment there is no cure, which is why one talks about a 'recovering addict' as apposed to a 'recovered addict'.

 "In a strange way, one could see addiction as a gift which compels you to really heal and to learn the tools of life. Many recovering addicts don't want to relapse because they value the friendships and support structures they've gained during their recovery. The process of recovery is a process of enrichment in a person’s life,” says McDiarmid.

 More about treatment

Harmony Addictions Clinic offers a full range of treatment options that includes individual counselling, group therapy, lectures, psychiatric and psychological treatment where necessary, yoga and twelve-step facilitation. The Minnesota Model has demonstrated the ongoing benefits of the twelve-step approach, which is a form of group support which originated with Alcoholics Anonymous (AA) in 1939.

A thorough assessment process ensures that clients are allocated the best treatment option based on their needs, motivation and financial considerations.

Residents stay on the premises for the duration of the 28-day programme, and are only allowed out under supervision.

“People are very vulnerable when they are in treatment. The problem is that they don’t realise just how vulnerable they are. It is for this reason that we don’t allow people out on their own,” says McDiarmid.

The clinic tries to accommodate families. Small children may attend the daycare facilities on the premises and overnight visits by family members can be arranged.

Gender separation

Unlike other clinics in South Africa, Harmony Addictions Clinic separates genders. This is done to make it easier for clients dealing with shame-based behaviour such as sexual trauma and acting out. It also protects patients from forming new intimate relationships which can distract people from their recovery process and make them more vulnerable to substance relapse.

It is recommended by the twelve-step fellowships that no new intimate relationships should be embarked on for the first year of recovery while the addict re-establishes a healthy relationship with him/herself, although a qualified therapist would be more likely to advise each case according to its own merits.

For example, if an existing relationship can withstand the necessary revelations and disclosures that come with a twelve-step recovery, then it is recommended that the relationship should be maintained for at least the first year of recovery, if at all possible.

Cost and information

The in-patient programme costs R28 000. Most medical aids cover a portion of this. Financial assistance is also available for those who cannot afford it.

For more information and a free, confidential assessment, contact Harmony Addictions Clinic on 021 7907779 , email or visit their website:

- (Ilse Pauw, November 2009)


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