What Is Addiction Coaching And How Can It Help Me?

What is addiction coaching, and what does it mean inside medical care?

Addiction coaching, in the wider world, is non-clinical support for a person in recovery. A recovery coach helps with goals, accountability, and the daily business of staying away from triggers. A coach is not a therapist, who treats trauma and mental health conditions, and not a physician, who treats the medical condition itself.

Inside Dr. Leeds’ practice, coaching is not a separate service, and it is not something you hire. It is the part of a medical visit that turns from the medication to the life the medication is supposed to give back.

A counselor who gave up her therapy practice to become a coach once told Dr. Leeds, on his podcast, that the people she worked with kept obsessing about their past because they believed that was the assignment. She found she did far more good by asking one question: now what? That question is the whole of coaching in two words.

While the question is simple, it is the part of addiction treatment most often left out, because the doctor is managing the medication and the therapist is looking at the past. So, what happens when the medication works, you feel normal again, and nobody has asked what comes next?

Suboxone or naltrexone can make you feel normal again. Then what?

Buprenorphine, the medication in Suboxone and its film and tablet generics, occupies the opioid receptors and holds them steady, and at a stable dose most patients do not feel high from it. For alcohol use disorder, naltrexone blocks opioid receptors, and the idea behind using it is that drinking stops paying off, so the habit fades over time rather than overnight. Within the first weeks, many patients say that they feel normal, as if the addiction had never been there at all.

Physical dependence is not addiction. Opioids and alcohol produce both, and the medication treats the physical side directly. While the compulsive side quiets down along with it for many patients, what remains is a person standing in a life that was interrupted.

In fact, this is the point where two views of addiction treatment part ways. The older view says the real work begins now: character defects, shortcomings, and a lifetime of vigilance. Dr. Leeds sees it differently.

What if there is nothing wrong with you at all? Addiction may be a coping mechanism, not so different from the other ways human beings cope with pain and boredom, and a coping mechanism is not a broken character. Maybe there is nothing “broken” to be fixed.

What would you do if you found Superman chained to a piece of kryptonite?

An analogy might help here, and it is an old one in this practice. Imagine that you found Superman lying on the ground with kryptonite chained around his neck. First, you would remove the kryptonite and throw it as far as you could. Next, you might help him to his feet and give him a few minutes to clear his head.

Then what? Would you sit him down and explain that he was born defective? Or, would you stand back and let him fly away to do what he does?

While this is not a perfect analogy, many people stuck in active addiction are supermen and superwomen with kryptonite chained around their necks. Remove the drug, and the potential that was there all along comes back into view. The medication is the removal of the kryptonite.

Coaching is what comes after the kryptonite is gone. It is not repair. It is pointing a capable person toward the place where they can do the most good. Then the coach gets out of the way.

Why do so many people feel lost once the drug is gone?

Patients coming off of opioids often describe what might be called life disorientation. They feel lost inside their own lives, with no idea why they are here or what the point of any of it is. It seems to be an awakening out of the numbing effect of the drug, and it is more common than people admit.

The drug did two jobs at once. It numbed the pain, and it supplied an all-consuming purpose, because in active addiction the purpose of every day was getting more. Take the drug away, and both jobs are gone on the same day. That is the disorientation.

Fortunately, the remedies are small and concrete. If your worst problem today is feeling lost, things could be a great deal worse, and noticing that is a fair first entry in a journal. Being aware of what you are doing and why you are doing it, which is all mindfulness really means, makes direction easier to find. And, if you are lying in bed anxious about your life, walking out the front door to look at the clouds and the trees will do more than another hour of thinking.

Helping other people may sound like a cliche. Yet, it is probably the most reliable way to give your own life meaning. Other people are looking for direction too, and community can be found in a volunteer shift, a class, or a team. Direction is built out of small things.

Honesty is the first act of recovery, and it is harder than it sounds.

Patients have described to Dr. Leeds a version of the same scene. The family gathers and delivers an ultimatum: stop using, or be sent away to a treatment facility. Out loud, the patient swears that he will fight them every step of the way. Inside, a second voice is begging to be locked up and saved from himself, and the words will not come out of his mouth.

So, he makes the same old promise never to use again, and everyone in the room knows what it is worth. So, this is why ultimatums so often fail. The ultimatum is addressed to the mouth. The mouth is not in charge.

Honesty starts smaller than a family meeting. If you cannot stop, one place to begin is by telling the whole truth to one safe person. It does not have to be your family, and it most likely should not be your coworkers. It does have to be someone you can be completely open with, such as your doctor or a private therapist.

Gratitude is the other habit that makes life without the drug feel worth keeping, and it works best on paper. Write down, every day, the things you notice: you are not in pain, the plumbing in your house works, someone called. Look back over the list in a bad week, and it will tell you something your mood cannot.

Do you have a yes problem?

Long before the first drug, many patients already had a yes problem. They said yes to a job they never wanted, yes to a loan, yes to a relationship that was making them miserable, and yes to every new obligation that came along. Unfortunately, the weight of all those yeses is exactly the kind of stress a drug is good at numbing.

Saying no is a recovery skill. This does not mean throwing away everything in your life today. Walking away from responsibility usually creates more of it. It does mean slowing down and weighing each new choice. For now, say no by default to new contracts, new promises, and new responsibilities.

You are not a pack animal. The load needs to get lighter, not heavier, and every no you say early in recovery is weight that never lands on your back. Overcommitment feeds the same stress that led to the drug, and lightening the load protects the work the medication is doing.

Learning your own patterns takes more than a medical visit, and this is where therapy fits. When Dr. Leeds prescribes buprenorphine, he refers patients to a therapist as well. There is nothing wrong with who you are. Knowing who you are, though, makes it easier to avoid the people, places, and situations that pulled you back before.

Recovery is about more than not using. It is about being true to yourself.

While medical treatment and therapy are the foundation of addiction treatment, they have to reach the reason a person used in the first place. Often that reason is that they were not living the life they believed they were meant to live, and the drug filled the gap. Take the drug away without asking about the gap, and the gap is still there.

The Greeks had a word, eudaimonia, for the kind of happiness that comes from living well rather than from feeling good. It is not the happiness of instant gratification, which is what the drug was standing in for. It is the deeper fulfillment of doing what you know is right for you, and it is the real target of recovery.

Some people get sick from living a life that was chosen for them. Call it working in the family business: the career, the marriage, or the town that everyone expected, followed for years because leaving seemed unthinkable. Success is not doing what everyone else thinks you should do. It is doing what you know is right for you.

The tools are the same three that keep coming up on this page: honesty with yourself, service to others, and a daily journal where you work out whether your life is pointed where you want it to go. If you are choosing a therapist, it is not a bad idea to ask up front whether they can help you find and live by your authentic self. If the answer is a blank look, keep looking.

Can moving away or traveling cure addiction?

Moving to a new city to get away from drugs is one of the oldest ideas in recovery, and it does not work. Wherever you go, you are still there, and the same problems that led to the drug come along with you. Drugs are everywhere, so even in a town where you know no one, you will eventually find them again.

With alcohol, the search is not even a search. A quick walk to the nearest convenience store reveals a new dealer, happy to sell you as much as you want. Nothing inside has changed, and the supply is on every corner, so the geographic cure fails.

There are few, if any, studies to say whether a trip early in treatment helps, and it would be hard to design one. Yet, Dr. Leeds has seen it help in one specific situation. If you travel with a spouse, a parent, or a sibling who does not use drugs or drink, the focus of the week is the trip rather than your past, and a family that has been at war for years gets to make new memories together.

There is a second benefit that lasts. Your phone stamps every photo with a date and a place, so years later, when you have forgotten exactly when the turning point came, you can look back and find the week your life changed. Treatment comes first and the trip comes second, but the trip is worth planning.

Freedom from addiction and freedom in life go together.

Dr. Leeds believes in agency, which means freedom and ownership over your own life. The more control you have over your days, and the fewer people trying to control you, the better prepared you are to avoid the triggers that lead back to the drug. Freedom from addiction and freedom in life are the same thing.

That is also why patients direct their own care in this practice. Nobody is made to attend group meetings as a condition of treatment, and 12-step meetings are not recommended as part of medical care. Some patients find real community in a 12-step group and keep going on their own terms, and that is their choice to make.

Freedom is not easy to obtain, and it takes work to keep. Of course, the early weeks can be the hardest, when the medication has done its work and the direction has not yet arrived. Fortunately, being aware of how far you have already come is the best fuel for continuing. And, once forward movement is the most rewarding thing in your life, prioritizing your days stops being a chore. You want to do the things that move you closer to where you are going.

What can the practice do, and what can it not do?

Dr. Leeds treats opioid dependence with buprenorphine by telemedicine for new patients anywhere in Florida, with in-office visits available in Fort Lauderdale. Starting the medication, known as induction, is done at home with phone support, and when fentanyl is involved he begins with a low dose when needed. For alcohol use disorder and gray area drinking he prescribes naltrexone, including the Sinclair Method, which does not require you to stop drinking before treatment begins. The coaching described on this page happens inside those visits, monthly and weekly when needed, and it cannot be bought as a separate service. The practice does not offer counseling or therapy as a service: Dr. Leeds counsels and coaches within medical care and refers patients out to a therapist for the deeper work. No meetings or programs are required.

If you are considering treatment, or you are in treatment elsewhere and want to talk about where your life goes next, contact Dr. Leeds through the contact form to ask about a consultation.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.