More on Medication Assisted Treatment

medication assisted treatment

I don’t really understand the resistance to medication assisted treatment (MAT) for addiction — according to NIH:

Medications are Not Widely Used

Less than 1/2 of privately-funded substance use disorder treatment programs offer MAT and only 1/3 of patients with opioid dependence at these programs actually receive it.8

  • The proportion of opioid treatment admissions with treatment plans that included receiving medications fell from 35 percent in 2002 to 28 percent in 2012.9

  • Nearly all U.S. states do not have sufficient treatment capacity to provide MAT to all patients with an opioid use disorder.10

Research has shown that, especially with opioids, medication is an essential tool in treatment. This is also from NIH:

Effective Medications are Available

Medications, including buprenorphine (Suboxone®, Subutex®), methadone, and extended release naltrexone (Vivitrol®), are effective for the treatment of opioid use disorders.

  • Buprenorphine and methadone are “essential medicines” according to the World Health Organization.3
  • Medications should be combined with behavioral counseling for a “whole patient” approach, known as Medication Assisted Treatment (MAT).
MAT Reduces Heroin OD Deaths

MAT DECREASES opioid use, opioid-related overdose deaths, criminal activity, and infectious disease transmission.4,5,6 After buprenorphine became available in Baltimore, heroin overdose deaths decreased by 37 percent.6

MAT INCREASES social functioning and retention in treatment.4,5 Patients treated with medication were more likely to remain in therapy compared to patients receiving treatment that did not include medication.4

Treatment of opioid-dependent pregnant women with methadone or buprenorphine IMPROVES OUTCOMES for their babies; MAT reduces symptoms of neonatal abstinence syndrome and length of hospital stay.7

At NewDay, we’ve experienced great results using a combination of medication, group therapy and individual counseling. Medication assisted treatment has proven its effectiveness. As we all learn more about best treatment practices, we can establish national standards so that quality of treatment is not hit and miss. Addiction is too serious to ignore the research on the use of medication in addiction treatent. Opioid addiction has become a national problem, and it’s time to address the problem with intelligence and consistency.

From Addiction Thinking to Recovery Thinking

From Addiction thinking to recovery thinkingIn addiction treatment we seek to move the addict from addiction thinking to recovery thinking. In active addiction a person’s constantly in conflict with reality, usually because the person is in some stage of denial. No one wants to be an addict — no one wants to be considered weak, flawed or out of control, so the addict constructs a defense system to deal with the consequences of addiction.

Often the person will blame other people, places and things for the consequences. The boss at work is unreasonable and has it in for me. My husband doesn’t understand the pressure I’m under. The police officer was looking to fill a quota and followed me from the bar. If the addict takes responsibility for consequences of his/her addiction this is usually an acceptance of the problem that the addict is not willing to embrace, so excuses are made.

Anyone who’s ever closely known an alcoholic, cocaine addict, opiate addict, etc., knows all too well the excuses and blame shifting — they understand the defense mechanisms built by the addict. Sometimes and addict’s defensive system will break down, and this is an opportunity to seek treatment. Family members often urge the addict to seek treatment. I hear all the time that treatment is useless the person addicted is completely ready — well. this is not entirely true. An addict who goes to treatment because others are pushing for treatment will often drop the defenses once around others in treatment who are talking openly about their alcohol or other drug problem. It takes an unimaginable amount of energy to maintain a defense system that’s at adds with reality. It’s exhausting.

We never know what’s going on in a person’s mind. The addict might be bellicose outwardly, denying they have a problem, but deep down they’re wishing something would happen to force them into treatment. They’re seeking relief, but don’t know what to do. I see this happen all the time — the consequence that drives the addict into treatment becomes the thing that saves them. The addict will often say they’re grateful for a DUI or grateful that their spouse temporarily left them.

Once a person is in treatment it’s a process of re-evaluating their thoughts and value judgements. Treatment is in large part a process of moving from addiction thinking to recovery thinking.

Gratitude in Addiction Recovery

Gratitude in addiction recoveryThanksgiving always reminds us of gratitude. Gratitude in addiction recovery is a topic we talk about on an ongoing basis as one of the main principles of recovery. The idea behind the principle of gratitude is that recognizing the things for which we should be grateful is more mentally, emotionally and spiritually healthy than obsessing over the negatives. In recovery it’s easy to fall into the trap of self pity, poor me, oh why did this happen to me? In reality, recovery from addiction opens up a new world.

Back in the 80s when I started working in the treatment field it was common for people working in the field to be in recovery from addiction. Recovering addicts could relate to the addict coming into treatment and could reach them when others couldn’t. This is how I got into treatment, through my own recovery. I now realize that counselors who aren’t in recovery can be as effective as a recovering addict, but both have strength and weaknesses, all training being equal. I say all this just to write personally about gratitude.

Before I got into recovery, I was lost. I had reached a point where life was meaningless. I felt dead inside and even when I drank alcohol all I felt was some blah sense of “normal” — the “good times” had disappeared a long time before I sought treatment. I had known deep down  for a long time that I had a problem with alcohol, but thought I could handle it myself. I thought I could regulate my drinking if I tried hard enough. Nothing worked. I kept drinking more than I intended to on most occasions. The hangovers got worse. The relationships with my family and friends got worse. They tried to understand, but from their perspective drinking was more important to me than the relationships. I couldn’t argue with them. I couldn’t deny my alcoholism any longer and I sought help.

After being in recovery for a while, my mind cleared up and my emotions returned. Sometimes the emotions were confusing and chaotic, but I talked to people in my support group and made it through without drinking or using any other substitute drug. The desire to create a better life returned and my relationships improved a 1000%. Clarity of mind was the one of the things in the beginning for which I was grateful, but there were many things. I could have fun again with my wife and kids — I could be a friend — I could recreate again and enjoy the little things I had forgotten about in my alcohol fog. My job performance improved immensely and finances were no longer a daily worry. Spiritually, meaning and purpose returned and I started working with other alcoholics who were reaching out for help.

Thanksgiving has a special meaning for me. Gratitude in addiction recovery is very important. I hope I never forget all the things for which I should be grateful. Happy Thanksgiving!

Alcohol – Teenage Binge Drinking

Teen drinkingIt’s difficult for parents of teenagers when it comes to alcohol. On one hand the modern, open minded parent doesn’t want to be an overbearing moralist, but on the other hand science is discovering negative effects when teenagers drink alcohol, especially if they’re binge drinking. This about teenage drinking is from Science Daily:

Teenage binge drinking is a major health concern in the United States, with 21 percent of teenagers reporting they have done it during the past 30 days. Among drinkers under age 21, more than 90 percent of the alcohol is consumed during binge drinking episodes. Binge drinking is defined as raising the blood alcohol concentration to 0.08 percent, the legal driving limit, within two hours (generally about five drinks for a male and four drinks for a female).

This is from the same article:

Repeated binge drinking during adolescence can affect brain functions in future generations, potentially putting offspring at risk for such conditions as depression, anxiety, and metabolic disorders, a Loyola University Chicago Stritch School of Medicine study has found.

Most experts state that the best way to deal with teenagers and alcohol use is to talk openly with them. Having one big “talk” with a teenager will not likely produce any effective results, but opening an ongoing dialogue is very helpful. If the teenager knows they can trust the parents, then it makes it easier for them to ask questions and solicit advice. Teenagers need to know the facts, but in order for parents to talk about alcohol and other drug use in an intelligent, factual manner, the parents must learn about alcohol and other drugs. If the parent is uncertain or has conflicting emotions and ideas regarding alcohol, then this will come across. Parents must be comfortable with the subject and what they think about alcohol and drinking in general. 

It would be helpful for parents to learn about alcohol abuse and addiction, the differences between abuse and addiction and the signs and symptoms. Another thing is that many kids are choosing abstinence. Abstinence is a very valid, smart choice. Teenage drinking is not inevitable. While the brain’s developing, it’s risky to put anything in the brain that can effect it negatively. As science advances, results point more and more to teenage abstinence as a healthy, intelligent choice. Abstinence is not realistic in many cases because kids will experiment, but after a few bad experiences, along with knowledge of the facts about alcohol and other drugs, maybe abstinence will look smarter and more appealing.


The Joy of Recovery From Addiction

The Joy of recovery from addiction

Celebrating Recovery

I find that most people are uncomfortable talking about addiction, addiction treatment or addiction recovery. The word addiction is loaded with negatives and stigma still remains. Some people have an image of a skid row “wino”, while others envision a drug addict using a needle in a run down house, and still others might envision the crazed cocaine addict with a crack pipe. Addiction is often perceived by  as a moral failing, or an unfortunate condition caused by lack of will power, or a purposeful consequence of too much irresponsible partying.

I’ve heard many times when discussing addiction and addiction treatment with someone who’s not very familiar with the subject that treatment doesn’t work –usually based on someone they know who went through treatment and started drinking or using drugs again. Even when some acknowledge that addicts stay abstinent in programs like Alcoholics Anonymous, they see them as pitiful characters huddled together trying to make it through the day without going back to their old lifestyle.

Although more and more people are learning about addiction and recovery from addiction, there’s still a long way to go. After working in the addiction treatment field for 16 years, I’m encouraged more now than ever before that addiction treatment and recovery will become widely understood as inspirational and life changing. I’ve had the opportunity to witness thousands of addicts receive treatment and transform their lives in recovery. Today I celebrate recovery. I never feel sorry for the addict who comes into treatment — addicts don’t need sympathy, they need empathy and understanding and encouragement and education and a helping hand. If someone just can’t get past their judgements regarding addiction, they can at least not do any harm. I’m a witness that treatment works and recovery is real.

Alcoholics Anonymous has what they call Open Meetings the general public can attend — it’s usually a speaker meeting where someone in recovery tells their story. If you want to witness recovery first hand, go to an open meeting and listen with an open mind. If it doesn’t change you, go to a few more — you’ll eventually understand.

The Presidential Election and Addiction

Presidential election and addictionI would like to think that whoever becomes our next President will have a good understanding of our nation’s problem with addiction, but I haven’t heard much at all about the subject from the candidates — they appear to have lots of other things on their minds. I’m not convinced the solution to addiction problems, such as the nation’s heroin epidemic, must necessarily come from government, and I tend to think that local communities might find better solutions than top down federal government solutions, but it’d be good if representatives making all the funding decisions in DC really understood addiction.

So much could be done to save lives if only government officials would handle fundamental problems with fundamental solutions rather than wasting money applying symptomatic solutions to symptomatic problems. It appears that most efforts to deal with addiction have created unintended consequences, like the War on Drugs. After decades of treating drug addiction as if it’s a part of an enemy plot to destroy America, the problem is arguably worse than when the “war” started. Locking up drug users along with drug dealers has only ruined the lives of many good people who could have received treatment and gone on to live productive lives. The money it costs to house drug users in prison where they learn criminal behavior is mind-blowing.

I don’t have much hope that the next President will do much that’s different from what other Presidents have done, but it doesn’t hurt to hope. Drug court programs are successful government efforts, although it’s more of a local solution. As middle class and upper class mothers and fathers lose children to heroin overdose, maybe the nation will wake up and pay attention to addiction in general, thus creating a path to apply fundamental solutions. We’ve wasted enough time, money, effort and lives battling drugs as if we can make an imaginary Drug Invader surrender. As along as the demand for drugs grows, the supply will follow. We need innovation, creativity and perseverance to find true, lasting solutions

More on Addiction Recovery

Addiction recoveryWe know all about the horrors of addiction. Media usually goes for the sensational, and they’re often weak on the stories of heroism, redemption, success, acts of love, feats of courage and recovery from affliction. You hear much more about the heroin addiction epidemic than you do recovery from heroin addiction. One of the soul enriching aspects of working in the addiction field is witnessing recovery. Addiction recovery is a beautiful reality that takes place on a daily basis across the world. This is the latest survey I could find related to addiction/chemical dependence recovery:

New York, NY, March, 6 2012 – Survey data released today by the Partnership for Drug-Free Kids and The New York State Office of Alcoholism and Substance Abuse Services (OASAS) show that 10 percent of all American adults, ages 18 and older, consider themselves to be in recovery from drug or alcohol abuse problems. These nationally representative findings indicate that there are 23.5 million American adults who are overcoming an involvement with drugs or alcohol that they once considered to be problematic.

You can go to just about any town in the US and find an AA or NA meeting, and in mid-sized and large cities you’ll find many AA and NA groups. Then there are those who recover from an alcohol or other drug problem and simply go about their daily lives clean and sober, or they find support in the church, or some other source — there are many, although not enough. Most recovering addicts find that support groups are not only helpful to their recovery, it also allows them to help a newcomer to recovery. If everyone who recovered from addiction went their own way, it would make it very difficult for the newcomer in recovery to find the support, guidance and inspiration they need. Getting to know someone who recovered from addiction and is now living a healthy, sane and fulfilling life free from drugs is very motivational for the newcomer.

We often hear negative reports that over half the addicts who go through treatment don’t make it and return to their drug of choice, but just imagine if we reached a million more addicts through improved outreach, and 500,000 go into recovery. These 500,000 will become motivational for the millions left and are seeking treatment. Going back to the heroin epidemic, I propose that recovering addicts helping other addicts who enter recovery can be the most powerful solution, if we help more addicts get into treatment. The more people in recovery, the greater synergistic effect there’ll be, much greater and more powerful than the sum of the parts. If we take the 50% recovery number and double down on our efforts to provide high quality, accessible treatment, that number will no doubt rise to 60%, 70%, and this is a good thing, right? One thing I always try to get across to a person in early recovery is that they can recover, and, if they do, they’ll have the opportunity to help someone who seeks treatment and enters early recovery. There’s nothing I’ve found more rewarding than watching a person rise from addiction (any affliction) to stand tall and free in recovery.

Treating Heroin Addiction

ndc-logoThe good news in the midst of the heroin epidemic is that treating heroin addiction is possible and recovery is likely if a comprehensive treatment plan is followed long term. There are many recovering heroin addicts in Narcotics Anonymous who’ve been drug free for decades. NA is not the only way to maintain long term recovery, but it’s one of the best, proven ways. Treatment of heroin addiction has a long history as we’ve found our way to where we are today.

One of the earliest attempts at heroin treatment was in 1935 at the Public Health Service Narcotic Hospital in Lexington, Kentucky. This facility was a combination of hospital, farm and prison. The recovering doctor who started an inpatient treatment facility that I worked at in 80s had gone through this treatment decades before when he was legally forced into treatment. This early treatment model tried to modify the patient/prisoner’s behavior. The idea was to instill a sense of responsibility and values through hard work and the isolation of a prison. The problem with this idea is that the doctor I referenced above had these qualities instilled in him from his childhood and medical training and became addicted to narcotics anyway. The doctor addict did not lack a good work ethic. I’m sure working on a farm helped his gigantic ego, but this wasn’t the cure for addiction. The treatment also proved ineffective for tough street addicts from the inner cities — they didn’t respond too well to milking cows and slopping the hogs.

The early failures hardened ideas that heroin addicts and alcoholics and such were incorrigible — they were irresponsible thrill seekers — they were mentally ill — they just wanted to escape — on and on. Synanon was one of these failures — at first, Synanon was based on Alcoholics Anonymous, but it took an ugly turn toward aversion therapy, shaming the addicts, shaving their heads and making them carry around disparaging signs, and really crazy stuff. Eventual discoveries in neurobiology regarding addiction changed the nature of treatment, although old ideas still abound that aversion therapy or religious conversion or jail time or talking therapy, etc, will resolve the problem. The better understanding of addiction created the Hazelden/Minnesota model of basically 28 day inpatient treatment based on addiction as a disease. Heroin treatment mainly went the way of maintenance through Methadone clinics until Suboxone, and other Buprenorphine products.

Currently, inpatient treatment has shared the load with outpatient treatment. Intensive outpatient programs utilize group therapy, education, medically assisted treatment and individual sessions to prepare the client for long term recovery management. Outpatient treatment is less disruptive, and the clients can attend treatment around their daily schedules and work. With medically assisted treatment, a heroin addict can get past the withdrawals and attend treatment long enough to learn long term coping skills and how to avoid relapse. This has been a major improvement. Although withdrawals from heroin won’t kill a person, the withdrawal is so painful that most people will not make it through the withdrawals without using heroin. Then, because they remember the pain of the withdrawal, they don’t try, or they go to a Methadone clinic to get maintenance doses. There are pros and cons to Methadone treatment, and I won’t get into that here. The good news from my perspective is Buprenorphine. Suboxone, the most popular form of Buprenorphine, acts on the opiate receptors and stops withdrawal (an oversimplification)– it’s an amazing drug, and you have to read the scientific explanations to really understand it. When a heroin addict can enter treatment without the fear of withdrawals, they can learn the same coping skills as the alcoholic to start a long term recovery management program. Addiction treatment which aims at drug free recovery is similar for alcohol, cocaine, opiates, benzos, etc.

No drug like Buprenorphine is a cure-all, it’s just a beginning, a tool that allows the heroin addict to enter treatment and establish a recovery routine that’s life long. The goal is to wean off the Buprenorphine once the person is established in recovery. We’ve seen great results with this model. Yes, heroin addiction is a huge national problem, but treatment works. Relapse happens, as in all medical conditions, but relapse is not a necessary part of the recovery process – it doesn’t have to happen. Many heroin addicts enter treatment and never use again — it can happen and it does. The old idea that treatment doesn’t work, especially for heroin addicts, has to be smashed. Treating heroin addiction is the fundamental solution to the heroin epidemic. The problem is that not all treatment efforts are equal — we must establish very strong national standards of treatment based on what works.  I’ll write about the stigma of heroin addiction in the next few days.

The Ongoing Heroin Epidemic


The ongoing heroin epidemic

Heroin overdoses have skyrocketed. The ongoing heroin epidemic is spreading across the country. Drugs now kill more people than car accidents or shootings. It’s affecting America’s youth in disturbing numbers — from ASAM:

Adolescents (12 to 17 years old)

 In 2014, 467,000 adolescents were current nonmedical users of pain reliever, with 168,000 having an addiction to prescription pain relievers.

 In 2014, an estimated 28,000 adolescents had used heroin in the past year, and an estimated 16,000 were current heroin users.

Additionally, an estimated 18,000 adolescents had heroin a heroin use disorder in 2014.

 People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use.

Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative. 

The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from 1994 to 2007.

So how does America deal with this problem? There are public information campaigns that’d be useful — the more information the better. If the information is sensational, hyperbolic and judgmental, it’ll likely be ineffective. For adolescents, straight forward information is always best. Acknowledging the allure to drugs is better than pretending heroin is a demon drug. The demonization of heroin has been tried over and over, and it’s never had much success. I suppose in the 60s, the demonization campaign had some effect on those who had never tried heroin, but the great majority of these people would never try it anyway. The demonization of heroin didn’t stop cocaine from becoming a popular drug.

It’s likely opioid use in general that’s created the current heroin epidemic. Opioids are over-prescribed. If the medical community wakes up, gets smart and slows the flow of opioids, it’ll likely slow the use of heroin. Healthcare providers need to better understand addiction — how to recognize addiction and how to deal with it. Cutting a patient off of opioids because they become addicted to them only drives the patient to the streets in search of relief from withdrawals, and this is where they’re introduced to heroin.

Heroin dealers know how to sell their product. The dealer will tell the person in withdrawal they don’t have to use a needle. The dealer will tell the person that heroin is an opiate and will give them the same relief as the Oxycodone. If the heroin is laced with Fentanyl, it won’t take much, and the powerful euphoric feeling, more powerful than prescribed opioids, will hook the person into using it again, and again, and again until, possibly, they use a little too much of a stronger batch and overdose. There are no controls on drugs sold on the street. Although the person was just as addicted to the opioids, when they start on heroin it introduces them to environmental, physical and legal dangers, and the slide down hill is faster and more dangerous. It would be best if medical professionals recognize addiction and deal with it like the medical condition it is, thus preventing the addict from getting lost in the world of drug dealers, social diseases, crime, etc.

I’m afraid that until there’s widespread knowledge of addiction and how to treat it, the ongoing heroin epidemic will continue. If you have a friend, co-worker or family member who has a problem, try to get them to talk to an addiction treatment professional — help is available. Tomorrow I’ll write about how opiate addiction treatment is no longer relegated to Methadone clinics — it’s treated with alcohol, cocaine, benzo and other drug addictions.