Twenty-eight days. That’s the typical length of time a person spends in a residential alcohol or drug treatment program.
It seems like a breathtakingly short amount of time to ask people suffering from addiction, especially to heroin and its chemical cousins oxycodone and hydrocodone, to come to grips with their chronic disease and to put new, healthy patterns in place.
I say “especially” opioids because, over time, they change the brain, altering areas that control judgment, decision making, behavioral inhibition and control. This re-wiring, according to physicians and addiction treatment experts, is a big reason why an addiction to heroin and prescription pain pills is so difficult to kick.
While reporting for our series, “Heroin: A different kind of drug problem,” I’ve been thinking about whether we need a different kind of solution. One that isn’t time-based but results-oriented. One that isn’t grounded primarily in psychotherapy and Narcotics Anonymous meetings, but in medication-assisted treatment programs. One that isn’t punitive and regimented, one that’s more forgiving of relapse.
Let’s start with the issue of time.
“The rule of thumb is duration, not intensity,” said Dr. Brad Lander, clinical director of Talbot Hall, the addiction rehab at The Ohio State University Wexner Medical Center in Columbus. “You know you need to keep that person in some kind of treatment for a couple of years.”
That’s right. YEARS.
“Typically, it take two full years for the brain to heal from opiate abuse,” said Lisa Ashafa, director of peer and specialty services at Coleman Professional Services, which offers intensive outpatient treatment programs in Allen and Hardin counties. She said a client enrolled in a medication-assisted treatment program will typically be on Suboxone, which helps reduce withdrawal symptoms and cravings, for two years and on Vivitrol, an opioid blocker and cravings management drug, for “two years, plus” after that.
That’s four to five years, if you weren’t doing the math.
As for that medication-assisted treatment, only one out of 10 people are getting it, according to the National Center on Alcohol and Substance Abuse. Most are enrolled in programs that only offer intensive psychosocial therapy coupled with peer support through groups, such as N.A. or Alcoholics Anonymous.
“While social support approaches are helpful and even lifesaving to many … they do not qualify as treatment for a medical disease,” CASA reported in its 2012 “Addiction Medicine: Closing the Gap between Science and Practice.”
It’s expensive, more expensive than counseling sessions and providing transportation to an N.A. meeting. And some treatment providers think pharmaceutical programs conflict with abstinence-only protocols. Or they believe it’s a crutch for people whose entire problem is one of relying on chemical crutches.
One physician put it this way to CASA: “I see this as an opportunity for drug users who are by class the most lying, scheming, dishonest group of patients. They need hard-based, no-nonsense treatment programs. I can’t stand their manipulative behavior.”
Ouch. Addicts would agree, they’re not to be trusted, at least not until their bodies and brains have healed to the point where they can start to untangle heroin’s mental re-wiring.
“Our problem,” said Talbot Hall’s Lander, “is our expectations of what (recovering addicts) are capable of doing.” Remember, he said, addiction is a brain disease. “You wouldn’t go up to someone who’s actively schizophrenic and say, ‘Stop hallucinating.’”
You also wouldn’t punish someone with a chronic health condition for relapsing, he said.
“Kicking people out of treatment is a ridiculous idea,” he said. “You don’t kick a diabetic out for not following protocols. You find protocols that are going to work.”
Patience. Medication. Money. Time. Do we have the political will to go the distance with our struggling sons and daughters, husbands and wives, neighbors and friends? Are we willing to dig deep — into our pocketbooks, for sure, but more important, into our capacity for compassion?
“I love working with addicts,” Lander said. “When you get someone sober, they become a completely different human being within months. There are days when I feel like I’m doing exorcism.”
Or is 28 days the best we can offer?
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