Recovering addicts need encouragement
Last week I shared my concern about the rising use of heroin and other opioids in our community, and how we can do more to prevent the onset of their use. This installment addresses the need to understand and support treatment for those persons already dependent on or addicted to these substances.
My previous use of terms like opioids and opiates may have caused unneeded confusion. To correct that and to further today’s discussion about treatment I cite this definition of opioid, from the National Institute of Health:
An opioid is a natural or synthetic psychoactive chemical that binds to opioid receptors in the brain and body. Natural opioids include morphine and heroin (derived from the opium poppy) as well as opioids produced by the human body (e.g., endorphins); semi-synthetic opioids include analgesics such as oxycodone, hydrocodone and fentanyl.
— National Institute on Drug Abuse, Research Report Series, “Heroin” available at https://www.drugabuse.gov/publications/research-reports/heroin/ .
A person’s abuse of opioids may fall at any point along a continuum of seriousness. One way to capture this progression is by identifying a user’s tolerance, physical dependence or addiction. Again I refer to the National Institute of Health for definitions of these conditions:
Tolerance: A condition in which higher doses of a drug are required to produce the same effect as during initial use; often leads to physical dependence.
Physical dependence: An adaptive physiological state that occurs with regular drug use and results in a withdrawal syndrome when drug use is stopped; usually occurs with tolerance.
Addiction: A chronic, relapsing disease characterized by compulsive drug seeking and use accompanied by petrochemical and molecular changes in the brain.
The newest Diagnostic and Statistical Manual of Mental Disorders also addresses this progression through its definition of “Opioid Use Disorder,” which can be diagnosed as mild, moderate or severe. Since each user is unique in their progression of use, treatment must be individualized. The types of treatment include abstinence only programs, counseling and behavioral therapy, and medications. The most promising treatment model combines the counseling or behavioral therapy with medication and is known as Medication-Assisted Treatment (MAT).
While some persons have reported success through abstinence alone, that outcome is uncommon, with a recidivism rate of over 90 percent. Abstinence alone poses serious concerns about the health impacts of withdrawal if not properly managed and relapse is especially dangerous as one’s usual dosage could prove fatal after a period of abstinence.
More promising results are reported from Medication-Assisted Treatment (over 50 percent success rates when followed for over a year). The three types of medications used in this approach work through the same opioid receptors as the heroin and painkillers do. The agonists, such as methadone, activate the opioid receptors. Partial agonists, such as buprenorphine, also activate the receptors but produce a smaller response. Antagonists block the receptors and interfere with the rewarding effects of opioids. Coupled with behavior therapy or counseling, these medications can help an addict live and function productively. Unfortunately methadone programs are of limited value to our community since the closest clinic is in Anchorage and treatment involves daily dosage. More hopeful is the availability of MAT using buprenorphine, which is currently provided by Dr. Sarah Spencer, a local physician and certified addiction specialist. For more information about this treatment, you can contact her at email@example.com, or at the Ninilchik Clinic at (907) 567-3970.
As community members what can we do to help connect treatment opportunities to those who need it? If you know someone struggling with these substances, support them seeking help as a health concern, not a character issue, armed with information such as the pamphlet by the Substance Abuse and Mental Health Services Administration, “Medication Assisted Treatment for Opioid Addiction, Facts for Families and Friends”, available at https://store.samhsa.gov/shin/content/SMA09-4443/SMA09-4443.pdf. (You can contact me at HomerExchange@gmail.com for a copy of that brochure or other materials referenced herein.)
Connect the persons who want help with others who support treatment and recovery, for example the Kachemak Bay Narcotics Anonymous group which meets every Saturday at 5:30 p.m. upstairs at Homer United Methodist Church (firstname.lastname@example.org).
Tell our legislators that you support the retention in the state budget of $30 million to develop additional substance use disorder services for Fiscal Years 2016-2019, a budget amendment that garnered bipartisan support two weeks ago in the House Finance Committee.
Just as you might help a person learning to live with diabetes, ask the recovering addict how you can help them maintain the regimen provided by their physician. Offer to provide practical help, such as a ride to the clinic or help getting work. Brainstorm ways you can help them progress in their behavioral therapy, such as resisting identified triggers or increasing skills in coping with life stressors.
Acknowledge the work involved in recovery. While treatment is hopeful, it isn’t easy. Non-judgmental listening to another person’s story can make a difference as they work to make themselves healthier. Finally, you never know when your smile or encouraging word can change a bad day into a hopeful one.
Ginny Espenshade has worked in juvenile justice for 20 years as executive director of the Kenai Peninsula Youth Court.