Treatment options for tackling addiction can vary from hours to months

Research shows that addiction treatment generally produces good initial results. But all addiction treatments are not created equal.

There are many types, including once-a-week sessions with substance-abuse professionals, treatments with medicines such as methadone or Suboxone, and residential programs with stays ranging from fewer than 30 days to more than a year.

Experts say it’s nearly impossible to compare the effectiveness of one treatment against another because so much depends on the needs of the addict — and there is debate about how well medication-assisted therapy works.

The 2012 Kentucky Substance Abuse Treatment Outcome Study examined 12-month follow-up results for 1,225 adults who received all sorts of treatment in publicly funded programs across the state. More than three-quarters reported no illicit drug or alcohol use.

Still, the clients probably won’t stay drug-free for life, experts say.

“Most will relapse,” said Joyce Willens, an assistant professor at Villanova College of Nursing in Pennsylvania. “It’s rare to have someone who doesn’t.”

Approaches differ

Outpatient treatment is most common in Kentucky, with clients coming in once a week for individual or group counseling sessions that last 60 to 90 minutes. Intensive outpatient treatment brings in patients three to four times a week for three or more hours at a time.

Experts say typical outpatient care — which allows addicts to work and stay with their families — is best suited for those who are able to stay abstinent or nearly so during treatment. Many addicts go through detoxification programs in hospitals before starting such treatment.

Residential programs are for those with more severe drug problems. Short-term residential care in Kentucky averages about 16 days, during which addicts detoxify, begin learning about recovery and get counseling based on 12-step programs such as Narcotics Anonymous.

Long-term treatment lasts several weeks to more than a year. Afterward, some addicts go into halfway houses designed to promote sober living, in which they are monitored by peers, may have staff supervision and generally are required to get jobs to help pay for rent and food.

Julie Duvall, executive director at Priscilla’s Place in Louisville, said women stay there six months to a year, attending support groups and classes with a strong biblical element, as well as participating in community service. The cost is $1,500 a month per person, although the program relies on fund-raising and takes indigent clients.

She said the center, part of a Christian treatment program called Teen Challenge, usually has a waiting list of up to 90 days.

“The faith-based component gives them a base for healing,” Duvall said. “Sometimes there are hurts only God can heal.”

Tommy Milton, 32, of Knott County, was treated for prescription-drug addiction at another Teen Challenge center called Chad’s Hope in Manchester in 2010, after winding up in prison when he failed a drug test during probation.

Chad’s Hope “got my mind renewed by God. Now my desire is to have a home for my family,” said Milton, who is married and has a 2-year-old son. “My mind does not even think about pills. When I come home and see my wife and my little boy, that’s it.”

Medication debate

Some recovering addicts have less glowing descriptions of medication-assisted treatment — although professionals say it can work well.

“It’s like a temporary solution to a permanent problem — like having a broken arm and putting a Band-Aid on it,” said Waylon Tackett, 31, of Greenup County, who took Suboxone before going to a residential recovery center in Morehead.

Bridget Bingham, a client at The Healing Place in Louisville, said methadone actually “made me worse.”

“It’s just a substitute,” she said. “It’s a legal way to get high.”

But many medical professionals and recovering addicts strongly disagree.

“Suboxone has been a lifesaver for me,” said Christian Fossdal, a recovering addict from Portland, Ore.

Doctors say medication-assisted treatment, when used properly — and supplemented by counseling and support — doesn’t create a new addiction.

There are three main types of medication used to treat opioid addiction: methadone, buprenorphine and naltrexone. Suboxone is a combination of buprenorphine and a drug called nalaxone that discourages people from dissolving and abusing the medication.

“All of the medications are about the same effectiveness,” said Philip Wenger, assistant professor of pharmacy practice at St. Louis College of Pharmacy. “Definitely, counseling in addiction to medication can be beneficial.”

According to experts at the U.S. Substance Abuse and Mental Health Services Administration, methadone and buprenorphine trick the brain into thinking it’s still getting the abused opioid, although the patient doesn’t get high or go through withdrawal. Naltrexone, which is used less frequently, works by blocking the effect of opioids.

People can take the medication for months, years, or even for life. Methadone is dispensed only at licensed treatment centers, while the other two types can be prescribed by doctors.

Wenger acknowledged drawbacks to medication-assisted therapy, saying “one of the concerns of methadone and buprenorphine is you can become dependent on them.”

But Michele Flowers McCarthy, community and government liaison for SelfRefind, a network of clinics offering Suboxone treatment, said medication can provide vast benefits for many patients. Officials said it’s often a good option for working people still able to hold their lives together.

“We’ve seen some people come through our program for six months and are still sober two years later,” she said.

Flowers said medication-assisted treatment is a necessary weapon in the treatment arsenal.

“We need to have all options available to all people,” Flowers said. “Everybody’s circumstances ... are different.”

This series was first published in the Courier-Journal on December 16, 2012
Photo Credit: Alton Strupp/Courier-Journal