By Beth Lawrence
Treatment for opioid addiction is as diverse as treatment for any other medical condition. Much like any illness, there is no one-size-fits-all cure.
Some addicts start their recovery by weaning themselves off of opiates and seeking treatment, such as a 12-step program. Some attempt to quit cold turkey. Others seek inpatient or outpatient treatment and counseling.
Dr. Annemarie Russell is a psychiatrist who treats persons with mental health conditions as well as those seeking recovery from substances.
Russell works for Appalachian Community Services and is the medical director of The Balsam Center Adult Recovery Unit on the Haywood side of Balsam Gap. The Balsam Center accepts patients from Jackson and surrounding counties.
Russell’s work in the mental health field led her to include treatment for addiction as well because some addicts do not suffer from addiction alone.
“Many have co-occurring mental health problems for which they seek treatment,” she said. “So treating people with some type of addiction has always been part of my practice. I currently have shifted my focus to treating people with more severe addictions due to working on an acute recovery unit, which provides mental health care as well as detox and relapse prevention services.”
The Balsam Center does not offer a one-size-fits-all treatment, instead focusing on the individual and any variables that play into the addiction.
“The process of substance use treatment depends on many factors, including the type of substance used, the severity of the addiction, the motivation of the person seeking services, prior treatment and co-occurring medical and mental health problems,” Russell said.
Depending on a person’s needs, treatment may start with detoxification and from there continue with a range of services such as rehabilitation centers, intensive outpatient programs and individual and group outpatient counseling.
Many addicts also choose to attend self-help groups such as Alcoholics Anonymous, Narcotics Anonymous and Refuge Recovery.
The first step in treatment is to decide whether the client needs to undergo inpatient detox. Some clients may first need to be treated for medical health issues in order to stabilize their condition, Russell said. Detox and any treatment necessary for mental health issues occurs at the same time and once acute treatment has been completed, the client can begin outpatient care.
Detoxing is more than simply stopping the use of a drug or alcohol. The body develops a chemical dependency on the substance being abused. When that need is no longer being met, the body undergoes intense physical changes. Withdrawal symptoms can be mild or severe and vary between substances. Withdrawal from some substances, such as alcohol, may be life-threatening due to risk of seizures, whereas withdrawal from other substances, such as opiates, may cause great physical discomfort and harm from muscle aches, runny nose, sweating, chills, goosebumps, vomiting, diarrhea, anxiety, headaches, mood swings, depression, fatigue and cravings, she said.
“Any detox from high amounts of substances is better accomplished in an inpatient setting, where a safe, supportive environment, medical support and mental health stabilization can be provided,” Russell said. “Detox from these substances may require medication to assist in a safe treatment process.”
Improperly controlled detox can also push addicts back into drug use. The physical symptoms can become so unbearable that they cause the person to seek drugs to cope with the pain, nausea and other side effects. Inpatient detoxing weans the patient off of opiates, sometimes using drugs that prevent seizures or ease withdrawal symptoms.
“In all cases, inpatient treatment can offer a safe place to rest, attention to diet and hydration and emotional support and education, which can ease withdrawal symptoms and ready a client for the next step on their recovery path,” Russell said.
During their inpatient stay, clients are encouraged to consider the next steps in their recovery, such as drug rehabilitation programs, intensive outpatient care which can include up to 12 weeks of treatment in groups that meet three times a week or individual outpatient treatment.
Some clients may be candidates for methadone, Suboxone or Vivitrol treatment. Much like opioids, Suboxone and methadone attach to opiate receptors in the brain and are used in medical settings to substitute for opiates and stop cravings. This allows doctors to step down the dosage and lets the patient focus on getting well.
Vivitrol works differently. It is an opiate blocker that attaches to the same brain receptors, but blocks any sensation of euphoria that opiates may cause.
Another important factor of inpatient treatment is access to care and support. Patients seeking recovery are also assessed for mental health issues and treated for those along with addiction treatment. Issues like post traumatic stress disorder, bi-polar disorder and anxiety sometimes lead sufferers to self-medicate and can end in addiction.
Russell knows that it is not enough to simply stop using a drug or to attempt to do so alone.
“Recovery is a team sport,” she said. “It starts with a patient’s determination and willingness to change. Beyond that, recovery requires a team that can support a person through therapy, group treatment, medication-assisted treatment and medical care.”
Recovery also requires psychosocial stability, including safe housing, income/employment, transportation and a sober support system.”
There is no one criteria for who becomes an addict. Russell has seen addicts from every socioeconomic background, age, race and educational level.
“Some clients come from families where drugs and alcohol were not condoned and some were raised in families where substance use ran rampant and they were introduced to drugs by family members,” she said. “Some were from loving and supportive families, but ‘fell in with the wrong crowd’ in school. Some were prescribed a narcotic after an accident and became addicted.
“I have seen clients who started using early and did not finish school and those who had periods of recovery, had jobs and family, but struggled through repeated relapse and became homeless and estranged from loved ones.”
Experts agree addiction is an illness, not a moral failing or a character flaw. Drug use effectively rewires the brain’s reward center and creates a dependence on the drug. That rewiring sets the stage for magnified reactions of euphoria to drugs such as opiates and intense cravings when the addict does not have access to drugs. In time, that response becomes harder to achieve requiring the addict to use increasing dosages to get high.
Recovery helps mitigate the physical effects of drug use.
“In long-term, sustained recovery, greater than one year, the signal of craving may diminish and over time disappear,” Russell said.
But that does not mean the addict is cured and will never want or use drugs again.
“Many people find that they get ‘triggered’ unexpectedly by situations or dreams, which can be likened to a flare-up of a medical illness,” Russell said. “This can lead to relapse. A person in long-term recovery may use a substance, such as alcohol, thinking that ‘just one’ will do no harm.”
These triggers or misunderstandings of what an addict can or cannot use are why treatment programs and attention to recovery are important.