Thursday, January 17, 2013

Are Treatment Centers Backing Off from the Goal of Complete Abstinence?

Recently, Hazelden announced that they were going to start to allow patients in their treatment program, and patients discharged from their treatment program, to take addictive medications.  This includes letting their patients being discharged home on Suboxone.  This decision is such a radical departure from their past philosophy that it is difficult to overstate it.  Hazelden, in Center City, Minnesota, was one of the first abstinence-based treatment programs in the world.  Hazelden has been so influential that standard 28-day treatment programs are still referred to as following the ‘Minnesota Model”.  Hazelden began in 1949 and based its treatment programs and philosophy squarely on their interpretation of the 12 steps of AA.  Part of that philosophy, as some interpreted it, is that any medication that may be used as a crutch hurts the chances of long-term sobriety.  Some people believe that any medicine that is a crutch is dangerous because patients shouldn’t use a crutch – they need to rely on their program, their sponsor, and their Higher Power.  So, in the past, Hazelden would restrict almost all medications and certainly not allow patients to be discharged on an addictive medication like Suboxone.

So, how could it be that Hazelden has now decided that it will allow patients to come to their treatment program and be discharged on an addictive drug that is itself very difficult to be detoxified from?  Hazelden was so staunchly opposed to any medications that could be used as a crutch that, a few years ago, they actually refused to admit one of our patients.  Our patient had completed a difficult detoxification off opiates and we had inserted one of our Naltrexone implants – a completely non-addictive medication that has no mood-altering effect.  The patient was very well motivated and was following our advice to go to an intensive treatment program.  He was willing to take the time, and spend the money and go to a 28 day program, so that he could enhance his chance of long-term sobriety.  The directors at Hazelden refused to allow him to be admitted unless he had the implant removed.  They refused to make an exception even after I called them and pointed out that Naltrexone is safe, non- addictive and is not mood-altering.  I also pointed out how serious this young man was, and how much he wanted to learn how to stay sober.  So, he came back to us, we removed his implant, and he went to treatment.

The reality is that success rates for patients who have opiate dependence is very low. Success rates of being opiate free 12 months after treatment are probably around 5 – 10%. This seems to be true even if patients complete a 28 day treatment.  Success rates do go up if patients participate in an extended (3-4 month) program.  Such a low success rate is the reason why, for over 40 years,  it has become quite an acceptable practice to put opiate dependent patients on Methadone.  For the last few years, it has also been possible for patients to go onto Suboxone, which is another long acting, “safer” narcotic.  It does seem logical that, if the alternative is relapse back to active drug addiction, it is better to put patients onto a controlled narcotic that has less abuse potential.

So, it is understandable that Hazelden would seriously consider using Suboxone to keep their patients from relapsing back to active opiate addiction.  But, the fact is, that Suboxone is not the best option to keep patients from relapsing.  Naltrexone is a blocking drug that can also prevent relapse and help patients stay clean long enough so that they do not relapse. And Naltrexone is not addictive or mood altering.  A number of studies have shown that twelve month success rates using Naltrexone implants are around 60%.

We have been using Naltrexone implants for over 14 years and have seen remarkable successes.  Now Vivitrol is also available as a monthly Naltrexone injection.  We believe that opiate dependent patients do need support to help them get clean and stay clean. We believe that, for the vast majority of patients, Naltrexone implants or Injections are the preferred method of providing that support and helping patients achieve long-term sobriety! 

At The Coleman Institute, we specialize in helping people get clean clean and stay clean from alcohol and drugs. If you or someone you love is in need of detox from opiates, alcohol, benzos, Methadone, or Suboxone, please do not hesitant to call Jennifer Pius at 1-877-77-DETOX (33869).  Have a happy, healthy new year!

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