Beating addiction takes a combination of medication, therapy, desire, experts say

Treatment experts say help is available for those caught in the grip of addiction, but recovery is rarely successful without professional help and a support system.

It usually takes several attempts for recovering addicts to reach their goal.

“The easy way is to just give up on people,” said Eric Millinder, a certified recovery specialist with Somerset Hospital’s Twin Lakes Center.

“It’s always easier for the addict to give up,” he said.

“Every day they have to fight not to take the easy way out.”

“Addiction is a chronic disease,” Fred Oliveros, case manager supervisor, said at Cambria County Drug and Alcohol office in Johnstown.

“Recovery is a lifelong process,” Oliveros said.

The American Society of Addiction Medicine defines addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.”

Dr. Jeanne Spencer, family medicine chairwoman at Conemaugh Health System, puts it this way: “It’s when you keep seeking out a substance even when it’s harming the rest of your life.”

‘Ask for help’

The fight toward recovery often begins with the county drug and alcohol office, which performs assessments and makes referrals for those in need of help.

Although the offices are primarily set up to direct those who don’t have insurance, anyone can use the services, said Erin Howsare, director of the Somerset Single County Authority.

“We are not going to turn them away because they have insurance,” Howsare said in her office in the Somerset County Office Building, 300 N. Center Ave.

Assessments take about 45 minutes and are scheduled within seven days, unless the addict is in immediate need of detoxification. Then the assessment will be done in 24 hours, she said.

“We’ll call the facility and set up treatment,” Howsare said. “We make it pretty smooth for them. It is hard for them to ask for help. We want to make it as easy as possible.”

“There are 10 levels of care, from education through long-term hospitalization,” Administrator James Bracken said at Cambria County Drug and Alcohol in the Central Park Plaza, 110 Franklin St.

Funding for the county offices comes through state and federal sources, with each local office contracting with private care providers. Somerset’s network of providers, for instance, reaches from York County to the Ohio line and as far north as Venango County, Howsare said.

‘Foundation for recovery’

With heroin abuse now surpassing alcohol as the No. 1 request for help, more clients are requiring detox and inpatient care as the first steps in recovery, Howsare said.

Last year, her office completed 426 evaluations, including 197 for heroin or other opioids, 102 for alcohol, 81 for marijuana and 46 for cocaine and other drugs.

From that total, 106 were admitted for inpatient care, with 90 percent of those being heroin users, Howsare estimates.

Inpatient treatment typically lasts 28 days, but that is not the end of treatment, Millinder said. Day-long sessions include group sessions and one-on-one counseling.

“What we try to do is lay the foundation for recovery,” Millinder said at the Twin Lakes Center in Somerset Township. “We want to find out what’s driving their addiction and work on self-motivation for change.”

Once discharged from inpatient care, recovering addicts often enter outpatient therapy. There are several levels of outpatient care, ranging from partial hospitalization’s daily counseling sessions that last for hours and tapering down to counseling every month or even every three months.

There are other tools that can supplement counseling, the experts say. Many addicts find help in peer support through 12-step programs such as Alcoholics Anonymous or Narcotics Anonymous.

Medically assisted treatments are finding growing support among those working in the field. Methadone has been in use for many years and has been joined by Suboxone and Vivitrol.

None will be very effective if the patient is not continuing counseling therapy, Dr. Frank Kunkel of Accessible Recovery Services said.

“The value of therapy cannot be overstated,” Kunkel said. “These medications without therapy are simply an expensive, bottomless pit.”

‘State of the art’

There remain some ardent supporters of abstinence therapy – going cold turkey through recovery, Kunkel said. But the experts are increasingly seeing the value of medication support. Major centers, including the famed Betty Ford Clinic, have begun to include medically assisted treatment.

“A combination of medication and therapy is the current state of the art in treating opioid addiction,” Kunkel said.

His organization offers both Suboxone and Vivitrol through its weekly clinics at 132 Walnut St., Johnstown.

Patients receiving Medicaid assistance are required to also continue counseling therapy through other providers, he said.

Suboxone is a combination of the synthetic opioid buprenorphine, and the opioid antidote naloxone. Buprenorphine attaches to the opioid receptors in the brain and “tricks” the brain into thinking it has gotten some heroin.

Meanwhile, naloxone is an opiate blocker. It is the same active ingredient in Narcan, which is used as an antidote for overdose patients. Naloxone’s presence in Suboxone prevents abuse, allowing physicians to prescribe the pills to be taken at home, Kunkel said.

Vivitrol is a long-acting opioid blocker that allows recovering addicts to get one shot a month to avoid withdrawal symptoms.

Both drugs prevent the user from getting the euphoria they would experience from recreational opioids.

Medication and therapy

Like all areas of therapy, the choice of medically assisted treatment will depend on the patient’s situation and stage of recovery, Kunkel said.

“Some patients would rather have their opioid receptors kissed with Suboxone, not blocked with Vivitrol,” he said.

Methadone can only be dispensed at federally licensed clinics, such as Alliance Medical Services, 1419 Scalp Ave., Richland Township. The division of Pinnacle Treatment Centers is primarily a counseling center, Director Pamela Gehlmann said.

“Alliance is an outpatient treatment facility, first and foremost,” she said. “We do offer methadone maintenance treatment in conjunction with counseling.”

Pinnacle also offers Suboxone in the same building, but under its Suboxone Services of Cambria County division.

Like Suboxone’s buprenorphine, Methadone is also a mild opioid that quells cravings and withdrawal symptoms. But buprenorphine has what is called a “peak ceiling effect,” meaning that additional pills won’t increase its narcotic effect.

“Medication is just a piece of the whole puzzle,” Gehlmann said. “It supports the therapy. Counseling focuses on working on all the other issues in their lives that got them into drug abuse.”

‘Productive life’

The local experts won’t say that addiction can be cured, and they agree it is difficult to measure “success” in recovery.

“I think this is a hard disease to treat,” Spencer said. “I think people who decide to quit and seek out help, they can be helped.”

She says they can be considered successful when they are able to return to family life and return to the workforce.

“They are not spending every minute thinking about how to get their drugs,” she said.

Gehlmann has a similar definition of success.

“We measure success by people who come through treatment, test negative on screening and are reintegrating into their family, reintegrating into the community,” she said. “They show success by getting back into school, by getting back into work, by getting back into their family.”

“The ultimate goal is to be drug free and living a productive life,” Howsare said. “The main thing it takes is the person’s mind and willingness to want to be clean. The other factor is the support. Do they have positive support from family friends?”

Millinder sees success measured day by day.

“What I am looking for in someone is the willingness to change,” he said. “You have to develop the willingness to practice self-reflection and be introspective.”

‘People get better’

At Peniel Drug and Alcohol Treatment Center, 760 Cooper Ave., commitment to change is paramount, Academics Director Stephen Shannon said.

“If a family wants someone to start, we ask the family to speak with the person,” Shannon said at the Tanneryville facility. “We want to know that they, themselves are wanting treatment.”

Any treatment may not work the first time, the experts say. Many recovering addicts relapse and may return to a more intense therapy.

“They are still making progress,” Millinder said. “Sometimes it feels like five steps forward and three steps back.

“When someone is discharged, I tell them I don’t ever want to see you back in residential care. Residential care is like the ICU.”

Millinder said he’s not always concerned about the addict’s motivation for seeking treatment.

“As a counselor, you can become hard-hearted,” Millinder said. “A lot of people start out not internally motivated. They may come in because they have a court order or to ‘get the wife off my back.’

“I had to learn that’s OK at the start. It’s our job as therapists to help that person see why it’s important – why it’s important for that person to change their life.”

Durean Coleman, Peniel’s public relations director, says many come to see the value of treatment during their 13-month stay.

“Their motivation may change over time,” Coleman said. “Over the course of that transformation of their life, they realize: I needed this change.”

The underlying message the local experts have for those struggling with addiction is that there is hope.

“This is a tough disease,” Kunkel said. “It’s not like appendicitis. It’s a tough disease that does not have a quick cure. But it’s treatable.”

“People get better and they stay better,” Millinder said. “They may have setbacks along the way, but I’ve really seen a lot of people change.

“People who work on things get better.”