Amy knows all about buprenorphine. She’s been on it three times, each course of treatment initiated as her addiction to opioid painkillers reached fever pitch, leaving her unable to deny the damage any longer. Each time, she would seek the help of her physician, one of the 32,000 physicians licensed to prescribe buprenorphine in the United States. “I didn’t see a need to go to a whole opioid addiction treatment program if I could just get what I needed from my doctor,” she tells me. And for a few months, she appeared to be right; she stopped taking Oxycodone or fentanyl or whatever else she could get her hands on, and stayed faithful to her buprenorphine. “It was always like a miracle drug for the first little while.”
But after her treatment ended, something would always happen that took her back to illicit drug use. “The first time it was a break-up with my boyfriend. My heart hurt so much I would have done anything to take it away,” she says. “Opioids were great at that.” The next time it was being laid off from her job. And the last time, it was her mother’s breast cancer. “I couldn’t handle it. I had no emotional resources to deal with what was happening. What I did have were drugs.”
But while catastrophic events are well-known to trigger relapse, Amy believes her cycle of use and temporary recovery wasn’t solely the result of triggers beyond her control. “I think a part of me was waiting to use again. Buprenorphine is an incredible drug. I would recommend it to anyone who wants to get off opioids. But unless you get at that part of you that wants to use more than it wants anything else, you’re not going to recover long-term. Unless you get at the underlying assumption that you can’t cope with the hard parts of life without drugs, you’re not going to stay clean. No medication is going to heal those parts of you.”
Expanding Access to Relapse Prevention Medications
As the national opioid addiction crisis rages on, public health officials, medical professionals, and the recovery community as a whole are working together to create meaningful solutions to the acute needs of addicts. Much of the focus has thus far been on expanding access to medical interventions in the form of medications such as methadone, naltrexone, and buprenorphine, which are proven to both ease withdrawal symptoms and prevent relapse. “For someone with … opioid use disorder, it’s very difficult to maintain abstinence without the use of relapse prevention medication,” says Dr. Steven L. Batki, professor of psychiatry at UCSF School of Medicine and consulting Addiction Psychiatrist at Alta Mira. “In my 33 years of working with people who have serious heroin or other opioid use disorders, it’s difficult for me to recall more than a handful of patients who did not benefit from the use of relapse prevention medication to facilitate their recovery.”
Unfortunately, only a fraction of recovering opioid addicts receive relapse prevention medication. As Christine Vestal notes, “Nationwide, a shortage of doctors willing to prescribe buprenorphine … and a federal limit on the number of patients they can treat, prevents many who could benefit from the addiction medication from getting it.” The result is long waiting lists for licensed prescribers and prolonged suffering for both addicts and their loved ones. In the meantime, opioid users continue dying at a furious pace; health officials say that someone dies of an opioid overdose every 24 minutes in the United States.
Seeking Long-Term Solutions in Opioid Addiction Treatment
While it is now undeniable that access to relapse prevention medications must expand widely and rapidly, these medications are not a panacea. At the American Society of Addiction Medicine conference last month, doctors expressed concerned that in the rush to get addicts the medications they need, providers are “losing sight of … the ultimate goal: long-term recovery.” “The disease is lifetime and the fix is short term,” said Dr. Robert DuPont, former White House Drug Czar. “Usually, for most medication-assisted treatment, it’s less than six months. What happens then? I want to have a longer term view. Where are they at five years from now?” He believes that treatment must include treatment of the psychological aspects of opioid addiction as well as “human connection and fellowship” to improve long-term outcomes.
Dr. Batki agrees with this assessment. In a recent interview, he stressed the vital role psychosocial supports and lifestyle changes, including psychotherapy, support groups, spiritual practices, and exercise, play in the recovery process. “Twelve-step support groups provide a community that can offer extremely valuable psychological support and encouragement,” he says. “Having a sober living environment can protect against impulses to relapse to substance use when experiencing withdrawal symptoms, experiencing one’s own uncomfortable or painful emotions, or experiencing the day-to-day stresses that come with life.”
Part of the reason a more holistic approach is necessary is the nature of addiction itself. While addiction is indeed a chronic brain disorder, it does not exist in a vacuum. Rather, it is deeply informed by a complex web of biological and environmental factors, many of which stem back to early childhood and leave you without the psychological resources to engage in healthy behaviors. “Many substance-dependent people who make it into therapy show a profound inability to calm and soothe themselves when stressed,” writes Michael Segell for NBC News. Often, this emotional deficit is rooted in formative experiences that left deep and lasting imprints on your psychological make-up, keeping you from developing the skills you need to successfully navigate through life without drugs. Although relapse prevention medications can quell the overwhelming urge to use on a chemical level, they do not teach you how to cope with the difficult emotions and complex histories that so often drive drug addiction. Left without the psychological resources to handle stressors in healthy ways, relapse is not only likely, but nearly inevitable.
Creating Holistic Recovery Experiences
While the importance of holistic treatment experiences is now beginning to enter mainstream consciousness, their value has long been recognized within the recovery community. Residential addiction treatment programs that combine medically-assisted therapies such as buprenorphine with a comprehensive range of psychosocial interventions are considered the gold standard for opioid addiction treatment owing to their unique ability to offer dynamic, well-rounded treatment. Through intensive individual, group, holistic, and experiential therapies, you can gain both the insight and skills to make meaningful changes that fortify your recovery and minimize risk of relapse while enhancing your overall quality of life. With the help of compassionate clinicians and peers, you can come to both understand the experiences that led to your drug use and move beyond them, empowering you to break free from opioid addiction once and for all.
However, long-term recovery doesn’t end with residential treatment. As such, selecting a treatment program with extensive continuing care services is often essential to the healing process, giving you the structured support you need to retain your sobriety as you transition back into the community. At Alta Mira, we understand the critical nature of these supports and offer a full range of programs and ongoing contact to help you reach your long-term recovery goals. Our personalized and complete aftercare planning gives you opportunities to continually recommit to recovery–even in the presence of serious stressors–in order to create the life you truly want.
Alta Mira offers a comprehensive range of addiction treatment services for people struggling with opioid addiction as well as co-occurring mental health disorders and process addictions. Contact us for more information about our residential and outpatient programs and how we can help you or your loved one start on the journey toward sustainable wellness.
Image Source: Unsplash user Sergey Zolkin