A model that works

A lot of media reports suggest that opioid replacement is the only effective treatment and/or that abstinence-based treatment is outdated.

Our personal stories demonstrate that this is not true, but there’s also a considerable body of research supporting a model of care that is abstinence-based. (Again, we’re not seeking to invalidate any other approach. We just want people to know that this is a valid approach.)

Choosing a treatment model

When confronting a difficult to treat medical condition, it’s sometime pointed out that there is one question that cuts through a lot of confusion.

We can ask a doctor, “If you had this disease, what kind of treatment would you get for yourself?”

This question avoids arguments about treatment models, evidence-based practices and the effectiveness of medications or 12 step groups. It moves past what physicians recommend for you or your loved one and what they actually do for their peers.

Ok. How do doctors treat addiction in other doctors?

Formal treatment. “The first phase of formal addiction treatment for two thirds of these physicians (69%) was residential care often for 90 days.”¹

Pharmacotherapy. “Use of pharmacotherapy as a component of treatment for SUDs or comorbid psychiatric conditions was uncommon. Only 1 of the 904 physicians studied was placed on methadone for an opiate-dependence problem. Naltrexone was prescribed for 46 physicians (5%) as an adjunct to treatment. About a third (32%) were prescribed an antidepressant for comorbid depression or anxiety disorders.”²

Supportive services. “Supportive services used by these recovering physicians included AA or NA 12-step groups (92%), aftercare groups from their formal treatment programs (61%), and follow-up from the PHP monitors (53%).”²

Long-term support and monitoring. “After completion of initial formal addiction treatment, all PHPs developed a continuing care contract with the identified physician consisting of support, counseling, and monitoring for usually 5 years.”¹

Drug testing. “Physicians were tested on average twice a month, usually with more frequent testing at the start of the agreement period and reduced testing following periods of stable negative drug test results. For physicians with substance dependence, the average period of testing was 47 months.”²

Dealing with relapse. “Relapses . . . were usually addressed by a combination of increased intensity of care and monitoring and by immediately informing family and colleagues of the physician to enlist their support in promoting compliance with the contracted behavioral changes.  The most common response [to more serious relapses]  was to recommend discontinuation of work to undergo a reevaluation.”¹

Outcomes. “Over the 5-year period, 22% of physicians had at least one detected instance of alcohol or drug use. As indicated, the detection of substance use usually resulted in more intensive treatment and monitoring, and among those whose substance use was detected, only 26% had a repeat positive test during the 5 years. At the 5-year follow-up, 71% of this sample were working and licensed; 18% had retired or had their licenses revoked, had retired, or died; and 5% had an unknown status.”¹

What’s the catch?

There are no “catches”, but there are a few things that are important for you to know.

First, there is no research on this kind of model for people other than health professionals, pilots and lawyers. There’s no reason to believe that it wouldn’t work for other people. (A study of physician recovery programs¹ found high rates of opioid addiction [35%], high rates of combined alcohol and drug problems [31%] and high rates of psychiatric problems [48%]. In addition, 74% were not self-referred.)

Second, this approach is a lot of work. For years. However, for most people it becomes like working out–it’s hard and unpleasant at first, but, eventually, it becomes something that makes you feel good, helps in lots of areas of your life and becomes something you look forward to.

Third, there’s no system in place to make it easy for you to access this kind of care. You (and your loved ones) probably need to build this system of care for your self.

Fourth, physician, pilot and lawyer programs have a powerful set of contingencies to help maintain engagement. If they fully engage in care, they get to return to work with a lot of support. These professions often provide strong identities with meaning and purpose. If they don’t fully engage in care, they risk losing their license.

What you can do

• Insist on high quality, long term care.
• Piece together the elements of good care as best you can.
  • If the addict won’t accept treatment, consider an intervention.
  • If possible, consider inpatient or residential treatment to start. The purpose is to stabilize the patient and begin laying a foundation for long term recovery. (Keep in mind that this is only a beginning. What comes after is the critical question.)
  • Make sure long term aftercare or outpatient treatment follows. Don’t trust assume treatment staff will line this up. You may need to play an active role in planning this.
  • Look for ways to build inlong term recovery support. Options for this include the following:
    • Sober housing.
    • A recovery support and monitoring service. (This report lists 4 of these services on pages 20 and 21.)
    • Boost your odds by creating a family recovery team. Debra Jay’s new book, It Takes a Family, is a step-by-step year-long blueprint.
    • In the event the addict is facing criminal charges of some sort, explore the possibility of getting their case transferred to a drug court.
  • Look for a primary care physician that is knowledgeable about addiction and recovery. They can help monitor and avoid prescribing any meds that might be dangerous for a person in recovery.
• Take care of yourself. Your personal recovery (from having an addicted loved one) is an important predictor of your loved one’s recovery.

Sources

1 DuPont RL, McLellan AT, Carr G., (2009). How are addicted physicians treated? A national survey of Physician Health Programs. Journal of Substance Abuse Treatment, 1-7.
2 Dupont RL, McLellan AT, White WL, Merlo LJ, Gold MS. Setting the standard for recovery: Physicians’ Health Programs. Journal of substance abuse treatment. 2009 Mar; 36(2):159–71.