Lessons Learned. Tools to Treat Opioid Misuse

Behavioral Health News, Winter 2020
By Staff Writer

In the 20 years it took opioids to become the deadliest substance misuse epidemic in American history, the response from the public is overwhelmingly in favor of controlling access to opiates by limiting their use, supporting prevention education and prevention campaigns, and equipping first responders with overdose reversal kits. Treatment, however, is a mystery to most people unless they or a loved one have needed care.

We asked Dr. Peter Provet, President and CEO of Odyssey House, a clinical psychologist who has worked in the addiction field for 30 years, about the increased role intensive residential and outpatient treatment plays in preventing more overdose deaths.

Dr. Provet: the first thing to understand about the opioid misuse crisis is that the lives lost are only the beginning of the devastation.

The collateral damage to our society is stunning. Families, especially children born to parents addicted to opioids who are now dead, in jail, or still using, are the latest tragedy unfolding before our eyes. Meanwhile, the cost to the economy – at least $631 billion from 2014 to 2018 – keeps going up and up, draining local municipalities from Ohio to New York already straining to provide services.

There is no quick fix for people addicted to opioids. Medication-assisted treatment that supports behavioral change is an essential way to reduce overdose deaths and help people rebuild their lives.

Yes, it takes time. Yes, people relapse. And, yes, treatment costs money. But compared with the enormous societal costs, broad-based psychosocial treatment is the only way we can save this generation and the one after it.

Has the opioid epidemic changed treatment at Odyssey House?

Dr. Provet: intensive residential treatment with linkages to community-based outpatient, supportive housing, and peer-led recovery services together represent a model we developed over 50 years ago to effectively treat surging heroin abuse in the 1960s to 70s; the cocaine and crack cocaine crisis of the 1980s and 1990s, and; the tragedy of today’s opioid epidemic.

During five decades of changing drugs of abuse in America, the Therapeutic Community rehabilitation model has evolved to include psychiatric and medical services, Medication-Assisted Treatment, housing, and vocational supports, and individual and family therapy. But underpinning all these elements is a commitment to peer-supported recovery and the development of a network of people who effectively support each other while in treatment and, most critically, when they rejoin society.

This model is still one of the most effective rehabilitation regimens for people who require a broad range of supportive services. Its greatest strength is its flexibility to adapt to different populations, from women with children, to adolescents, and to older single adults all the while supporting each individual’s drug-free/medication-assisted treatment goals, and preparing them to function independently.

While the opioid crisis has increased awareness of drug addiction and its profound costs, it has not changed the demands on public treatment providers to save and rebuild lives as quickly, and cheaply, as possible. This is despite the fact that many of the people we treat have endured decades of marginalization and disadvantage – on top of chronic substance use and mental health disorders.

You talk about the evolution of treatment services. What changes do you want to see?

Dr. Provet: As a treatment provider I have long fought against the stigmatization of addiction in our society. I want people suffering with substance use disorders to be seen as just as worthy of compassion and resources as those with other chronic, relapsing disorders from mental illnesses to medical challenges.

To me, the criminalization of addiction and relegation of substance abusers to the prison system and homeless shelters has done a great disservice to young men and women, particularly from minority communities. As we enter a new decade, I hope overdose deaths from prescription opiates will decline and not be replaced by street heroin and/or fentanyl. I also hope as the legalization of marijuana is adopted by more State Legislatures, we will not see an increase in teenage substance use disorders.

For more than 50 years Odyssey House has provided cost-effective, quality treatment services for people with a range of substance abuse disorders from heroin, cocaine, marijuana, and alcohol. Starting in 1967 and continuing right up to today, the reason we have been able to help thousands and thousands of people change their lives for the better is because of the professionalism and dedication of our workforce.

Without counselors, social workers, administrators, teachers, medical personnel, and facility managers, we would not be able to meet the needs of our population. But this workforce is under stress from increased workloads and a demanding regulatory environment that insists we do more with less.

As treatment steps up to address the opioid crisis that continues to devastate our society, my responsibility and privilege as an industry leader are to retain our professional staff and ensure they have the tools they need to do their jobs and the compensation they deserve as they carry out this essential work.