Center succeeds fighting heroin with medicine


Using medication-assisted treatment, Solutions Community Counseling and Recovery Centers boasts a success rate six times the national average when it comes to rehabbing heroin users.

When patients are given two shots or more of Vivitrol — made by Alkermes, which has a manufacturing facility in Wilmington — Solutions found they have a 62 percent success rate, according to Michelle Box, outpatient director. Box said that rate is defined by those who complete the program without falling into a pattern of drug use.

According to Box, the national success rate for all programs is about 10 percent.

Medication-assisted treatment, or MAT, remains a controversial topic for many. Drug courts in Kentucky, until earlier this year, didn’t allow addicts to take any medication. Critics say replacing one drug with another doesn’t address the underlying issues, while proponents argue that scientific studies show MAT to be more effective than abstinence.

Box stressed that MAT doesn’t replace cognitive-behavioral therapy, but complements it.

Vivitrol, Box said, is an injection lasting for 28 days that blocks receptors in the patient’s brain. If someone takes heroin after receiving Vivitrol, he or she wouldn’t be able to experience the pleasurable side effects and could still become physically ill. In that way, it differs from medications like Suboxone and Methadone, which are used in replacement therapies to help with detox and to avoid withdrawals.

Vivitrol costs about $1,200 an injection, but insurance carriers and Medicaid have, in the last three years, included it as a covered cost in programs.

Those participating in the MAT are usually at an intensive outpatient treatment level, meaning they are meeting with three groups a week for three hours a night as part of their treatment, as well as individual sessions with therapist and case managers.

It’s a weekly commitment of about 10 to 12 hours, Box said, and that’s for those without an additional mental health diagnosis, too. Mental health disorders co-occur with heroin addiction frequently.

Data from the National Institutes of Health shows that almost 70 percent of those dependent on drugs, including heroin, also have a personality disorder, which may include schizophrenia, anti-social disorder or a host of other disorders. Researchers have suggested that mental health disorders contribute to drug dependence and vice versa.

“A good portion of our drug and alcohol clients do have a mental health diagnosis as well … at least half,” Box said. Solutions prioritizes “offering that full continuum of care” to address those issues. “Our clinicians in drug and alcohol are going to be working with the mental health clinicians to make sure that we’re addressing both aspects and working towards the same goal.”

In addition to Vivitrol and counseling, Box attributed some of Solutions’ success to having staff designated to provide same-day diagnostic assessments to people. Monday through Thursday from 12:30 to 2:30 p.m., staff do those diagnostics for all who provide proof of insurance and proof of income. Those same-day assessments have tripled the number of assessments done by Solutions, Box said.

“To me, what that says is people are begging for those services,” Box said. “They’re going to engage. The quickness that we provide services to people, that cannot be underestimated. If somebody’s walking in our door and telling us that yes, they’re ready to do this, if we send them away and tell them to come back in two or three weeks for an assessment appointment, we have lost an opportunity with them.”

Solutions has seen stories of success and grief over the years. The grief comes from losing clients, and their lives, to heroin.

“When that happens in the course of treatment, it knocks the wind out of your treatment team,” Box said. “When something like that happens we want to make sure that we’re pulling that team together to do a debriefing of some sort” and talk about feelings and grief.

Box said the team discusses what it may need to change, but the immediate goal is to support the team members.

One of the original cases for the 2010 pilot study for Vivitrol told his psychiatrist and the then-director of the program that his time with the program was the first he had been clean for more than a week since he was 14. In 2010, he was in his late 20s or early 30s, according to Box.

“For that person to spend half of his life trying to get clean from heroin” and then to finally succeed with help from Vivitrol, that is significant,” Box said.

For Box, the biggest issue facing recovery efforts is the social stigma of it all, though she also said that the faith-based and judicial segments of Clinton County have done “a wonderful job” of fighting that stigma.

“Once we can all accept that this is a condition much like heart disease or diabetes we have the opportunity to move treatment forward,” Box wrote in an email. “Once we move past the idea that this is a moral condition and approach it as a medical condition we see the doors for funding, awareness, and treatment potentials change.”

Reach Nathan Kraatz at 937-382-2574, ext. 2510 or on Twitter @NathanKraatz.
Vivitrol injection blocks brain receptors

By Nathan Kraatz

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