If you’re an opiate addict (or physically dependent on opiates) today, nobody is quite sure what to do with you. You buck the trend, you don’t quite fit into any of the pre-defined categories of substance abuse and your dependency doesn’t progress in a linear and predictable fashion. You’re different and that makes you very difficult to treat…or rather, it makes “The Opiate Addict” in general very difficult to treat. Most of the drug-rehabilitation community has no clue how to treat your addiction the way that you need to be treated and it’s driving everybody nuts…especially you.
Let me explain. Have you heard the term “evidence-based medicine” before? Well, I could write a long, nauseatingly boring essay on the central tenets of evidence-based medicine but I’ll spare you and just give you the basics. As a result of numerous factors including, managed care, litigation, legislation and a bunch of other issues that don’t have to do with you, doctors have been “forced” to adopt treatment protocols as opposed to being able to treat you based on their intuition and what their experience has taught them.
For instance, if you go into your doctor with a series of symptoms, your doctor will most likely treat you based on what the “data” has shown to be clinically effective as opposed to what his or her experience has taught them. The “data” that I’m talking about includes, clinical trials, other studies, clinical abstracts, clinical advisory panels etc. etc. The data is the “evidence” in evidence-based medicine. Most doctors these days are going to treat you based on the odds and pre-defined clinical protocols rather than treating you as an individual case with unique circumstances. And most of the time, these clinical protocols work…but sometimes you could be the odd man out. It’s all about risk-avoidance and not necessarily about good medicine. Again, I don’t fault the doctors for protecting themselves against lawsuits and to their credit they are also following clinical protocols because that provides you with the best chance of getting your treatment paid for. If the insurance company sees that your doctor is not practicing “evidence-based medicine” they are not going to pay for it.
Well these same clinical protocols and evidence based medicine applies to the treatment of addiction. However, there’s a bit of a problem. Opiate addicts are a unique breed and do not follow the same “rules” that -say- an alcoholic might. By the numbers, alcoholics follow a pretty reliable pattern of behavior therefore, the treatment follows the same reliable pattern. “John Doe” begins drinking, John Doe drinks more, John blacks out occasionally, then John crashes car and eventually, John either dies of disease, gets killed, is put in jail or checks into a treatment center. Regardless of where or how John begins his alcoholism, John usually ends up in the same place as the rest of the alcoholics…”the bottom.”
As a result of John’s inexorable slide towards “the bottom”, it’s much easier for rehab and addiction centers to anticipate what type of treatment John is going to need when he arrives at a treatment center. The “Data” says that John will need 30 days in-patient treatment in a rehab facility, complete sobriety for the rest of his life and some type of cognitive or psycho-therapy. And in most cases, The Data is correct and although it’s a stretch to say that the medical community has found a panacea for alcoholism the point still remains that most of the “Johns” that enter rehab need similar treatment…evidence-based treatment. So what makes opiate addicts so tough? Well what if you mixed, “John” with “Sue” with “Uncle Freddie” and threw in Sheriff Jackson just for good measure? What if all of these people did NOT follow the same pattern of addiction and behavior?
Well that’s where I believe the addiction and rehabilitation community finds itself now when it comes to opiate addiction. All of these people could be taking the same drug yet have wildly different behaviors and therefore completely different therapeutic and clinical needs. Well just go ahead and throw out the evidence based medicine would be the simple answer. But that’s not what has happened. Most treatment centers and detox facilities treat every opiate addict the same way because they cling to the notion that evidence-based treatment is still the best way to approach opiate addiction and dependency. Without clinical protocols, the whole system breaks down. In fact, most opiate addiction treatment facilities don’t even HAVE an opiate addiction treatment protocol; they base their treatment on alcoholism! This is not good medicine and it’s not reality. People with opiate dependency deserve better.
The reality is that opiate “addicts” sometimes aren’t even addicts! Many of you out there had an injury or an accident and had been taking the pills as directed until they didn’t work anymore so you take more to keep the pain at bay…you couldn’t care less about the “high.” Then there are those of you who do have addictive personalities and ALL you care about is the high. Are you telling me that the construction worker that has been taking Vicodin for 2 years due to a back injury and is now physically dependent on the drugs should receive the same treatment that a person who snorts Oxycodone and vice versa? Absolutely not.
The key difference between opiate addiction and something like meth addiction is that the VAST majority of those people who are addicted or physically dependent to opiates today are people who began using prescription drugs for a legitimate reason. Nobody began using Meth for a toothache. So you have millions upon millions of people out there who truly want to stop using but see no viable or appropriate options for them within the addiction/rehab community. They need help with withdrawal! And I read news article after news article talking about the rising tide of opiate addiction and how alarming it is that these addicts aren’t getting help when all of the rehab centers stand arms outstretched waiting to heal them. The “reason” as per the rehab community? Denial!
Listen Mr. Administrator at “Sunshine Rising Recovery”, it’s not denial that is witholding the run-of-the-mill opiate dependent person from your $40,000, 30-day inpatient treatment program from checking in, it’s the fact that your “product” is not what they want or need. For every one person who is an opiate addict in denial, I’ll show you ten that are achingly not so. I’ll show you ten people that would give their right arm to get off these pills if they could find a way to do so comfortably without having to resort to some, outrageously expensive, slightly-tweaked alcoholism treatment just to get through the withdrawal. Most of the people that I talk to on a daily basis are more than willing to accept their predicament and to accept that they need help; but they need the right kind of help and for the most part, the addiction and recovery community is not providing it. So… most people just keep taking their pills waiting for the right treatment to come along. And if they have to keep waiting, then how much are we contributing to the issue of opiate addiction as opposed to intervening before people really get hooked?
There’s evidence that a few rehab and detox centers here in Texas are willing to accept opiate addiction as a truly unique pathology and are creating outpatient detox or short-stay detox treatments with intensive out-patient programs which are more appropriate for the many different types of opiate addiction and dependency. Yes, they do have long-term in-patient programs for people who truly demonstrate addictive behavior but they also have several “Intensive Out-Patient” Centers in Texas and Louisiana that treat primarily the physical withdrawal and detox from opiates and then provide ongoing therapy to make sure you stay on-track and comfortable as you transition your life from one that revolved around pills to one that revolves around things that matter.
Opiate addiction is a BIG deal these days for good reason; it’s the fastest growing drug addiction problem by far. I can only hope that the drug-rehab and recovery community begin to truly appreciate how different opiate addiction is from other types of addictive behavior and make meaningful and progressive changes to their treatment protocols. Otherwise, those of you who are desperate to get off pain killers comfortably and get the treatment you need might be in for a long wait.