Dying to Get Into Treatment

The Plain Dealer reported today that there were 47 Heroin overdoses in July, 280 this year in Cuyahoga County and 15 in August already.  Anyone who works on the streets with the homeless population can testify to the fact that the heroin epidemic is out of control in Northeast Ohio.  The number of heroin addicts is staggering!  We need to radically change our approach to solve this problem.  One thing I hear from a lot of addicts is that they want help and are ready now.  They are afraid to go one more day using these dangerous drugs, but the addiction and craving for the drugs takes them places they don’t want to go.  They never thought they would be so hopelessly addicted that every moment of every day is filled with wondering where they are going to get the money for their next “fix”. 

Their body craves the drug and gets physically sick when deprived of it for just a few hours.  The addict will steal and do other immoral things when the sickness and desperation for the drug kicks in. Most addicts need to use heroin 3-4 times a day.  Once the sickness sets in, they begin the ritual of finding the means to pay for their next bag, or bags of heroin.  They may start out with a one bag  for around a $10.00 habit, but it quickly grows to several bags per use, some up to 5 bags or more at a time.   Some resort to spending the night removing catalytic converters from cars, or collecting scrap metal to redeem at the scrap yard.  Others brazenly go into stores and steal several times a day.  They have a route and are able to steal enough to keep their habit going.  Once a person gets addicted they cannot function well enough to hold down a job.  The sickness keeps them from being able to work an 8 hour shift and the money that they make from a normal job is not enough to cover the expenses of their habit.  The one thing that all addicts have in common is that none of them ever thought it would end up like this.  With all the knowledge of what happens to a heroin addict, up to and including death, people never think it could happen to them.  They always think they have the control to stop, until the sickness starts and the cycle continues to keep the sickness away.

Addicts have issues in their lives that compel them to try the drug in the first place.  This drug takes away emotional and physical pain, it becomes their best friend, their crutch, it’s easily accessed (many would be surprised to know that heroin dealers sit in McDonald’s waiting for their clients to come in), it takes away the burdens, it makes life tolerable, they don’t have to wait for a doctor’s appointment to get it, no prescription is needed and it works immediately!  Once it wears off, they want more, and more and more…..It only takes using it for 3 days to become addicted, and what seems to be the perfect answer to their lives problems, becomes a monkey on their back.  They may come to the addiction from not being able to get pain prescriptions or they may venture into prescription drugs because the heroin is not working like it did when they started.   The pain they were trying to get away from is replaced by the pain of the addiction. 

Once they find themselves in the throes of addiction, most want and seek help.  The addicts know they can’t continue to live like this.  The chance of death is thought about often by those playing Russian roulette by abusing themselves with this drug.  They can’t go through the sickness on their own.  It takes an inpatient detox unit and usually 3-5 days of medicated detoxification to get the heroin out of their systems and be free from the sickness.  Cleveland has three and sometimes a fourth affordable inpatient detox units that are attainable for an addict that can’t afford their own treatment.  Harbor Light of the Salvation Army has 21 beds, Stella Maris has 16 beds, at times Lutheran Hospital has around 16 beds that can help for specific individuals with multiple addictions and Rosary Hall at St. Vincent Hospital has 27 beds.  That is a total of 80 beds which are occupied by each individual for about five days just to get a person through the sickness of withdrawal.  We could fill these beds with three people waiting if we had more spaces. 

After the withdrawal (detoxification) is over, more treatment is needed to change the behavior of the addict.  There are several programs, and houses, throughout the city where people can stay to continue their treatment and live with others who are going through the process.  This can take months or a year for each individual.  It takes a lot of determination and concentration to continue to stay off of opiates.  There are 12 step programs, there are behavioral modification programs and there are programs where the patient relies on medication (Suboxone and Methadone) to keep off of heroin.  There is a lot of debate which programs work the best, it really is up to each individual person.  Bottom line, it’s a long process where the person has to modify their thinking and behavior to keep off the drug.  The cravings for heroin continue for a long time and unexpected triggers can bring on a sudden desire to use.  Many of them have been addicted for years.

I believe one of the main problems is actually a shortage of affordable inpatient detox beds for people in Cleveland.  When an addict wants to detox, the waiting list is detrimental to getting free from the drug. Today, the waiting list is up to 4-6 weeks long.   People have died of an overdose while waiting to get into treatment.  They have made the decision and are ready now, but may have to wait weeks to get a detox bed.  The problem is there aren’t enough affordable detox beds at any given time. When a bed opens up the individual may not be ready anymore or may not be able to be found.  The drug courts fill a lot of those beds with court ordered treatments purchased by the court.   A lot of the programs after detoxification that help maintain sobriety are easier to find than a detox bed.  Many are outpatient. When an addict is ready for detox, they have to wait. 

The detox facilities are usually always full and the thought of waiting is very disappointing and they feel hopeless.  When a heroin addict is ready, they are ready.  One day is too long to wait, they risk their lives every time they use. Having to wait weeks for treatment when an addict is ready to put down the drug is so dangerous.  Addiction has been classified as a disease, but it is treated as more of a criminal activity or recreational activity by health care professionals.   Would you make a stage 4 cancer patient wait weeks for life saving treatment?   On top of that, many fail at their first attempt to detox.  The pain and physical illness they experience is severe.  The medication they receive to help them through their detox may not take away the symptoms of the withdrawal.  Many walk out of detox and go right back to the thing they know will take it all away.  When they do fail, they feel defeated and a vicious cycle of self-loathing begins.  I have seen many addicts in this position and they are angry at themselves for failing not only themselves, but the people who encouraged them to go through detox.  It may take several attempts before a person can successfully get through the detox.  The addict’s desire to get off the drug is huge, but their relationship with the heroin is also complicated.  There is a mental dependence on the drug that needs to be treated as well, which is why going immediately to an inpatient program for continued treatment is so important.

The shortage of available inpatient detox beds prevents people who are ready to kick heroin from getting the real help they need.  In my opinion, more beds for detoxification are needed.  When a heroin addict is ready to kick the habit, there should be a bed available for him or her to start the withdrawal process as quickly as possible, even if he or she has failed before. 

I hope with the new focus on this issue will lead to more beds.  I hope that the new funding coming to combat the heroin crisis will improve our detox system.  Those in charge of these decisions locally need to take into consideration the fact that the first and most important step in treating an addict is a detox bed as a safe place to withdrawal.  Once this process is over, they need a sober place to go to continue getting the treatment to learn how to live a sober lifestyle.  Unfortunately, right now there are not enough detox beds available and people are literally dying before they can get the treatment they need.  The bottleneck of the system at detox level keeps many people who have addictions from receiving treatment when they are ready.

Denise Toth

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Alcohol and Drug Addiction Services Effective?

Are we light years behind Europe in how we treat people with addiction? The Diane Rehm Show on Monday featured one hour on the changes in treating alcohol addiction services.  This comes after the release of the The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry (co-written by Lance and Zachary Dodes).  All Things Considered did an interview with Dodes back in March 2014 available here.  

There is a huge split within the homeless community about this issue.  There are those Housing First folks who are winning the argument who admit people to housing even when they are not sober.  Then there are those who feel that a person must be sober to get housing.  They feel that if a sober person is "rewarded" with housing while not taking care of their addiction, they will just mess up and become homeless again.  They also worry that an out of control addiction will contaminate others who will fall off the wagon. 

The problem is that the current treatment method especially for those without health insurance is awful and fails more than it is successful.  Those with insurance can go to inpatient treatment where they are away from the drugs and alcohol that is everywhere around them.  Dodes' book shows that Alcoholics Anonymous is successful between 5 and 10%.  This is disgracefully low success rate that would not allow a prescription drug trial to go forward or behavioral health experiment move to the next trial with a success rate of 7%.   What else do we have for the low income addict living at 2100 Lakeside?   As the book Hooked by Lonny Shavelson from a 2001 details the treatment system is completely broken. 

If we have designed a completely failed system for treating alcohol and drug what other choice is there, but to put people into housing and work on their addiction?   The State of Ohio has suddenly come to the realization that we have a serious prescription painkiller and heroin problem because our kids are dying in large numbers.   So they announce this Public Service Campaign to get people help, and then when your child needs professional assistance, you find that there is a three week wait for treatment.  They tell you to go to meetings and try to maintain your sobriety while you wait for help.   This is an insane approach to the problem of addiction.  Imagine if there were no emergency room health care and instead they just told you to go watch a video about coughing up blood and work through your own problem while you wait three weeks for a medical bed or a doctor visit.  This is the system for behavioral health at this point.  It is no wonder the shelters are bypassing the Alcohol and Drug system by putting people right into housing and hoping that they can find help for the person if they have a room to return to every night. 

Diane Rehm also had a nice show this last Tuesday on income inequality. The guest was Nick Hanauer who is a proponent of increasing the minimum wage.  He has made millions and talked about giving workers more income to be able to be able to live without government support.   It was a good discussion.  Check it out.

Brian Davis

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