Opiate treatment a multifaceted process

Ryan Carpe Staff Writer

December 25, 2013

DARKE COUNTY - With the recent increase of regional opiate addiction, many agencies are bracing against the societal and economic impacts.

Darke County Recovery Services is one of those agencies on the front line, and they’re experiencing the effects first-hand.

“I’d say at least once or twice a month someone dies that we’ve known,” said Cynthia Cook, Darke County Recovery Services Clinical Supervisor/Associate Director, recalling the names she’s read in the newspaper. “The deaths have skyrocketed because of the heroin epidemic.”

In a little over a year, she’s personally experienced the loss of two people she’d known since their childhood.

“People that we care about die all the time,” said Cook.

The increase of opiate addiction is not only felt in the number of patients the treatment center sees, but also in the amount of call-ins due to crisis situations.

And in most cases those calls are a result of withdrawal symptoms, which take the form of sweating, muscle aches, nausea and vomiting.

“We get plenty of calls from people struggling with an addiction, particularly with opiates right now, who are looking for answers,” said Cook. “It’s been a much, much higher rate than it was five years ago,” said Cook.

Cook emphasized that Recovery Services is a time-limited treatment center, which means that the organization’s offered classes and educational courses operate on a clearly defined time line.

“We’re here to help them learn, get education, and discover what their personal triggers to relapse are, and what resources that they need outside of (Darke County Recovery Services). It’s so they can finish with this program and be a productive member of society armed with the knowledge of where they can receive support within the community.”

In Cook’s experiences, what works for one person may be completely different for another, and there is no universal treatment that applies to everyone.

“The variables are all completely different, because we’re dealing with human beings,” she said.

Around 90 percent of Dark County Recovery patients are undergoing treatment because of court orders. But chiefly, their problem is that many of them are still in denial of their addictions.

Some people realize they need to change their life after one life-altering event, while others may go through years of trauma before they reach their breaking point.

But for Cook and the rest of the staff at recovery, it’s not only about offering effective treatment.

“If you look at the mission statement of Darke County Services, it reads ‘To Save Lives.’ Because what we’re dealing with is a life and death situation,” said Cook.

And even if relapse occurs, which is often the case, Cook knows that their prior classes and education help lay the foundation that may one day lead to their salvation.

Cook recalls one meaningful moment as she ran into a past client while shopping, and noticed he had married and was raising a happy, healthy family. Before approaching Cook, she noticed that he leaned into his wife and said that, “this was the woman I was telling you about.”

“He remembered he was cared about. That’s what was important,” said Cook. “People talk about treatment failure, but you don’t know what you put in those people’s hearts. It’s about building relationships, and even though we have to be tough, we let them know we care and we don’t want their names to appear in the paper.”

Ultimately, one of their most important lessons is teaching the difference between drug abuse and drug dependency, and helping clients determine which category they fall into.

“My job is to work myself out of a job. I want to get (our patients) to the point where they don’t need me anymore. Where you’re comfortable walking out the doors and are working, productive and are attending AA or NA meetings. You’re helping others and you don’t need me anymore,” said Cook.

Cook stated that she’s noticed in-patient or residential treatment facilities have become viewed as more effective solutions, they’re not the only answer.

“The reality is that if you look up the statistics, there’s no higher success rate for in-patient than there is for out-patient treatment,” said Cook.

Regardless, Darke County Recovery Services encourages all forms of treatment based on the individual needs of their clients, but that doesn’t mean that everyone gets the treatment they desire.

“We will give out information on in-treatment facilities, but they’re few and far between,” said Cook, elaborating that the programs are even less available to families with financial restrictions. And some of the closest in-patient treatment facilities are limited by transportation, as they’re located near Dayton, Columbus and Indianapolis.

Regardless, the Tri-County Board of Recovery and Mental Health Services, which provides addiction treatment for Darke, Miami and Shelby counties, currently does not offer in-patient or residential treatment centers due to a lack of funding.

And Cook has worked with many families that have pursued residential treatment and still experience relapses.

“The pain level and the loss has not accumulated and clicked for them yet,” she said.

Treatment efficacy also relies largely on reaching addicts during specific times in their lives when they’re open to listening.

“With an addicted person, you look for what is called a window of opportunity,” said Cook. “And those windows, when they might be able to hear you a little bit, are during the down-cycles.”

Essentially, patients need to reach a low point in their lives where they realize that their habits are far more detrimental than staying sober.

“No addict or alcoholic wakes up one day and decides that it’s a really great idea to get sober. That’s not how it happens. It happens because painful things have happened in their life that accumulate to the point where it is no longer worth it.”

Those down-cycles most commonly take the form of crisis situations, for example someone experiencing withdrawal symptoms, a loss of employment, the recent souring of relationships or running afoul of the law.

In the near future, Cook sees many programs leaning towards opiate replacement therapy, which focuses on prescribing drug alternatives to wean people off their addictions.

While many of the prescribed substances can be abused themselves, the treatment still can provide results,” said Cook.

“It can be helpful if it’s prescribed correctly,” she said. “It can be a good tool to wean somebody off to make their withdrawal symptoms less horrific.”

But even with the most effective treatments, controlling and resolving the opiate epidemic will require help from all aspects of the community.

“There’s no quick fix answer. Everyone wants just one answer, but there isn’t one. We have to keep plugging away, giving treatment, the courts need to keep giving consequences, the police need to keep arresting people. We all have to keep doing what we’re doing. And moving forward, we’ll need to be looking for new avenues because we’re trying to save lives.”