Drug use is escalating at a disturbing rate throughout our country. Regardless of age, ethnicity, socio-economic status, religion, no segment of the culture is immune from this reality. Both legal and illegal drug addiction is rampant, and one truth applies in both situations: the earlier one starts and the longer one misuses drugs, the higher the likelihood that addiction will follow.
Many of our residents enter treatment with addiction as one of their presenting problems; some have an alcohol use disorder, while others are addicted to an entire host of pharmaceuticals and/or illicit drugs. Opiate addiction is extremely common, including drugs such as oxycodone, hydrocodone/Vicodin, morphine, and heroin.
Many residents started down the path of addiction similarly; they took a prescription pain killer as prescribed by a physician for a medical problem and eventually became dependent on it. What usually happens when dependence develops for a woman, is that her doctor either continues to prescribe inappropriately or simply denies further prescriptions, at which point the woman may turn to doctor shopping, obtaining the medication or a similar drug over the Internet, or even buying it on the street. Eventually, this can lead to using heroin, due to the decreased cost, increased availability and quick relief of extremely distressing withdrawal symptoms.
Opiate addiction is a disease which affects the body, mind and soul; the addiction is very difficult to break, which is why many outpatient and even inpatient efforts fail. Medical research definitively indicates that many of those with addiction benefit from some form of medication to achieve recovery. The National Institute on Drug Abuse (NIDA) strongly supports the use of medication as part of an integrated treatment program. According to NIDA, medication therapy may increase patient retention in addiction treatment programs and decrease the rate of relapse among alcoholics or addicts in recovery.
At Timberline Knolls, we use medications when indicated for those suffering from a substance use disorder—always in tandem with comprehensive therapy and 12- step facilitation. This gives residents the best chance to achieve life-long, sustainable recovery.
We utilize medications such as naltrexone (Revia or Vivitrol), acamprosate (Campral), and buprenorphine (Suboxone) to assist with some of the physical aspects of the disease. Some of these medications decrease cravings (like Revia or Vivitrol) while others (Suboxone) help to curb the symptoms of withdrawal. Use of these medications allows residents to begin to focus on the process of recovery, abstain from managing their own medication or substances, and surrender that to a sponsor (substances) and their doctor (medications).
The Food and Drug Administration (FDA) initially approved Vivitrol for treating alcohol dependence in 2006. Its scope has since then been expanded to include Vivitrol in the treatment of opioid addiction. Once a person is opiate free for seven to 10 days, she can be given Vivitrol without fear of causing or worsening withdrawal symptoms. However, if given too soon after last use of an opiate, this medication can precipitate severe withdrawal. Vivitrol is a non-narcotic extended release version of the daily oral medication Revia (naltrexone); it is given approximately once a month via injection. This medication combats cravings and decreases the potential for a person to experience a high after using if they relapse. Importantly, Vivitrol is not addictive, therefore people do not develop physical dependence on the medication.
Vivitrol is an opiate blocker; this means it literally prevents opiates from connecting with receptors in the brain. Therefore, if an individual on this medication ingests an opiate or drinks alcohol, the high typically associated with using will be dramatically reduced. This knowledge alone can be helpful to residents in the treatment process. For a period of time, until they are able to heal more emotionally and spiritually, until they establish a recovery support system, they can use this medication as a physical support in their daily commitment to sobriety. It is our goal that residents will ultimately learn to rely on human and spiritual support to maintain sobriety.
In 2002, the FDA approved the use of the opioid-naloxone combination called Suboxone for the treatment of opioid dependence in the U.S. Similar to Vivitrol, this medication can suppress cravings, and provides a partial block on opioid receptors in the brain. It also partially stimulates this receptor and thus, helps relieve excruciating withdrawal symptoms; it is usually these symptoms that lead to relapse.
Suboxone comes in pill or film form and is taken daily. It is a combination of two medications. One ingredient is buprenorphine, which is classified as a ‘partial opioid agonist,’ and the second is naloxone which is an ‘opioid antagonist’ or an opioid blocker. This first ingredient binds only partially to the opiate receptor, which means it has less of an impact on the brain than a full opioid. Oxycodone, hydrocodone, morphine, heroin and methadone are examples of full opioids. This is a critical distinction. When an opiate-addicted person first takes Suboxone, they will feel a relief of withdrawal symptoms, but they do not experience the mind-altering high that their drug of choice would produce. In ongoing use, Suboxone serves to decrease cravings normally associated with early recovery. IF a person on Suboxone does relapse and use a full opiate, they will not experience their usual high due of the blocking property that Suboxone provides.
Because Suboxone does have abuse potential, it must be carefully prescribed and monitored. Ideally in early recovery, it is administered daily by a professional with addiction expertise and a working knowledge of 12 step recovery. It is also important to prescribe the appropriate amount for each individual–too much can lead to a person being sedated and unable to optimally engage in the real healing work that therapy and 12 step participation provide.
Acamprosate (Campral) was approved by the FDA in 2004; this prescription medication is designed to help those who are addicted to alcohol. It is the third medication, after (Antabuse) and naltrexone (Re Via), to receive approval for post-withdrawal maintenance of alcohol abstinence.
It is thought that acamprosate helps modulate and normalize brain activity, particularly in the (GABA) neurotransmitter systems. It helps our recovering resident by reducing symptoms of post-acute withdrawal, such as insomnia, anxiety, and restlessness. Acamprosate (Campral) modulates/normalizes the previously alcohol-disrupted brain activity, particularly in the glutamate neurotransmitter systems.
Acamprosate reduces the craving for alcohol; it is not addictive and appears to have no potential for abuse; patients maintained on the drug have developed no known tolerance for dependence on it. It also carries little overdose risk. Acamprosate therapy can be continued for one year.
Comprehensive Treatment at Timberline Knolls
A plumber comes to your home with a toolbox; it contains wrenches, hammers and all manner of plumbing-related instruments. The pipe is repaired; the plumber replaces the tools in the box and leaves.
Medications such as Vivitrol and Suboxone are pharmacological tools. They no more fix an addiction than the wrench, on its own accord, fixed the pipe. These medications are used judiciously, with 24-hour medical monitoring, and are tapered down as treatment progresses.
The holistic treatment at Timberline Knolls is what leads to recovery. But the truth is, if a resident is so distracted by symptoms of withdrawal, or so consumed with the relentless drive for more drugs, she will not have the focus, nor the desire to embrace the therapy that will change her life.
Because addiction impacts a person’s entire life, we address the whole person in therapy, her mind, body, soul and spirit. Her brain chemistry has been altered, and her body has suffered the consequences of drug abuse. Additionally, her relationships apart from the drug world have been impacted and need healing. When an individual is severely addicted, she doesn’t just want the drug, she needs the drug. Lying and stealing from family and friends is not unusual, which means trust is lost. A relationship with God or a higher power is often broken, which makes spiritual healing an important aspect of treatment.
Detox is often a first priority; a resident may need to admit to a local hospital for medical detox. When medically indicated, medications such as Suboxone can be used to facilitate the process.
Whether a woman became addicted to drugs due to physical pain, which necessitated the use of strong pain killers, or due to recreational drug use that got out of hand, the addiction needs to be broken. The woman or adolescent then needs to reengage with the real world armed with new tools and skills to help her cope.
At Timberline Knolls Residential Treatment Center, we follow the guiding principles of recovery found in the 12 step program and utilize the tools of Dialectical Behavior Therapy (DBT). In addition to individual and a wide range of group therapies, residents participate in art, dance and yoga. Residents also participate in our family therapy program. Regardless of how someone is connected to a person with an addiction, whether a spouse, sister, child or parent, they have been seriously impacted by the addiction. Healing for the individual, as well as the family unit, is a critical aspect of complete treatment.