Hazelden Introduces Antiaddiction Medications into Recovery for First Time

Recovery from opioid addiction may no longer mean complete abstinence from drugs

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Founded on the idea that abstinence is the bedrock of any recovery from drug or alcohol addiction, Hazelden will now incorporate anti-addiction medications in its rehabilitation programs.

Treating drug addiction is as much about addressing why people become hooked on substances like alcohol, painkillers or illegal drugs as it is about weaning them off of their habit— at least that’s the core of the Hazelden recovery approach. From its founding in a Minnesota farmhouse in 1949, the program has championed the 12-step method, with its roots in the principles of Alcoholics Anonymous. That philosophy is anchored by the belief that true recovery can only start with addicts admitting they need help from others. Abstinence from all potentially addictive substances has always been the cornerstone of this strategy, which has become known as the “Minnesota Model.”  Some 90% of American addiction counselors rely on Minnesota Model principles.

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But for the first time, Hazelden will begin providing medication-assisted treatment for people hooked on heroin or opioid painkillers, starting at its Center City, Minnesota facility and expanding across its treatment network in five states in 2013.  This so-called maintenance therapy differs from simply detoxifying addicts until they are completely abstinent. Instead, it acknowledges that continued treatment with certain medications, which can include some of the very opioid drugs that people are misusing, could be required for years.

“This is a huge shift for our culture and organization,” said Dr. Marvin Seppala, Hazelden’s chief medical officer, who pushed for the new practice.  As the program’s first adolescent patient, and someone who has been in recovery from multiple drug addictions for 37 years, Seppala is keenly aware of how dramatic this decision is for the organization, which once debated whether or not coffee was acceptable in its abstinence-based program. “We believe it’s the responsible thing to do,” he says.

Driving the need for change is the sobering reality of what happens to patients addicted to prescription pain relievers— a growing segment of those in need of drug recovery— once they leave the Hazelden program. Within days of leaving the residential treatment facility, most were relapsing— and at least half a dozen have died from overdoses in recent years.  It was time, Seppala argued, for a radical change.

In the coming months, Hazelden will begin to prescribe the drug buprenorphine (Suboxone) for some people addicted to opioids — the class of drugs that includes prescription pain relievers like Oxycontin and Vicodin, as well as heroin. At low doses, buprenorphine acts like methadone or heroin, which helps addicts to avoid severe withdrawal. But at higher doses it prevents opioids from working.  That means it’s much harder to misuse or to overdose on buprenorphine, making it safer than methadone, the other commonly used anti-addiction medication.

MORE: Should States Let Families Force Addicts Into Rehab?

Making The Case

Using the appropriate medication to treat addiction is an idea whose time has certainly come, at least according to the latest research, which has documented the effectiveness of such strategies for decades. But it’s taken longer for the leading treatment providers in the community, including Hazelden and Betty Ford, to accept the idea that giving drug addicts medications similar to those to which they were addicted can be part of recovery.

The science, however, is getting harder to ignore. Studies show that people addicted to opioids more than halve their risk of dying due to their habit if they stay on maintenance medication.  They also dramatically lower their risk of contracting HIV, are far less likely to commit crime and are more likely to stay away from their drug of choice if they continue maintenance than if they become completely abstinent.

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The first maintenance drug, methadone, was introduced in 1964 after studies supported its effectiveness in fighting heroin addiction. Based on that data, leading health organizations — including the Institute of Medicine (an independent U.S. body of experts authorized by Congress to study health-related issues), the World Health Organization and the U.S. “drug czar’s” office — recognized the importance of  medication-assisted treatment for opioid addiction.

“The evidence shows much, much better outcomes,” says Dr. Nora Volkow, director of the National Institute on Drug Abuse.

But to a treatment program based on the 12-steps of Alcoholics Anonymous—whose first step involves admitting “powerlessness” over one’s addiction— the idea of maintenance on a potentially mood-altering drug has always been suspect.  For an alcoholic, substituting vodka for gin or even beer for wine wouldn’t really represent progress:  so why would replacing an illegal opioid like heroin or non-prescribed painkillers with a legal one be better for recovery?

MORE: Addicted: Why Do People Get Hooked?

The answer lies in the different ways that opioids and alcohol act on the brain. In alcoholism and other addictions, pleasure areas in the brain get misdirected as addicts continue to chemically activate the system in order to achieve greater “highs.” The repeated behavior leads to tolerance, and over time, larger and larger doses are needed just to feel normal, let alone “high.”

But where drinking alcohol is always accompanied by some degree of physical impairment— like loss of motor coordination and reduced cognitive ability, with opioids, there is no significant mental, emotional or physical impairment if someone  regularly takes the exact same dose. In fact, research shows that patients addicted to opioids who are on maintenance doses of anti-addiction drugs like buprenorphine can drive safely, work productively and engage emotionally like those who aren’t addicted.

“For most people using opioids daily, they are no longer getting high, even when they are still using.  It’s just become maintenance,” Seppala says. The effect is similar to the tolerance people experience with caffeine.  “If you drink caffeine on a daily basis, after a while, you don’t notice the effect of one cup of coffee,” he says, “But if you drank two, you would.”

New Beginnings

Still it wasn’t until the FDA approved buprenorphine in 2002 that Hazelden even began considering lifting its ban on medication-assisted recovery. Unlike methadone, buprenorphine can be prescribed by family doctors (although there are still some limits on the number of prescriptions physicians are allowed, in an attempt to prevent “pill mills” from dispensing the drug without proper supervision).  Like other medications, it can be picked up monthly at pharmacies, not daily at clinics.

Watching many Hazelden patients leave the facility only to overdose soon afterwards, Seppala realized change was needed. “This is a place of healing,” he says, “To have people die after treatment is just horrible.” Buprenorphine, he realized, might help to avoid some of those deaths.

To his surprise, he found far less resistance than he expected when he approached Hazelden officials to consider using buprenorphine.  Over a period of 10 months, the facility’s experts analyzed the available data and in September, the group’s full board approved a plan for change, which involved integrating medication-assisted therapy thoroughly into treatment, not just handing out drugs.

MORE: Preventing Overdose: Obama Administration Drug Czar Calls For Wider Access to Overdose Antidote

Hazelden will start using buprenorphine maintenance cautiously at first.  The drug will not be provided to people who have been addicted to opioids for less than a year and complete abstinence will remain the ultimate goal for most patients, even as the program recognizes that years or even lifetime maintenance on the drug may sometimes be needed. And the rehab will now consider people who are taking maintenance medications in their program as being “in recovery” from the day they start these drugs and stop taking non-prescribed drugs. The program will define relapse as any drug use outside that provided by medical advice.  Those changes will be integrated into the counseling and even the 12-step meetings offered onsite.

And because clinicians expect that a single treatment strategy won’t be enough to address the recovery needs of all of those addicted to opiates, for some patients the program will also provide Vivitrol, a time-release injection of naltrexone that prevents opioids from from being effective for about a month.  Although this approach may seem like a better option than maintaining people on an opioid medication indefinitely, studies so far have not shown that naltrexone reduces mortality in opioid addiction in the same way that maintenance drugs like methadone and buprenorphine do. The National Institute on Drug Abuse is currently conducting the first trial to compare Vivitrol directly with opioid maintenance to determine its long term effectiveness.

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As for Hazelden, “We will never change from being a solid, 12-step based program,” Seppala says. “But I am a physician and we look at the research and want to use evidence-based treatment.”

The reaction among academic addiction experts to the change has been, not surprisingly, positive.  “I was delighted,” says Volkow of Hazelden’s decision. “This was a change that I’ve been waiting for. I would predict that as data emerges as to how this change improves the outcome of their patients, then others may realize that this is beneficial for patients and not harming them in any way.”

The ultimate test, of course, will be with the patients, whom Hazelden will study closely. And already, they have been encouraged by a success story. J, who failed to overcome multiple addictions during seven different attempts at rehab, including at Hazelden, finally took the first steps toward recovery after a doctor prescribed buprenorphine. J’s mother, Cheryl, a former heroin addict who recovered at Hazelden and became a counselor and supervisor there, witnessed the difference that the anti-addiction medication made for her daughter, and realized that recovery, and recovery treatments, have to be flexible.

What worked for her, she now knows, may not work for everyone. Now free of illegal drugs and alcohol for more than a year, J has regained custody of her son, which she had lost due to her addiction. “I’m as proud as I can be of her,” says Cheryl, “She’s responsible and reliable. I don’t get these calls any more where she has frantic mood swings or is feeling so down and desperate that she is threatening suicide. Without that Suboxone, I don’t think my daughter would ever have been able to develop these sober living skills.  The oldtimers are just going to have to accept it.”

MORE: How to Find the Best Drug Treatment for Teens: A Guide for Parents
Maia Szalavitz is a health writer at TIME.com. Find her on Twitter at @maiasz. You can also continue the discussion on TIME Healthland’s Facebook page and on Twitter at @TIMEHealthland.

26 comments
ButchWarner
ButchWarner

Buprenorphine is technically not Suboxone, which is two drugs combined: Buprenorphine, a "partial agonist" opioid, and naloxone, a drug that partially blocks the effects of opiates/opioids and throws active opiate users into toxic withdrawal.

randodvol
randodvol

I've seen my share of people die attempting total abstinence. Thank God people are finally using logic and science in helping people SURVIVE opiate addiction. Suboxone is a life saver. Anyone who thinks differently should reevaluate their motives for trashing such a relatively harmless, effective medication that SAVES PEOPLE'S LIVES.

BokehGirl
BokehGirl

Substituting one Opiate for another has already created the perfect storm as addicts suffer unspeakable pain when attempting to get off replacement Opiates. Even with slow, carefully monitored tapering, the physical/ emotional pain lasts weeks, months and longer.

thefreedomtorecover.com
thefreedomtorecover.com

While I applaud Hazelden's decision to expand its horizons, it appears as if they are looking to endorse buprenorphine as a lifetime maintenance tool rather than one which might help one overcome the addiction entirely. This of course follows their "12-Step" philosophy that the best someone battling a dependency can hope to achieve is a status of "recovering" for life. The goal should be to become RECOVERED, not recovering "One day at a time" for eternity! The whole 12-step religion is counter intuitive to the message that should be sent to people trying to overcome their "addiction". Powerlessness (Step 1) and surrender (Step 3) is the WRONG approach. The idea that only a "power greater than ourselves" can cure us is absolute nonsense. More people overcome alcohol dependence on their own than all treatment methods combined. How? They finally realize that using is a CHOICE and that the power to overcome their dependencies comes from within. The whole "disease" theory towards addiction was advanced by the very industry (The recovery industry) that was entrusted to help these people. The reason quite simply is financial. With addiction accepted as a disease by the AMA, it opened the floodgates for $1000 a day rehabs that offer little more than FAITH healing.

thearmbarkid
thearmbarkid

How very predictable...the disciples of Steppist faith healing will naturally decry anything that isn't a derivative of Bill Wilson's Oxford Group cult offshoot.  Never mind the fact that 12 Step programs fail more people than they help, as faith healing programs are wont to do!

thinknow
thinknow

How many more will die? There is no shortage of heartache. Treatment works and people recover. I am sure the stigma associated with addiction and alcoholism has kept many from speaking up, but we must do something about these needless deaths. If you are looking for a treatment centre that helps you successfully address your addiction in a comfortable, supportive and confidential environment, please call 888-513-6392..   open 8:30am until 9:00pm Monday-Friday.


Jason7428
Jason7428

Recovery from chemical dependency is not "One size fits All" - people use, churches, sober houses, individual therapists, recovery coaches , hypnotists, accupucter, psychiatrists, and medication to recover. I am glad to see that Hazelden made this change. Twelve step recovery works for a lot of people, but it doesn't work for everybody. There is nothing wrong with treating this disease with medication - it saves lives, and helps people become productive members of society and out of jail. When it comes to recovery I suggest finding a shoe that fits and then hit the ground running.

PhilipHenderson
PhilipHenderson

Is it not time to look at the 12 step model and incorporate it into an overall personal recovery package  -  a concept that is bigger than any individual organisation ??????? as is advocated in Lifering

naiou1day
naiou1day

this is the most retarded thing ive ever read....replacing drugs with drugs...

Denis_F
Denis_F

You can not treat or cure drug addiction to opiates by taking opiates. This is what it really is. It is fueled by greed. I have been on drug replacement therapy and know the slavery it is. A non-addict may look at the clinical short term "before and after" data and see it as successful but I assure you that it is still using drugs, just cheaper and provided in a legal way. There is much proof that long term treatment works but that costs money instead of making them money. No truly clean recovering addict will agree with this.


Read more: http://healthland.time.com/2012/11/05/hazelden-introduces-antiaddiction-medications-in-recovery-for-first-time/#ixzz2JrrYxzcs

ShawnT.
ShawnT.

Ops.... must not mush.........

ShawnT.
ShawnT.

The 12 step program of A.A. preaches that A.A is a program that deals with only alcohol. A.A.s opinion is that as long as a person is not drinking it is ok to use other substances to get through the day. They call the daily use of marijuana as "The marijuana maintenance program". I've also experienced people from A.A. that consider the use of other mind and mood altering substances besides marijuana as a good thing as long as it allows a person to continue with not drinking alcohol. So it does not surprise me to see a doctor (who in my opinion is just another pusher of the pharmaceutical companies) use A.A. as his basis for prescribing drugs as a treatment for drug addiction. As a member of Narcotics Anonymous I can tell you that "N.A." treats alcohol as a drug and that in order to claim that one is clean/sober they mush abstain from ALL drugs. Including any substitutions that the medical community deems "safe" to get an addict off of their drug of choice. The only thing that will get an addict to stop using is a "solid bottom" that can be used as a foundation to build the rest of their life on. I hit mine 5 years ago and with the help of other like minded individuals I have been able to maintain a clean/sober life. But it is my choice to continue on or slide back to my old ways. As you can probably see I am not a supporter of the "harm reduction" strategy used by A.A. and recommended by the majority of doctors in the medical community. I hope the best for anybody struggling with addiction and my best advice to anybody looking for "a way out" is don't give up before the miracle happens!!!!
                                 PEACE,
                                 Shawn T. a grateful recovering addict and member of Narcotic Anonymous.

somebody's-mom
somebody's-mom

My son went to Hazelden, Minn. back in August, 1999 for Heroin addiction. He continued with their after care program in Chicago. He has not yet won his battle with Heroin addiction.  He has had 6 Naltrexone implants put in him then continued with oral naltrexone on and off for years. He too has had Suboxone tabs which he learned how to   melt down and shoot up. His Heroin addiction is going on 14 years now. I am appalled that Hazelden would even consider this addictive drug as any type of help. It is not. You are putting a bandaid on the problem. Sooner or later the addict has to stop useing drugs, legal or illegal. You are just putting off the inevitable. Don't.

jhuney
jhuney

My daughter is dead. 20 Years old. Suboxone only held her over until she could get the fix she needed.....or she sold it to get what she wanted. Hazelden, you are selling out. So disappointing to read.

joede
joede

Well its nice to see Hazelden and others admitting that their traditional "treatments" for drug addictions don't work. It appears after they realized that fact, instead of creating new treatment regimens that do work, they find its easier and more profitable to become drug dealers themselves. 

Wonder how much Hazelden and others are charging people to be run through their programs just to be switched from one addiction to another? 

Please note that all these new "medications" for addiction require a prescription. Guess the Docs and the drug companies have decided if they can't beat the illegal drug dealers.....then they may as well join them. 

The only real improvement here is now the addicts won't have to go to the illegal drug dealers for their fix. The MD's will fix them right up! Suppose that's safer than the back alleys and illegal labs. That alone is some cancellation. 

Wonder if the addicts can afford the scripts for the legal drugs for the rest of their lives. Guess if they can somehow afford the illegal stuff they can afford the legal stuff. 

In all fairness better to be addicted to a legal drug that does not cause you or others harm.....unless its abused.

Wonder when some pesky reporter or grad researcher is going to look into how much profit the MDs and big Pharma look to make off of this new and legal drug dealing market / business AND how many people typically relapse while using these new meds AND how many people now abuse or end up abusing / over using these new meds? 

Wonder when someone is going to expose these new "medication assisted recovery" programs for what they are........legal drug dealing of addictive drugs? 

How wonderful for the docs and big Pharma. They will now have an ever growing client list and new cash flow from thousands of people who will be  addicted to them and their drugs instead of to the street dealer.

Ain't greed wonderful?

PS Anybody working on treatment that does work i.e. treatment that leads to recovery without relapse without the use of ANY addictive drugs? Thought that might happen now that the treatment industry appears to be admitting at least in part that what treatment they now provide seldom works.

kdennis
kdennis

As the CEO and Medical Director of Timberline Knolls Residential Treatment Center, just outside of Chicago, I am proud to see Hazelden making this shift. I think it points to forward movement in the field as a whole. If a patient needs a controlled substance prescribed by a physician in a responsible way, for a year or two years, in order to stay alive and connect to the Solution (working through the 12 steps with a sponsor and the support of the recovery community), why not? A dead person can't work the 12 steps. I can't treat a dead patient. As a woman in recovery myself, I know that recovery takes time. I know that recovery (like the disease itself) is progressive and grows/changes/deepens over time, I know the 12 steps work, and I know that imposing my way and my will on other people definitely does not work! As far as I'm concerned, medications are an outside issue, and as the 12 traditions tell us, AA as a whole has no opinion on outside issues. There are many people within AA that have very strong opinions about outside issues. I will share one of my favorite examples of this. I attended an open AA meeting in Chicago that I had not been to before. I was speaking to a man with 25 years of recovery before the meeting started. He passionately conveyed to me his opinion that you are not really sober if you are taking ANYTHING that affects you from the neck up...as he took puffs on his cigarette and drank gulps from his extra large coffee. I suppose he just didn't count caffeine or nicotine!

Tanner48
Tanner48

Sooo what drug company now owns controlling interest in Hazleden?  Stupid.  I have clients who know how to cook the patches and shoot it.  I also must say I HATE articles that state 'alcohol and drugs'.  ALCOHOL IS A DRUG!!!  Why do we have to fight the same fights? 

JohannesHolleritter
JohannesHolleritter

Hazelden, please reconsider your intention to use Buprenorphine (Suboxone) to treat drug addiction. It is difficult to reconcile the wisdom of treating addiction to addictive narcotic drugs with another addictive narcotic drug. The need to detox from a detox medication is head shaking. Please educate yourselves about the media accounts and studies concerning crime, overdoses, death and diversion problems associated with Suboxone / Buprenorphine. Please visit the “Problem” page located at: www.SuboxoneAbuse.Wordpress.com for more information. Quite frankly, it is "stunning" that Hazelden would treat addiction with another addictive drug. This is a new era in the history of Hazelden...  

SocraticGadfly
SocraticGadfly

This is NOT "maintenance," certainly not naltrexone. that's why alternatives are needed to the 12-Step/Minnesota Model version of help. 

Fortunately, such alternatives **already exist.** Go visit Lifering, http://lifering.org and find out just how an alternative program works.

damelilla
damelilla

In my home area, we're seeing so many problems with Suboxone. Addicts are selling Suboxone to buy heroin. We are seeing an uptick in admissions to treatment centers for Suboxone detox followed by abstinence-based treatment. Families are furious about their 20-something kids being put on Suboxone and tell anyone who'll listen about their anger with the treatment center responsible. The local treatment center that had a Suboxone-maintenance program has cut the program, and now uses Suboxone for detox only -- typically 5 days. Hazelden may encounter some unintended consequences. It's a shame to see such a great treatment center make such an uninformed decision.

lookingdeeper
lookingdeeper

High quality programs that were early adopters of suboxone are running away from it now. It's a disaster on many levels, and the positive story highlighted in the article is not the norm. The fact is that suboxone is now sold on the street and has become part of the addict lifestyle, a drug of abuse used to manipulate the system. Suboxone is harder to get off than heroin and it continues the cycle of dependency. Parents in particular are getting fed up with programs that get their kids hooked on suboxone. It's great from a public health perspective (when you look at large groups who aren't getting as much HIV), but terrible from an individual perspective, where people keep relapsing. My friend who recently died of an overdose was adamant about suboxone's dangers: "Don't let anyone tell you that suboxone doesn't get you high," he said. "They've had me buzzed on that stuff for months." He didn't make it. 

addictionguy
addictionguy

Just as a point of clarification, these drugs are not 'antiaddiction' rather anti-craving medications.    I hope that Hazelden continues to move towards the use of Naltrexone, Prazosin, Campral, Vivitrol (injectable Naltrexone), Baclofen, etc,

JulieAnn
JulieAnn

@thefreedomtorecover.com Wouldn't you also suspect the "medication-assisted treatment" model to have a strong financial incentive--a built-in recurring revenue model? Just another prescription-drug benefit? I know someone who has been on methadone for more years than I can count. He is still enslaved, unable to consider moving outside walking distance from the clinic that dispenses his daily dose of "medicine". 

KassandraMarie
KassandraMarie

As a recovering addict I don't agree with you. When I was using heroin, my kids would be dropped off at my mother's house and I would be gone all day. It would be spent finding money, finding my drug, shooting up and then nodding out for hours in my parked car hidden somewhere. On suboxone, I'm home every day when my kids get out of school. They have a snack waiting for them, I help with homework and cook supper. None of that could I do while using heroin. I don't care what other addicts say because to me I'm 2 months clean while taking suboxone to treat my opiate addiction

CEAr
CEAr

@ShawnT. The experience you had with AA is ABSOLUTELY not the case for AA as a whole (as someone who has been clean from absolutely everything through AA). ButchWarner is right, Marijuana Maintenance is a joke. I bottomed on weed but I still use AA because AA is where it all began. It's not my only step program but it's my core program.

ButchWarner
ButchWarner

I don't think you understand AA. AA endorses complete abstinence from all mind-altering substances, with exceptions for legitimately prescribed medications. Smoke weed in AA and your sponsor will ask you to consider a new sobriety date or sponsor.

"Marijuana Maintenance" is a term AA members use jokingly and disparagingly.