The following article is part of a continuing series of articles examining the effects of illegal drugs in Fayette County.
Stephanie Madl has worked with clients in treating drug and alcohol addictions for years.
And through her experience, she believes the best treatment for an addict is a large continuum of care.
Prior to a person receiving treatment, however, he or she must be assessed, according to Madl, director of Outpatient Treatment for Southwestern Pennsylvania Human Services Inc.
To complete the assessment, treatment programs in the state use the Pennsylvania Client Placement Criteria, which determines the substance abuse issue as well as the level of care that matches the needs of the person.
Madl said a person could be placed a five- to seven-day detox program, either hospital-based or non-hospital-based.
From her experience, drugs that usually need detoxed are alcohol, heroin, oxycodone, vicodin and benzodiazepines, including valium, xanax and klonopin.
A person also can be placed in an in-patient program.
“Historically it used to be … 30 to 40 years ago, you could go into inpatient for three or four months, then it trimmed back in the (1990s) to a 28-day program,” Madl said. “Around 2000, managed care took a stronger involvement in the treatment process, and it was trimmed down to seven to 14 days. Unfortunately, most are seven days and for an individual who has been using a long time and under the influence of substances. After seven days in an inpatient center, their head is just starting to clear.”
Funding cuts, Madl said, are largely responsible for the decrease in the length of stay.
Following detox, a person could then enter a halfway house, where group and individual therapy takes place. After that, a person can step down to a partial hospitalization program, where a person receives more than 10 hours of group and individual therapy each week. The next step is intensive outpatient, which requires five hours of therapy, but less than 10 at three days a week. From there, traditional outpatient therapy is the final step.
“Most of the individuals we see in our system have been using and living these addictive lifestyles, five, 10, 20 years. So to think that seven to 14 days of inpatient is going to correct years of a behavior, years of a physiological disease in them, is really unrealistic,” Madl said. “So to really have somebody go through the continuum of treatment … of inpatient to halfway house, to partial hospitalization to IOP (intensive outpatient), to outpatient is really, really important for an individual. We've seen great success if somebody has gone through that continuum of care.”
What sometimes happens, however, is that a person fails to follow through the entire continuum after the seven- to 14-day inpatient program, and he or she ends up cycling back through the process.
“We're talking years of a disease, years of a behavior, that in seven to 14 days, the inpatient programs do a great job, but to really carry through with changing people, places and things, and changing that lifestyle and that behavior, it doesn't give quite enough,” Madl said.
In therapy, a lot of time is spent on educating patients to help them understand that they have a disease, she said.
Medications to combat addiction
In addition to therapy, there are several common medications an addict can receive, the most common one being methadone.
While it is another opiate, it's managed in a methadone maintenance clinic where individuals attend daily, check in with a nurse, and receive their dosage at the site, Madl said.
“Because of the brain chemistry change with an opiate like heroin, the research has indicated, if you're providing medication like methadone in a controlled setting ... that helps the brain chemistry adjust,” she said. “Ultimately, the goal is to taper off, or to be on the lowest dose for an individual who is getting their life back on track.”
Methadone, Madl said, is appropriate for very heavy heroin users.
Another common medication is buprenorphine, an opiate, which is also known by a brand name of Suboxone.
One form of the medication includes naloxone, which helps prevent buprenorphine from being abused. It's prescribed in a film.
However, with addicts, Madl has found that where there's a will, there's a way, and they could find a way to abuse it.
Buprenorphine is designed to help those who were prescribed painkillers but had become addicted to them.
It is for low to moderate users, and those who are prescribed buprenorphine as a medication usually do not need to receive it every day, Madl said.
Vivitrol is the third most common medication.
The medication works to block the pleasurable feelings produced by opioids in a person's brain. It is not addictive and does not lead to physical dependence.
It does not replace or act as a substitute of opioids and it is not pleasure-producing.
Anyone who receives Vivitorl must be clean and sober for at least seven to 14 days before the first administration of the medication, which is given as an injection about one time each month.
Vivitrol's predecessor was prescribed in a pill form, and a person had to take multiple pills every day.
“If somebody would commit and do that, we saw a lot of success,” she said. “Remembering to take a pill every day or multiple pills every day for a lot of people is a struggle.”
According to Madl, there are some very good success rates with it.
Madl said the National Institute on Drug Abuse (NIDA) has found that the best success occurs when psychotherapy is combined with a medication-assisted treatment.
Vivitrol has been used more and more in the past three to four years.
Madl spoke to a former client of hers who had been battling addiction for 17 years, and attributed her recent success to Vivitrol.
“She said 'It gave me time to really let my head clear,'” she said. “In all the therapy she received over the years, she could really start implementing and sticking with those changes that needed to be made. It blocks the high for an individual and it also helps block their craving. I see more and more agencies looking at it.”
Madl has seen that in small communities like Uniontown, it can be very difficult for a person in recovery to change people, places and things.
“They feel that everyone they know uses,” she said. “In some communities there's a high rate of drug usage. Seeking out those people who aren't using … it's a very scary endeavor.”
Although there is a great deal of assistance available in Fayette County for those struggling with addiction, Madl said she would like to see more sober support.
One concept that she would like to see implemented in Fayette County is the Oxford House concept.
Oxford House is a concept in recovery from drug and alcohol addiction. In its simplest form, an Oxford House describes a democratically run, self-supporting and drug-free home.
“They are recovery houses, not like halfway houses,” she said. “The house is run by the residents. It's for people who are trying to be in recovery. They're clean, they're sober. People are encouraged to be in treatment. They go to (Alcoholics Anonymous) and (Narcotics Anonymous). They'll challenge each other to say, 'Look, your thinking's not in the right place. That's your addiction talking. Let's talk about what your recovery is saying to you.'”
Such houses are located in other parts of the state, including Armstrong, Butler, Westmoreland and Washington counties.
"They've been very beneficial," Madl said. "We've seen a lot of people who -- going home was not the best answer for them, because that was putting them back in a community where their neighbors were using."