Former opioid addicts looking to succeed in long-term recovery benefit from integrated healthcare, safe housing, employment or education, and a stable, supportive community. But experts do not necessarily see eye to eye on what constitutes success when it comes to long-term recovery, including the importance of abstinence from drug use.
What they do agree on is that New Jersey could do more to enhance and expand services. The panel of treatment experts on the topic were participants in an NJ Spotlight roundtable discussion on opioid addiction and long-term recovery on Thursday, the last in a series of three events on the epidemic. (The author moderated this event.)
The panelists each described different models for helping those addicted to opioids achieve and maintain healthy lives; some said a full range of support services is necessary to create long-term stability and ensure drug users recover, while others said that certain patients can benefit from participation in some parts of a recovery program.
“We’re not talking about an event, we’re talking about a process. [Recovery] is about that process of getting better,” explained panelist Ken Pecoraro, director of recovery and co-occurring services with CPC Behavioral Healthcare, a Monmouth County organization founded in 1960.
While abstinence may be an ideal, “Not everyone is going to choose that path,” Pecoraro said, stressing that success in recovery is a highly individual thing. “If you’re on that spectrum of getting better, you’re in recovery.”
Helping people to maintain recovery
Regardless of the route to recovery, or the specifics, reaching a more stable and healthy place in their lives has significant benefits, the speakers agreed, and the long-term process deserves more attention and support. Former drug users who can stay clean for five years have an 85 percent chance of not relapsing, explained Mariel Hufnagel, executive director of the Ammon Foundation, which supports recovery work and helped sponsor the event.
“So often when we talk about addiction we only talk about prevention and treatment — and that’s a really big problem, guys,” said Hufnagel, who is also in recovery, during her keynote presentation. Great work has been done, she said, “but for the most part we still do not have systems in place that address addiction as a chronic, treatable relapsing, condition, and support someone in their recovery process, in order for them to maintain recovery.”
Tens of thousands of New Jersey residents seek treatment for opiate addiction annually and it is expected that some 3,000 will die of overdose-related incidents this year alone, nearly twice the number who lost their life this way in 2016. Despite efforts to rein in prescribing and to expand treatment, the spread of fentanyl — a deadly synthetic substance often mixed with heroin — has kept the death toll climbing.
In June, NJ Spotlight hosted a panel that examined efforts to reduce the flow of highly addictive pills, including a successful program created by St. Joseph’s Health that is now being shared with hospitals statewide. In September, a second roundtable dug into the details of treatment, particularly the use of medication-assisted treatment, or MAT, considered the gold standard in care.
Last week’s event focused on what comes after an individual is addicted and seeks treatment and it explored how the public sector and healthcare providers can support people in recovery long term. This may include the use of MAT and medical care for other chronic health needs like diabetes or hypertension, but it also involves ongoing therapy and nonclinical services like housing, job skills and community encouragement.
Integrity House has been doing this work for 50 years, with many services clustered around its headquarters in Newark, said president and CEO Robert Budsock. Its programs cover detox, inpatient and outpatient care, counseling, job skills, education sessions and exercise options, among other things.
“It’s really wrapping your arms around someone,” he said. “We take pride at our organization that when a client comes here, they’re going to be set for life.”
For Budsock and Integrity House, recovery involves not actively using drugs, working full-time or being in school, and having safe, affordable and supportive housing. “Those are key areas. Another success would be improved health, in terms of physical health,” he said.
But Dr. Petros Levounis, chair of the psychiatry department at Rutgers New Jersey Medical School and chief of service at University Hospital in Newark, which also sponsored the event, had a different take. He said many recovery programs ask too much of the participants, both patient and physician, setting up unrealistic expectations for success.
“I think it’s criminal if you say, ‘We are only going to give you buprenorphine (a form of MAT) if you go to the (therapy) groups and (sit in) the hard chairs that drive you nuts,’” Levounis said, “or ‘I’m only going to accept you to the program if you go to a psychologist and go on medication for your bipolar disorder.’”
‘…starting where the patient is’
Grant programs often require a checklist of measurable outcomes — including regular doctor’s visits and stable housing — to consider someone a success, noted Eric McIntire, assistant director for recovery support services at RWJBarnabas Institute for Prevention and Recovery, another event sponsor. “But just engagement alone, even if she’s only doing once-a-month groups, is better than doing nothing,” he added.
“That’s starting where the patient is,” agreed Pecoraro. “A bird in the hand is worth two in the bush.”
A former drug addict himself, McIntire said the key to creating and building on this engagement is a personal touch; his goal is to find out more about the individual — what music they like, where they are from, what group sessions they feel comfortable attending. He has worked to expand these peer support programs, which he said are key to helping individuals navigate the programs and system that do exist.
“The strong part that’s been missing is the peers to walk them through the process,” he said. “We need to support one another.”
The panelists agreed there is a need for more robust insurance coverage for these services; too often, patients are covered for weeks or months, if lucky, but not for the years of care required to assure long-term success. There is also a need for more funding overall for the system, especially recovery programs, they added.
A chronic disease
But for that to happen, addiction must be treated like the chronic disease it is, akin to how policymakers, healthcare providers and those paying the bills address other long-term conditions, like asthma or diabetes, the panelists stressed. Addiction “is a condition that requires disease management over time,” Budsock said.
“Every illness has a before, during and after part, and all these three components need major attention,” Levounis added. Even a broken arm can raise questions for clinicians about why it happened and requires aftercare to be sure the patient gets physical therapy and doesn’t get reinjured. Addiction also requires a full arc of care, he said.
“This has been happening (in medical care), but not in addiction. Somehow in addiction we still have through-the-roof expectations” that short-term treatment will suffice, Levounis added. Even with MAT, he said, “somehow the expectation is the medication is going to go in there, change something in your mind and throw the addiction out the window once and for all and, from that point on, you’ll be happy go lucky. It just doesn’t work that way.”