On a cloudy, cold and rainy day in November, Tom walks out of his front door at 6:00 AM. He doesn’t have to be at work until 7:30, but as usual, he has a stop to make before work. He pulls into the parking lot of “the clinic” around 6:30 and parks close to the building. There aren’t many people here yet. As he walks in the front door, a middle-aged African American woman greets him, “Hey Tom!” “Good mornin’ Ms. Janey, He responds as he beams at her. They exchange a few quips as she flips through a stack of tickets. She pulls out one and stamps it twice; once with a number indicating his place in line and once with an mark indicating he is required to leave a drug screen today. He looks down at the ticket, and says, “Have a good day, Ms. Janey,” as he takes a seat in the waiting room. The ticket he holds in his hand has his name, the afore mentioned stamps, and a check mark next to something that says, Methadone Dosing. Tom, is a heroin addict and has been for 12 years now. He is being treated for his addiction at a clinic that provides medication-assisted treatment for opiate addiction.
Opiates include drugs like heroin, morphine, and codeine as well as synthetic drugs like oxycodon and hydrocodone. When individuals use large enough amounts of such substances, frequently, over a long enough period of time, their brains become physiologically dependent on (or addicted to) that substance. The chemistry in their brains acclimates to the presence of the substance, and when that substance is no longer present, it takes a while for the brain to reacclimatize to functioning without that substance. The result is withdrawal. Withdrawal from opiates can include a variety of symptoms, including anxiety, insomnia, sweats, vomiting, diarrhea and muscle pain. Many who decide they want to stop using opiates find that they continue to use simply to prevent the severe withdrawal symptoms. Those who share needles to inject the substance also put themselves at risk for contracting infections like hepatitis C. Finally, in order to afford to continue using, some find themselves engaging in other risky and illegal activities.
One way to break this cycle is “medication-assisted treatment.” This means that an individual is prescribed a medication by a physician in an amount that will stop withdrawal symptoms and will decrease or eliminate cravings to use. This allows a person to discontinue use of the substance, without going through withdrawals, while they are making lifestyle changes, developing a support system, and learning skills for coping. It also promotes discontinuation of illegal and/or risky activities.
The National Institute on Drug Abuse indicates that research has shown participation in a medication-assisted treatment program using methadone is most effective when the individual remains engaged for a minimum of one year. Some individuals remain on medication-assisted treatment for many years because they are unable to maintain abstinence any other way. Others use this treatment for a period of time and then eventually taper off of the medication, i.e. they are prescribed smaller and smaller doses over time until they are no longer in need of the prescription. This slow taper allows a person to discontinue the need for the prescription without triggering an onset of severe withdrawal symptoms. According to the Substance Abuse and Mental Health Services Administration, “For optimal results, patients should also participate in a comprehensive medication-assisted treatment (MAT) program that includes counseling and social support.”
Tom, mentioned at the outset, looks down at his ticket, “Drug screen,” he mutters to himself. He is a little annoyed thinking about the extra time it is going to take and how that means he won’t be able to get out of the clinic before the heavy traffic kicks in. On the other hand, he is looking forward to it. The person who was in line in front of him comes back down the hall. He gets up and walks down the hall and around the corner to the window where a nurse is waiting. “Morning Judy! He says with a light-hearted grin. “Looks like you’ve got a drug screen today, Tom” “Yes ma’am.” As his grin widens, Judy raises her eye brows. “This will be my first clean drug screen!” She smiles back. “Keep up the good work, Tom,” she says as she watches him drink today’s dose of liquid methadone. As he walks away from the window, he smiles again to himself, “I’m clean.” A reminder pops up on his cell phone, “Therapy appointment at 6:00 PM.” “That’s right,” he says to himself, “and I have my home group NA (narcotics anonymous) meeting after that.
*I am a Psychologist and Clinical Addictions Specialist at the Chrysalis Center. I specialize in working with individuals with addiction challenges as well as those with binge eating, anxiety, trauma, depression and other mental health challenges. Feel free to call to schedule an appointment. –Lillian Hood, LPA, LCAS
Substance Abuse and Mental Health Services Administration
National Institute on Drug Abu7se