Heroin recovery treatment 'a partnership, a collaboration,' counselors say
Treatment isn't magic.
When it comes to heroin, there's no wand to wave and no spell to recite. There's no potion to loosen the hold of the drug on those who've tried it. And there's no magic moment when a former addict is suddenly free from all danger of ever using again.
Treatment isn't magic, but Jim Scarpace says it can work.
Scarpace is executive director of Gateway Foundation Alcohol & Drug Treatment in Aurora, and he's one step removed from the front lines of providing treatment to people struggling to overcome heroin addictions.
Roughly 60 percent of people in residential treatment at Gateway in Aurora are there because of heroin. They're working to get clean, understand the mental triggers that caused them to use and begin a sober life.
Counselors, under Scarpace's direction, get patients on medication to help lessen the effects of withdrawal as they detox from the drug, from the only thing that made them feel OK.
"With heroin, you're always trying to chase that initial high that you could never re-create," Scarpace said. "In treatment, you learn the skills to manage the distorted behaviors associated with addiction."
Learning that lesson is a slow process.
People might enter treatment, then leave against counselors' advice. It's Scarpace's job to persuade them to stay.
But, he says, patients often don't listen. Instead they follow the siren song of the next high, thinking it'd be easier to use again than to suffer through what some medical professionals call the "excruciating" symptoms of withdrawal -- the muscle aches, insomnia, sweating, abdominal cramps, diarrhea, goose bumps, nausea and vomiting.
"The effects of heroin withdrawal are not fatal," Scarpace said. "Withdrawal makes you feel like you're going to die, but you're not."
Treatment involves trial and error, and it requires commitment and honesty. Some drug users, sentenced to a rehabilitation center instead of jail, lack the motivation to end their addiction, overcome their disease. Those users aren't likely to succeed unless they change their mindset, Scarpace said.
"Sometimes it takes two or three times in treatment for something to click and someone to be honest," he said. "Once they start opening up, then we can help them."
Treatment isn't magic, Scarpace says, but give it time, and it can work. Give the recovering addict support, and he or she can hold the addiction at bay.
"Treatment is a lifelong process," Scarpace says. "If treatment was a magic bullet, we wouldn't have these issues we're having."
And there are issues.
When it comes to heroin, treatment centers in the fight against the drug also are fighting insurance companies that might hesitate to pay for as much treatment as patients need. And they're fighting critics who say that using prescribed medications to help heroin addicts come off the drug is curing one addiction but creating another.
Scarpace fields questions about how to deal with insurance companies from staffers as he hurries to a meeting.
During the meeting, counselors discuss a drug they hope to give to more patients as they finish residential treatment, a drug that prevents heroin from reaching the brain and producing a high.
If a person uses heroin while also taking this drug, he or she won't feel a thing. Scarpace says this could have potentially powerful effects -- it can make the process of using no longer seem rewarding.
"It changes the addiction pathway in the brain because it really doesn't create that positive reinforcement," Scarpace said about the drug called Vivitrol, a medication that isn't habit-forming and therefore draws little criticism. "It doesn't flood the brain with those neurotransmitters, the rush, the high."
The other main drug used in heroin recovery treatment is the one that often comes under attack.
Suboxone is a partial opioid blocker and a partial opiate, so it has some risks, said Dr. David Lott, medical director for addiction treatment programs at Linden Oaks Hospital at Edward in Naperville. It was approved as a heroin addiction treatment in 2002.
"It really helps stabilize withdrawals, stabilize cravings, and a lot of people have been able to get off heroin because of it," Lott said.
Gateway prescribes Suboxone and so does Linden Oaks, but carefully. Both work to ween patients off the drug before they form a new habit.
Timing is key.
So when insurance companies refuse to pay for enough days of treatment, Scarpace tells his staff members to look for alternatives, to investigate whether a patient could be eligible for state funding of if he or she can pay out-of-pocket.
"A lot of insurance companies are really pushing back and not giving us the time we need to treat someone to the point where we feel like they need to be treated," Scarpace said.
Gateway hopes to treat patients for at least 28 days, but the average stay ends up closer to 21.
When mental health issues are present, as they often are with heroin users, 21 days just isn't enough, Scarpace says.
Those who turn to heroin sometimes struggle with anxiety -- not the garden-variety anxiety anyone might feel before an important test or a big presentation, but the kind that makes even leaving the house nearly impossible because of overwhelming worry and fear. Trauma victims and manic-depressives who haven't been diagnosed also are among people who turn to heroin, Scarpace says.
"A lot of people will turn to opiates as a way to manage those symptoms, especially when they fluctuate between mania and depression so frequently," he said.
It takes time to get a patient on the proper medication for any such mental issues and help them prepare for a life without heroin.
A federal bill U.S. Rep Bill Foster introduced could provide funding to allow people to stay in residential treatment for up to 60 days. Foster says the bill is designed to give drug users "at least one good shot at getting rid of their addiction."
That "one good shot" might involve more than just residential treatment. Partial-day programs could be the next step, followed by time in a halfway house, recovery home or sober living facility. Joining a 12-step recovery program such as Heroin Anonymous or Narcotics Anonymous is recommended, as is recruiting the support of sober friends and family members.
"The success rates for individuals are so much higher the longer they can remain in a somewhat structured, sober, safe environment," said Lisa Labiak, executive director of Serenity House Counseling Services in Addison.
Recovering addicts who come to Serenity House likely will have completed detox and already finished a residential program. Then they can live in a halfway house in Addison for three months before moving to a separate recovery home off the Serenity House campus for up to two years.
Clients are expected to work during the day, then come back to the halfway house in the evening for individual or group counseling.
Counselors at Serenity House work under the same philosophy as Scarpace -- that treatment isn't magic, but given time it can work.
"It's a pretty significant time they can spend with us," said Tom Stamas, former vice president and clinical director at Serenity House. "When they leave, what they have is the support network they build while they're here."
The support of loved ones can be the closest thing to magic in the entire recovery process, Scarpace says.
"If you go back to an unhealthy system that doesn't support your recovery or everyone you know is still using, the chance of you maintaining sobriety goes down significantly because you don't have a healthy support system," Scarpace said. "There is nothing magical we're going to do to you. This is a partnership, a collaboration."
• This article is part of our "Heroin in the Suburbs: Through Their Eyes" series. For more see http://bit.ly/DailyHeraldHeroinSeries
Part 9Heroin has taken hold in the suburbs and turning a blind eye to it isn't acceptable anymore. In an occasional series, the Daily Herald examines those the problem affects and those who are fighting it. Today, we take a look through the eyes of Jim Scarpace, who oversees treatment for recovering users as executive director of Gateway Foundation Alcohol & Drug Treatment in Aurora.