Better game plan needed for addiction treatment

Karen Brown has some sense of what Eagles coach Andy Reid and his family are going through. Her 29-year-old son got clean eight years ago, but only after being treated for addiction 14 or 15 times.

Marti Hottenstein understands the never ending battle against a chronic disease in which everyone blames the patient. Her son, 24, died of a methadone overdose after trying to detox on his own. "I died with him," she said.

Barri Pepe told Andy Reid about her daughter, 29, a decade in recovery from heroin addiction, at a Philadelphia Eagles dinner for volunteers last year. Reid's son Garrett, 29, died Aug. 5 after a long battle with addiction.

"We know what it's like," said Pepe, who is 13 years clean herself and active in the recovery community.

A surprising number of people know: An estimated 23 million Americans, 9 percent of those age 12 and older, needed treatment for illicit drug or alcohol use in 2010, according to the National Survey on Drug Use and Health. Only one in 10 got the care.

Half of them relapsed - about the same rate as those who fell off their treatment plans for diabetes, hypertension, and asthma.

"With asthma . . . sometimes it takes many times to get the message that you have to stay on these medications or the asthma will choke you to death," said Thomas Kosten, an addiction researcher at Baylor College of Medicine in Houston.

If you think of addiction as a chronic disease, he said, "treatment is very effective."

Advances in neurology and genetics over the last two decades have helped convince most researchers that drug and alcohol abuse is a chronic illness. But much of the public, politicians, and even physicians still see it as a moral failing, a belief that shaped a treatment system that is largely divorced from mainstream medicine and is funded like its poor stepchild.

"Addiction changes the brain," said Charles P. O'Brien, director of the Center for Studies of Addiction at the University of Pennsylvania School of Medicine. It creates the memory of a euphoric new reality, reinforced by myriad new habits, that is extremely difficult to get rid of.

"It's like when you learn to ride a bike at age 8 or 9. You never forget it," O'Brien said.

The big breakthroughs in addiction treatment for opioids - illicit drugs such as heroin and the far more common prescription painkillers such as Percocet and OxyContin - have been the development of medications that either suppress withdrawal symptoms or block the high entirely. They allow the long process of unlearning habits to move forward through intensive counseling, 12-step programs, and other forms of support. Research shows that taking such drugs greatly reduces the chance of relapse.

Yet the vast majority of treatment programs don't use medications. And while the National Institute on Drug Abuse says that residential or outpatient treatment shorter than 90 days is of limited effectiveness - experts often recommend one to two years - surveys show that more than 80 percent of patients are discharged immediately after detox.

Relapse is most common before the brain has been trained to sustain itself. Issues that were overlooked during years of drug use - from dental pain to court orders removing children from their mothers - often reappear then, at the worst time.

"All of a sudden I'm stopping using, which is really hard, every part of my body is saying 'use, use, use' and I'm saying 'no, I want a better life,' and all these things are crashing in," said Beverly Haberle, executive director of the Council of Southeast Pennsylvania, the regional affiliate of the National Council on Alcoholism and Drug Dependence.

A relapse when the body's high tolerance for drugs has begun to decline can easily result in a fatal overdose. Suicides are more common, too.

Haberle's group is at the forefront of a national movement to open "recovery centers," where people get support and learn basic life skills - how to use a computer, apply for a job, find an apartment - that they never developed before disappearing into substance abuse.

"All normal living and everything related to it was irrelevant to me," said Doug Gould, 51, who lost 22 years to an alcohol addiction.

He credits the staff at the Livengren Foundation in Bensalem for "convincing me 100 percent that I was done." They ensured that his 14 days as an inpatient would be followed by residence in a recovery house, where he attended 12-step meetings five times a week and ended up living for the next year.

Without all of that, Gould said, he "absolutely" would have returned to drinking. Instead, he celebrated 14 years clean on July 29, runs a version of a recovery house of his own in Levittown, and raises money for an organization that has gotten hundreds of people into treatment; the main event, 12 hours of "substance-free music," Soberstock, will be held Sept. 1 at Snipes Farm in Morrisville.

Getting approval for an inpatient stay for opiate detox may require wrangling with health insurers, said David Jones, medical director of the Mirmont Treatment Center in Media: "A lot of companies encourage that to be done outpatient in a physician's office."

Cost-cutting "is an issue that we have to deal with," said Gary Tennis, secretary of the new Pennsylvania Department of Drug and Alcohol Programs.

Pennsylvania is widely seen as having one of the strongest laws in the nation for coverage of drug and alcohol addiction, mandating a full range of care for most commercial health plans and Medicaid.

Still, it doesn't kick in until the substance abuse reaches a definition of addiction that would seem ridiculous for other chronic diseases, said Thomas McLellan, chief executive officer of the Philadelphia-based Treatment Research Institute. If that standard were applied to diabetes, he said, a patient would have to lose his eyesight or a finger before coverage began.

So why are relapse rates for diabetes no better than those for addiction?

In the absence of mainstream medical recognition, McLellan said, the recovery community developed Narcotics Anonymous and other forms of peer support to manage the illness. When more patients get full treatment, he predicted, relapse rates for addiction will be lower than those for other chronic diseases. Peer support is now starting to develop in other communities, such as diabetics.

Eventually, he said, "we will have better, cheaper, illness management for all the chronic illnesses, including addiction."

McLellan, who served as deputy director of President Obama's Office of National Drug Control Policy, said progress has vastly speeded up as a result of two federal laws: the Mental Health and Addiction Parity Act, signed by President George W. Bush in 2008, and the health-system overhaul signed by Obama two years later.

Various provisions move substance-abuse treatment into the mainstream, from screenings at primary-care offices to insurance coverage at earlier stages of disease. More treatment would encourage drug companies to spend more money researching addiction medications, which have not been big moneymakers in the past. Better drugs would get more use.

The bottom line is that substance abuse would be seen - by everyone - as, simply, a disease.

Karen Brown, whose son was in treatment 14 or 15 times before he was ready to get clean, said she hopes that news of Garrett Reid's death ultimately serves the same purpose.

It shows that "the drug addict is your lawyer and your son and your professor in college," said Brown, an archaeologist who lives in Ridley Township.

Marti Hottenstein, whose son, Karl, 24, died of an overdose in his Warrington apartment six years ago after failing to find a treatment center to admit him, put it this way:

"Do we turn a cancer patient away if they have lung cancer? No, we don't. How can you turn away someone who has a disease? This country needs to get educated."