Challenges of treating opioid addiction
There is no easy solution to fixing the opioid epidemic. The issues behind what drives opioid abuse are as varied as the individual addicts themselves. Some might be self-medicating to deal with mental health issues like trauma or depression. Others might have gotten in too deep when experimenting with recreational drugs. Increasingly, people have become addicted after being legally prescribed painkillers for chronic pain or an injury.
“Anyone can become dependent who uses them,” Dr. Aryeh Levenson says.
Levenson has been a psychiatrist for about 25 years and could be considered a jack-of-all-trades in his field. His work has focused on a variety of subjects. He developed the opiate treatment program for Southcentral Foundation and his experience in treating addiction has made him acutely aware of the complex issues driving opioid use.
“The problem is very significant—it’s at epidemic proportions and we probably haven’t seen the worst of it yet,” he says.
A major issue behind treating opioid addiction is relapse. The drugs are so addictive and the withdrawal symptoms so severe the relapse rate can be over 90 percent. As opioids affect the brain and the functions therein, decision making can be drastically altered by the addiction.
“It’s a double whammy,” Dr. Levenson says. “It’s not just this compelling desire and need, but [addicts’] cognitive ability to stop or to process is more limited.”
He says that dealing with the issue requires a multi-pronged approach that includes a medical component and substance abuse therapy catered to the individual. While Dr. Levenson considers the substance abuse treatment extremely important, it’s just not enough on it’s own. Therapy and sheer willpower will only go so far.
The medical component consists of replacement therapy with medication like methadone or Suboxone, which can help addicts deal with their withdrawal symptoms.
“For some people, it’s a lifesaver,” Dr. Levenson says.
When replacement therapy is used, he says the relapse rate drops to 40 or 50 percent, but when it’s stopped, research shows the rate will eventually go back to 90 percent. Despite the effectiveness of replacement therapy, he thinks it’s unwise to put too much stake in medication alone.
“In the medical field, the danger is [that] medicine is the answer,” he says.
Without the therapy component, he says the medicine is less effective because any underlying mental issues that might be contributing to the addiction are still present.
“Medications alone, by and large, can’t do it. They need substance abuse treatment,” he says.
In theory, if every addict could get into some sort of addiction counseling and be treated medically, there might just be a chance to make an impact on the opioid epidemic, but that’s unrealistic. Not every addict is at a place in their life where they want to seek help, but one of the biggest issues is that many of those looking for help can’t get it.
“The problem is so immense and the numbers of people seeking help are so immense, there’s not enough resources,” Dr. Levenson says.
“The waitlists are profound,” he adds.
When an addict is in the mindset of getting clean, Dr. Levenson says the window of opportunity can be short and waiting weeks for treatment can seem like a lifetime.
When asked if he has any advice for those who might have loved ones dealing with addiction he says: “There’s a balance between love and support and enabling. So, in general, the advice is if the person is trying to get help, support them and help them. If the person is not trying to get help—sincerely trying to get help—supporting them financially [or] with rides is enabling them. It’s easy to say, it’s very hard to do, especially when it’s a loved one.”
Despite the challenges ahead, there are still success stories.
Dr. Levenson worked with a patient who had been addicted to opiates since he was 9-years-old. The patient got hooked after he started running drugs for his mother. By his early 40s, he had never held a job and had been an addict for most of his life. He eventually managed to get clean and showed up at Dr. Levenson’s office one day and said something peculiar. The patient told the doctor he never realized there were mountains around Anchorage. Confused, Dr. Levenson asked the patient what he meant.
“He goes ‘you don’t understand. When every moment of your day is spent thinking about how do I get the opiates? How do I survive? You don’t look up. You don’t look at the mountains. I don’t know if I knew leaves were green a year ago. I wake up and I can see.’”