Publicly Traded Addiction Treatment Understanding Addiction is a difficult realm to comprehend because each addict has their own reasons why they took up the drug use. There is no cookie cutter reason why people become addicts. Many of these addicts also have mental illnesses, with the symptoms masked over by the drug abuse. It is my contention that the drug treatment centers need to spend an inordinate amount of time weighing in on what was the cause of the addiction and structuring a clinical treatment plan to meet the patient’s needs. A poorly conceived clinical treatment plan will result in unfavorable outcomes and a high degree of recidivism. I believe that high degree relapse might be influenced by many factors:
- mental illnesses
- patient returning to the same environment as pretreatment
- associating with other active addicts
- past demons that remain unaddressed triggering use
- dysfunctional home settings
- child abuse
- domestic violence
- sexual assault
- sex trafficked
- bridges burned with family and or friends
- poor insight and judgement
- a discharge plan that was unrealistic
- unable to cope with being sober
- no case management follow up
- unwillingness to stay sober
- suicidal ideation
- poor coping skills
- poor life skills
- no employment
- learning diabilities
- undiagnosed developmental disabilities
Drug Treatment is a Multi Billion Dollar Business
Forbes Magazine has stated that the Drug Addiction Treatment is a $35 Billion Dollar Business https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#1c9c2e7517dc
Publicly Traded Addiction Treatment. Addiction Treatment is Profitable But is it Helping. $35 Billion Dollars is serious money and for that kind profit, one would hope the patient outcomes were exceedingly favorable. The recidivism for recovering addicts relapsing back on drugs is very high. These treatment centers have variable lengths of stay and much of that has to do with insurance approvals, degree of addiction, motivation and or some are ordered through the court. The treatment centers are from the basic ordinary inpatient unit to a high dollar swanky place like the Betty Ford Clinic. Singer musician Eric Clapton, a Addict now in recovery, is the founder of Crossroads Centre located on the island of Antigua. I think going to the island of Antigua for treatment would be highly favorable. The island would be totally positive and patients would likely tolerate the treatment woes better. https://crossroadsantigua.org/
Quitting Addiction Without Treatment
Publicly Traded Addiction Treatment. Some addicts have kicked their addiction without treatment. This was seen at the end of the Vietnam War when many military personnel were addicted to heroin and other drugs. The government fearing that the men would return home still addicted. The government mandated that all military personnel must first have a clean urine drug screen before returning home. Those that failed the urine drug screen were held in country until they could pass the urine drug screen. This was a significant finding, which verified that addicts could quit addiction without treatment.
Some Addicts Do Well With Outpatient Drug Treatment
Some opioid addicted patients do very well outpatient wise with methadone maintenance, prescriptions for Suboxone , Subutex or the intramuscular injection of Vivitrol. The addicts undergoing outpatient care also need a thorough intake assessment and clinical treatment plan. Some of the physicians dispensing Suboxone , Subutex and Vivitrol injection do so without much of a follow through clinical treatment plan to address the underlying issues. The reason is most likely they do not have the time to dedicate to this endeavor. These patients need to be referred to an outpatient counseling center.
Inpatient Drug Treatment is Necessary For Some
Publicly Traded Addiction Treatment. For many addicts who cannot quit on there own, some kind of Drug Treatment is no doubt necessary. According to the recent literature, only 17% of active addicts go for formalized treatment program. If a person does seek of the clinical treatment, then it should meet the patient’s needs. I am not entirely convinced that all drug treatment programs utilize individualized treatment plans of care. Apparently the success rates of staying clean post discharge are not optimum.
In contrast in acute care when a respiratory comes to the hospital emergency department for an exacerbation related to Chronic Obstructive Pulmonary Disease (COPD), there will be similar standards of care that all patients may receive (Mini Nebulizer, Steroids, Chest X-Ray). But if the COPD patient is not responding to the implemented care, then clinical treatment team make adjustments. The Segway here is that treatment facilities should manage patients individually. As discussed earlier many addicts have mental health issues, which are largely unaddressed while they are using a substance. As the person undergoes treatment and enters into drug recovery the mental health issues / symptoms might resurface. I think that more ought to be done to individualize the addicted patient’s plan of care if needed and also include mental health treatment.
There are Dual Diagnoses facilities that treat addiction and mental illness. Its real important during the admission process that a through intake assessment take place. As people progress through treatment new issues may surface and these need to be addressed.
Case Management For All
An important component of recovery should be an involved case management strategy while the patient is inpatient at treatment center and for those under the guise of outpatient care of methadone clinic or a physician. Whenever a patient is discharged from an inpatient and outpatient setting, there ought to be case management follow-up to check in on progress.
Accredited Continued Nursing Education Course Understanding Addiction here:
Prescription painkillers and the opioid crisis. Trying to get a clear understanding of the relationship between Prescription Painkillers and the Opioid Crisis has, for a long time, been a difficult journey in which consensus has been a circuitous, moving target. Theatlantic.com has taken a lengthy and clear-eyed look at the issue, from the earliest days of the dawning awareness that a new and devastating social ill of opioid addiction was proliferating, through today, where the long held professional opinions on the best way to treat opioid-using pain patients is undergoing profound reconsideration.
It a true deep dive on the subject, but if you take the time to read it, you will gain a fuller understanding of why it’s been so difficult for many to even begin to understand all the complex factors that must be integrated into efforts to alleviate suffering without exacerbating the challenges of the addiction rehabilitation process.
In the early days of the opioid crisis, public officials had reasons to blame it on all the pills. News stories featured people who, to the shock of their neighbors and loved ones, had died unexpectedly of a drug overdose. In an emergency, authorities do what they can with the tools at hand. In tightening controls on doctors who prescribed pain relievers, state and federal agencies were focusing on the aspect of the problem most subject to regulatory intervention.
To some degree, that strategy worked. According to the Centers for Disease Control and Prevention, overdose deaths declined by about 5 percent in 2018—a dip attributable almost exclusively to fewer deaths from oxycodone, hydrocodone, and other prescription opioids. (Fentanyl deaths are still climbing.) Now that the fever of the opioid crisis may be breaking, Americans can revisit some of the stories we have told ourselves about the role of prescription medication in the crisis.
By now, the outlines of the story are familiar: Opioid prescribing began to rise in the early 1990s, powered by two forces. One was a campaign by oncologists and pain specialists to correct the undertreatment of pain. The other was the introduction in 1996 of the potent time-release oxycodone medication Oxycontin, which the drug company Purdue Pharma vigorously marketed to doctors.
Read more at theatlantic.com
Link to our course on Understanding Addiction
The questions that I have about opiate addiction & recovery via drug rehab are:
- What is the percentage of recovering opiate addicts who stay clean & sober?
- What is the percentage of opiate addicts who were addicted to prescription pain medication who stay clean & sober?
- What is the percentage of opiate addicts who were addicted to heroin (aka dope) who stay clean & sober?
- Is there a clinical difference in treating opiate addiction of those addicted to prescription pain medication versus to heroin?
Every single week, I read someone’s post on Facebook or a blog about how they are trying to get into and/or stay in recovery from opiate addiction. The media reports ‘X’ number of arrests made for selling drugs or possessing drugs.
It’s insane to see so many people addicted to opiates! No doubt that Drug Rehabilitation & Treatment Programs are staying busy because opiate addiction is spreading like wild fire. There is no end in sight to deal with the Opiate Addiction issue. When I say no end, it means that more people are becoming addicted to opiates and I don’t see the addiction ending. In has been my professional nursing experience that once someone is hooked on heroin, then, sadly far too frequently, “it’s a wrap.” That same direct nursing experience tells me that very few heroin addicts who get clean stay that way.
Nearby my home, we have a methadone clinic that opens up at 5:30am and closes at 1:00pm, Monday through Saturday. Person after person, alone in their vehicles, and getting dosed. Some stay for groups and others leave to go home or to work. Then there are multiple livery vans transporting people to get dosed. Well, issues related to Methadone is a whole other discussion to be had another day, but the point is to underscore the prevalence of the addiction problem.
Back to the focus of this story: Clients attending these Drug Rehabilitation and Treatment Facilities ( Inpatient Drug Rehabilitation ) are not experiencing a high degree of success at staying clean & sober. I can say this with great conviction and evidenced based experience. How do I know? I have worked in the Emergency Department, Psychiatric & Addiction Care Facilities. I am also a Clinical Instructor, and I ran Homeless Health Link, LLC during the capstone course of my Master’s of Science in Nursing. I case managed the homeless addicted by linking them to services; medical, dental, behavioral health and addiction treatment. I did this for 9 months. I was nominated for the service excellence award at my university. Of 68 clients, 11 were compliant and now five years later 7 are still clean, sober & remain in recovery.
Changing How We Discharge Drug Rehab Clients
Hooray! The Client has completed Drug Rehabilitation and is going to discharged from a structured, stable clinical environment — most likely to an environment with no stability, no structure, and maybe unsafe circumstances.
Many Clients who have completed drug rehab are not experiencing a high degree of success at remaining in recovery because they return to the same social existence that they had prior to treatment – and that environment is the one within which the problem emerged in the first place.
Idle time to an addict is one of the biggest defeating elements. This population must have something constructive to do; be case managed for a number of months following discharge. A lot of these folks might not have suitable living circumstances. They need a JOB. But its not easy getting a job when you don’t have a cell phone, Internet access, transportation, clothes and a suitable place to live. Not to mention that many may have past criminal records and employers might be apprehensive about hiring them.
Its so ludicrous to Rehabilitate Clients and turn them out, on their own, to start over. No Job, No Permanent Housing, No basic amenities such as clothes, cell phone. No Case Management. I have seen it from a clinician standpoint:
Scenario: Larry age 26. At group the day prior to discharge, the counselor ask; Hey Larry what is your plan? I am going to live with my sister and her husband. Larry goes to his sister’s and maybe it works out. But maybe his brother-in-law doesn’t like Larry and they have an argument. Larry gets kicked out and he is back on the street. Larry says screw it and wants to get high. So he goes to the local pharmacy and boost (shoplifts) and gets busted by the camera. Police come and arrest Larry. Or maybe Larry gets away with shoplifting. He sells the merchandise for 20 dollars. He goes to cop two bags of dope and buys works (syringe, etc.).
Scenario: Amy age 24. Is discharged following a 30 days inpatient drug rehabilitation and returns to her Mom’s home. Mom is an alcoholic and her live in boyfriend is abusive. He also likes to try to have sex with Amy after her Mom passes out from drunkenness. Amy decides to bolt and goes over to her girlfriend Rachel’s place. Rachel still uses and she tricks on Broadway to support her habit. Rachel just had a date with a John and has scored 4 bags of dope. Amy is feeling herself at the edge and ask for taste. So she shoots up and feels a nice high. The high wears off and Rachel’s dope is gone and Amy wants to get high. Rachel and Amy go to Broadway to catch a date and score some more dope.
Holding Rehabilitation Facilities Accountable
For many clients, the victory of completing drug rehab is short lived because of similar scenarios to those described above. Drug rehabilitation facilities should be highly invested in how they prepare clients for discharge and how they case manage Clients after discharge. I believe these facilities must be held to the same standards of accountability that hospitals are held to with regards to discharge planning and avoiding readmissions for the same morbidity.
Hospitals have had to do a better job at keeping patients from being readmitted soon after discharge to avoid not being paid for an untimely admission that occurred, and addiction rehab facilities need to be held same or even higher level of accountability to ensure the Client doesn’t fail and go back on drugs. Addicts have problems by definition, and require a steady hand to help them stay compliant. As I said, they need a job and suitable, stable and safe housing. Many of these clients would stand a far better chance of staying in recovery if they went to a reputable halfway house or sober living facility as part of their discharge plan.