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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.

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