Treatment seen as critical front in heroin war

Success of programs hard to track, officials say.

By the numbers

21.5 million: Number of Americans 12 or older who had a substance use disorder in 2014.

586,000: Number of Americans whose substance use disorder involved heroin.

47,055: Number of lethal drug overdoses in the United States in 2014.

2,744: Number of overdose deaths from Ohio that year.

10,574: Number of overdose deaths in the U.S. involving heroin in 2014.

Sources: Government statistics

At the Nova Behavioral Health residential treatment center in Dayton, Jessica Snoeberger keeps a photograph of her 12-year-old daughter on her nightstand.

She hopes to win the war against her heroin addiction and one day be reunited with her daughter, who is living with family members. But Snoeberger knows her recovery isn’t guaranteed

Her current stint in residential treatment is her fourth.

More than a half-million Americans used heroin in 2014, and nearly a quarter of those who experiment with the drug develop an addiction, according to government statistics.

Hundreds die locally every year.

The epidemic has spurred anxious calls for more crisis intervention and a concentrated effort to arm police officers and first-responders with Naloxone, the opioid-blocking medication that literally snatches death from addicts.

But making a serious dent in the heroin problem requires more than keeping addicts alive with a wonder drug or attacking the supply chain. It means attacking the demand with the right treatment — and the right length of treatment.

And it requires that those in the throes of addiction make the painful choice to break through the cycle.

One of the big arguments in the treatment community is whether 28 days — the standard treatment time in many residential programs — is enough to modify a user’s thinking or remove the tug of someone’s drug environment. The 28-day stay became standard more for billing and payment purposes than for health reasons, and for many addicts it isn’t enough.

Snoeberger was one of them. She got hooked on Percocet after nearly losing a finger in a severe hand injury at age 27 and then moved on to heroin when Ohio’s crackdown on pill mills made it difficult for her to feed that habit.

Multiple stints in treatment didn’t rid her of her addiction to heroin.

“Putting the drug down is just the first part,” said the 34-year-old Snoeberger, who grew up in Englewood. “What comes after is most important so you don’t go back to those old behaviors.”

Snoeberger on Tuesday will complete the 28-day program at Nova and enter recovery housing, which offers a drug-free environment in a more residential setting, for six months. She’s determined to make it this time.

“I paid somebody to kill me every day and that’s ridiculous,” she said of the heroin she used daily. “But each time I come here I learn something new.”

Lives in the balance

Not every opiate user requires residential treatment, said Tom Otto, associate CEO at TCN Behavioral Health Services in Xenia.

Most treatment providers, including TCN, base services on criteria set by the American Society of Addiction Medicine (ASAM). Clients are assessed to determine their placement over five broad levels of treatment options that can range from early intervention to outpatient counseling to medically managed intensive inpatient care.

“The issue that drives treatment is the diagnosis,” Otto said. “The guys shooting up daily are the highest risk group of folks. Those are severe and the guys who are going to need in-patient (treatment).”

Men admitted to residential treatment at TCN’s Christopher House in Xenia are on the higher end of ASAM’s spectrum.

Lives at Christopher often hang in the balance.

“I came in here physically, emotionally, spiritually bankrupt. I was lost and I was dying,” said Griffen Hurley, 35, of Bellbrook, who just completed a 55-day stay at the 16-bed facility.

“It takes about 30 days to get it all into your head and start figuring stuff out,” said Hurley, who combined alcohol and heroin and got addicted to both. “I really don’t even remember the first three weeks I was there, to tell you the truth.”

Hurley, who said he started using drugs at age 12, never got serious about treatment until 2013, when he passed out behind the wheel and hit a utility pole, nearly killing himself.

Like Snoeberger, he’s been in treatment before only to succumb to a familiar temptation.

“A lot of us we’re little kids when it comes down to it,” he said. “We have different lives than most people. We’re using drugs and alcohol so much of our lives that we don’t even know how to be a part of society.”

Generation ‘under siege’

Separating an addict from the drug scene is the most immediate and beneficial aspect of residential treatment, said Chauncey Wallace, regional director of Access Residential, a Dayton treatment provider.

“We have a generation under siege right now,” Wallace said. “From a treatment perspective, it’s important for an individual to get out of the environment that they’re in and into a safe environment where they can have an opportunity to not just detox but also settle down.”

An addict can take months or more to break the negative pull of heroin, said Wallace, whose facility’s clients stay on average two to three months.

Wallace said it takes at least two weeks for “the dust to settle” and for clients to begin understanding behavioral therapy and identifying negative thought patterns. Medically assisted treatment with Vivitrol, an injection that blocks an opioid high for a month, is also an important, relatively new component of long-term recovery, he said.

Access Dayton opened its residential doors in October and is licensed for 28 beds currently serving only men. The private company has plans to add another 28 beds locally for women and open other centers across the state, according to Wallace.

A drop in the bucket

Getting a message of abstinence through to an addict can take weeks if not months, said Maj. Debra Taylor, administrator of the Dayton Salvation Army’s Adult Rehabilitation Center on South Patterson Boulevard.

The spiritually-guided abstinence-only program has 12 beds for women and 58 for men. The program is broken into four phases of six to eight weeks lasting at least six months.

“Usually we don’t see the turnaround until between the second and the third phase,” Taylor said. “That’s when the head becomes unclouded and they’re really ready to receive what we have to offer them. It takes awhile for them to get accustomed to being clean and sober and to wake up and function like people function on a daily basis. I don’t think 28 days is sufficient at all. You can be clean in 28 days, but what tools are you going to have in that 28 days to go out and completely say no?”

Jodi Long, director of Community Behavioral Operations at the Alcohol, Drug & Mental Health Services board of Montgomery County (ADAMHS), said a 28-day standard has been in place for decades, well before she got into the field 20 years ago. Long said the program should be looked at as only a starting point.

“A 28-day residential treatment program should never be looked at as a stand-alone treatment option for a person seeking recovery,” Long said. “It needs to be part of a larger continuum of care of treatment services… It needs to be followed up with less intense treatment services such as intensive outpatient or outpatient services.”

John Goris, CEO at Nova, which offers 28-day residential treatment, acknowledges the limitations.

At Nova, clients receive a minimum of 30 hours of programming each week, including group therapy, individual counseling and vocational training.

A heavy focus is placed on communication and coping skills.

But no one believes addicts can be cured in 28 days.

“What we know now and I think what everyone can probably recognize is 28 days for someone who’s been using heroin for five years and shooting six times a day is really just a drop in the bucket,” said Goris, whose 45 beds are typically full. “That gets you some of the tools to use for your recovery. Your mind starts to clear a bit. But the doctors that we’ve talked to in different presentations say sometimes it takes eight to nine months for your mind to work and really start functioning back the way it used to.

“And that’s without using heroin all the time,” he said. “The mind takes a long time to get back to a functioning mind.”

Expensive treatment

Drug treatment isn’t cheap, and taxpayers fund most of the local treatment programs, at least in part. The Salvation Army program is privately funded, but most other local programs receive money through Medicaid, the county human services levy or some other public funding source.

The Montgomery County ADAMHS board spends more than $4 million a year on residential treatment, including funding for the 45 beds at Nova and another 20 at MorningStar, a Nova-operated facility that primarily treats those with significant mental illness.

The cost to patients is based on a sliding scale that takes into account income and family size. At Nova, the daily cost for alcohol or drug treatment is $216.70, or $6,067.60 for 28 days.

Christopher House in Xenia offers a longer program. There, a 60-day stay costs between $11,000 and $12,000, said Nathan Crago, the facility manager. Medicaid covers the cost of therapy while the Mental Health & Recovery Board of Clark, Greene & Madison Counties funds room and board.

‘Some of the clients died’

Studies show any amount of treatment is beneficial, but determining success based on the length of a treatment program is complicated.

“We’re trying to track outcomes but it’s very, very difficult,” said Donna Hawkins-Green, residential services program manager at Nova. “There are a lot of variables in there so it’s hard to track.”

Some clients leave before they complete the program. Some relapse after graduating from residential treatment, return and eventually get clean. Some hide their drug use, at least for a time.

Some don’t survive, which can be heart-breaking for those who work with the population on a daily basis.

“One of the things we have noticed is that some of the clients died within 90 days of leaving the program,” Hawkins-Green said.

Could some have been saved if they were in the program longer?

“I don’t know for sure,” she said.

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