“New Paradigm” Addiction Recovery Model Takes Long-Term View

/BY CELIA VIMONT

August 6th, 2014/

People in recovery from substance use disorders who have had repeated relapses can benefit from being monitored for at least five years after treatment, according to a former head of the National Institute on Drug Abuse.

“Addiction is life-long and treatment is brief,” says Robert DuPont, M.D., President of the Institute of Behavior and Health. “We need to shift our thinking about treatment from the current focus on short-term episodes to long-term recovery management. That should include frequent random drug testing for alcohol or drug use, with serious consequences for failing. That is the lesson from state Physician Health Programs (PHP), which set the standard for good long-term outcomes from substance use disorders.”

He described the model for such care, called the New Paradigm for Recovery, at a recent meeting of the CORE (Clinical Overview of the Recovery Experience) conference. The New Paradigm is not a new treatment program. It is a system of long-term care management for substance use disorders that enhances and extends the benefits of all treatment programs.

Currently, formal episodes of substance use disorder treatment are relatively brief, even though addiction is a life-long disorder. In a recent report, the institute stated the median length of stay of a person who completed treatment in 2008 ranged from four days for detoxification, to 124 days for outpatient treatment and 197 days for outpatient medication-assisted opioid therapy. “Whether or not an episode of treatment is completed, the large majority relapses to alcohol and drug use,” the report noted. “Relapse after episodes of treatment is so common that it is often defined as a central element of this chronic disorder.”

The model for the New Paradigm is the Physician Health Program (PHP), which helps addicted doctors get the drug, alcohol and mental health treatment they need to keep their licenses and return to practice. If a doctor in the program uses alcohol or drugs even once, the consequences are swift and serious. They are pulled out of practice, evaluated, and if they are told they need residential treatment they must comply, or risk losing their licenses.

Doctors in the program routinely are monitored for five years after treatment. DuPont’s organization conducted the first national study of PHPs. In a follow up, they found that even five years after the required monitoring stopped, the large majority of physicians reported being completely abstinent from alcohol and other nonmedical drug use. “Most physicians after completing the PHP program are still abstinent and still going to 12-step meetings. The large majority report that the PHP program saved their lives and their careers,” says DuPont, who was also the second White House Drug Chief. “This study shows the way to make recovery, not relapse, the expected outcome of addiction treatment.”

New Paradigm programs treat addiction as a chronic illness. Just as blood sugar is monitored in a person with diabetes or blood pressure is measured for a person with hypertension, drug testing should be regularly conducted, eventually and ideally as part of routine medical care for patients in recovery from a drug or alcohol disorder, DuPont says. Two differences however, he notes, are the random nature of the drug testing, and the swift and certain consequences of a positive test result.

Some private addiction treatment programs, as well as independent monitoring services, use the New Paradigm. Several criminal justice system programs, including drug courts, also use the model. The New Paradigm can be especially useful in this setting, he observed. “In the criminal justice system today, a person on probation is tested on scheduled visits (not randomly) and they commonly have eight, 10 or even 15 substance abuse violations before being sent to prison often for long periods of time. That system of delayed, uncertain and draconian punishment does not work in anyone’s interests,” he says.

The New Paradigm begins with a signed mutual agreement between the person and the supervising entity (such as the family, an employer, or legal authority) to abstain from alcohol and drugs, and spells out the consequences of a failed drug or alcohol test. A successful program makes the consequence subject to the signed agreement, DuPont notes. “For example, teens who fail drug tests could have their driving privileges revoked.” Employing such a system of a signed agreement enforced by frequent random testing makes it practical for families, employers, probation and others to support recovery far more effectively, he says.

The program strongly encourages, and usually requires, participants actively to engage in community-based support meetings, such as AA or NA.

The New Paradigm is not needed for everyone being treated for a substance use disorder, DuPont says. While it helps everyone, it is most needed for those who have had repeated relapses. “Even after a person has had terrible problems with substance use, the brain’s memory of the reward experience of using alcohol or drugs hijacks the person’s thinking. They believe they can go back and manage their alcohol and drug use this next time.” That is why DuPont is critical of treatment programs, including some medication-assisted treatment programs, which tolerate continued alcohol and other drug use while in treatment. “When a person comes into treatment, they seldom want to stop using alcohol and drugs —they want to cut down or to have a respite from the pain their use is causing them.”

Inpatient Treatment for Heroin Abuse Would be Funded Under Proposed House Bill

/BY JOIN TOGETHER STAFF

August 6th, 2014/

A bill introduced this week in the U.S. House would establish a federal grant program to fund inpatient treatment for heroin abuse, the Hartford Courant reports.

The Expanding Opportunities for Recovery Act is designed to increase access to inpatient drug treatment services for heroin and opioid abuse and addiction, its sponsors say. Under the bill, states could apply for grant funding to provide up to 60 days at a residential facility for people who do not have health insurance, or whose plans do not cover inpatient addiction treatment.

The bill was introduced by Representative Bill Foster of Illinois and Sean Patrick Maloney of New York, both Democrats. “The heroin and prescription drug epidemic is ripping apart families and our communities, but tragically, many folks face too many hurdles to access treatment,” Maloney said in a news release. “The Expanding Opportunities for Recovery Act will help turn the tide on the epidemic by expanding treatment options for our neighbors.”

Maloney noted that while inpatient rehabilitation is a proven effective treatment for opioid abuse, many people cannot afford such treatment because they lack health insurance. He added many insurance providers require patients to exhaust other options, such as outpatient treatment and counseling, before they will agree to cover inpatient treatment.

For an individual to qualify for inpatient treatment under the measure, they must either lack health insurance or have insurance that places a barrier to inpatient treatment, such as requiring that less expensive treatment be exhausted first.

More Prescription Drugs Withdrawn or Got Black-Box Warnings After Drug Law Passed

/BY JOIN TOGETHER STAFF

August 6th, 2014/

More prescription drugs have received black-box safety warnings since a law designed to speed the drug approval process was passed in 1992, according to a new study. An increasing number of drugs have also been withdrawn from the market because of safety concerns since the law was passed, CBS News reports.

Almost 27 percent of drugs approved after the Prescription Drug User Fee Act was implemented in 1992 received black-box warnings or were withdrawn from the market within 16 years, compared with about 21 percent before the law was passed. The law allows the Food and Drug Administration (FDA) to collect fees from pharmaceutical companies to speed the drug approval process.

“New drugs have a one-in-three chance of acquiring a new black-box warning or being withdrawn for safety reasons within twenty-five years of approval,” the researchers wrote in Health Affairs. “We believe that the ultimate solution is stronger U.S. drug approval standards.”

The researchers looked at all 748 drugs approved by the FDA between 1975 and 2009. They found 15 percent received one or more black-box warnings, and 4 percent were withdrawn from the market because of concerns over safety.

After the law was passed, median drug approval times were reduced from 33.6 months in 1979-1986, to 16.1 months in 1997-2002. Between 1999 and 2009, outpatient prescribers wrote 30 million prescriptions for each of the nine drugs that were later withdrawn due to safety concerns, or that received black-box safety warnings.

“Our findings suggest the need for reforms to reduce patients’ exposure to unsafe drugs, such as a statement or symbol in the labeling, medication guides for patients, and marketing materials indicating that a drug was approved only recently,” the researchers wrote.

Drinking Problems Among National Guard Soldiers Often Caused By Civilian Life

/BY JOIN TOGETHER STAFF

August 6th, 2014/

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Drinking problems in returning U.S. National Guard soldiers are more likely to be caused by civilian life, rather than wartime experiences, according to new research.

As many as 13 percent of veterans may drink because of problems such as job loss, financial problems or divorce, the researchers found. Almost 7 percent of Americans overall have drinking problems, HealthDay reports.

The study appears in the American Journal of Preventive Medicine.

The researchers collected data on about 1,000 Ohio National Guard soldiers who returned from Iraq or Afghanistan. The soldiers were interviewed three times over three years. They were asked about their alcohol use, as well as exposure to traumatic events such as land mines, vehicle crashes, enemy fire, the deaths of fellow soldiers. They also were asked about their injuries and about stress in their lives since they returned.

Sixty percent of the veterans had experienced combat-related trauma, and 36 percent had experienced problems since they returned. The researchers found 13 percent of veterans reported alcohol abuse or dependence in their first interview, 7 percent in their second interview and 5 percent in their third interview. In addition, 17 percent said they were sexually harassed during their most recent deployment.

Having at least one civilian stressor or an incident of sexual harassment during deployment was associated with an increased risk for alcohol problems in soldiers who had not abused alcohol before, the article notes. The study found combat-related events were only marginally associated with alcohol problems.

“Exposure to the traumatic event itself has an important effect on mental health in the short-term, but what defines long-term mental health problems is having to deal with a lot of daily life difficulties that arise in the aftermath—when soldiers come home,” lead researcher Magdalena Cerdá of the Columbia University Mailman School of Public Health said in a news release.

Welfare Applicants in Tennessee Must Declare Prior Drug History Under New Law

/BY JOIN TOGETHER STAFF

August 6th, 2014/

Under a new law in Tennessee, welfare applicants must declare any prior history of drug use, NPR reports.

The new law, which went into effect July 1, requires new applicants to fill out a questionnaire that asks whether they have recently taken drugs, and whether they lost employment or had court appearances scheduled in the past three months because of drug use. Most applicants so far have answered no to the questions. A person who answers yes must undergo drug testing.

So far four people have been disqualified from receiving benefits because they refused to submit to the law’s requirement that applicants undergo drug testing, according to theAssociated Press.

Supporters of the law say it is designed to prevent public funds from being spent on illegal drugs. Critics say the law unfairly penalizes vulnerable people.

State Senator Stacey Campfield, who wrote the law, says applicants who test positive are connected with treatment programs. The American Civil Liberties Union of Tennessee says the law is a violation of privacy. The group is planning on challenging the law in court.

“We don’t test individuals who are seeking government support like farmers, veterans and students, so we have to take a step back and question why limited-income people are being targeted and have to submit to these intrusive searches,” said Hedy Weinberg, Executive Director.

Legislators in a number of states are continuing to pursue measures that would deny welfare benefits to people who use illegal drugs.

In December, a federal judge in Florida ruled the state’s drug-test requirement was unconstitutional. Florida’s law required welfare applicants to undergo mandatory drug testing. Judge Mary S. Scriven of the United States District Court in Orlando ruled the testing requirement violated the protection against unreasonable searches.

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