Andi Peterson, a 26-year-old from Utah, went through half a dozen substance treatment programs and countless detox centers during her years-long heroin addiction.
In those many stints, she found that she and many other addicts tended to fail out of treatment within a week of arriving.
She told Business Insider there’s a major reason why.
Opioids, unlike many other substances, can rewire the brain and radically change thought patterns. The powerful physical addiction presents difficult withdrawal symptoms that can crush many new patients’ resolve.
Patients in many treatment and detox centers are given a form of buprenorphine, a prescription medication that reduces opioid cravings, to ease the withdrawal. Patients are then put on a “taper” — a process of taking smaller and smaller doses — before they finally stop taking buprenorphine entirely.
Peterson said coming off that “taper,” usually a few days after detoxing ends, is one of the most difficult points in the recovery process.
“When I was on Suboxone [a brand name version of buprenorphine], I felt like I could do it,” Peterson said. “Every time I came off of it, I wanted to get high and I couldn’t get that thought out of my head long enough to focus on anything else. It was a constant, ‘I need to use right now.'”
Peterson relapsed numerous times throughout the five years of her addiction and often did so immediately after going through detox. Those relapses occurred even after she had moved from a “precontemplative” mindset — not accepting she had a problem — to a state of actively trying to change her negative behavior.
Justin Hatch is the program director at the Alcohol and Chemical Treatment Center (ACT) in Ogden, Utah, one of the many treatment centers Peterson attended. He told Business Insider that the “secondary withdrawals” Peterson experienced are common during the two weeks after the “taper.”
Those first days after detox are one of the most critical times to get patients into an intensive treatment program, according to Hatch.
“Dealing with this population, depending on how long they’ve been using, that window of opportunity to start treatment is very small,” he said.
At ACT, about 50% of detox patients move directly to some kind of inpatient or outpatient treatment program. Many of those who don’t move to treatment lack insurance to pay for it or can’t afford out-of-pocket costs, though some are simply in denial about their needs, according to Hatch.
But even among patients who do move into a treatment program, the risk of relapse remains high. Most treatment centers, like ACT, base their treatment around abstinence and many addicts’ physical dependence on opioids makes abstinence incredibly difficult, if not impossible.
The addiction treatment industry has traditionally been dominated by Alcoholics Anonymous and its abstinence-based 12-step program. That has begun to change as new treatment modalities for alcoholism and other conditions have been introduced, but abstinence-based treatment still dominates.
The opioid addiction epidemic has forced treatment centers to rethink their programs and integrate medication-assisted treatment (MAT) , which many experts consider the gold standard of opioid-use treatment. Over the past decade, ACT’s admission moved from almost exclusively alcoholism ten years ago to approximately 50% opioid addiction last year, according to Hatch. Other treatment centers have experienced a similar shift.
Medication-assisted treatment uses prescription medications like buprenorphine to reduce cravings, allowing patients to work on the underlying issues leading to their substance use, without the constant pressure of withdrawal.
Studies in 2008 and 2011 conducted by the National Institute on Drug Abuse found that treatment using suboxone, the most commonly prescribed version of buprenorphine, showed a “marked reduction” in drug use for participants. Approximately 50% of participants in the 2011 study reduced their substance use during extended Suboxone treatment. The success rate dropped to 8.6% once it was discontinued.
Because of these promising results, MAT has gained advocates in statehouses and on Capitol Hill. But it’s expensive and not yet widely available.
While Peterson was prescribed buprenorphine for short stints while detoxing, she was never offered medication-assisted treatment. ACT currently only offers medication during detox.
Weber Human Services, which provides public treatment programs in Utah near where Peterson lives, told Business Insider that it is slowly shifting away from abstinence-based treatment and working to improve access to MAT.
Medication-assisted treatment can be the difference between life or death for deeply entrenched opioid users, Turner Bitton, the president of the Drug Policy Project of Utah (DPP), told Business Insider. Bitton is working to improve MAT access in the state.
Peterson was finally able to get and stay clean while serving a year in prison for narcotics possession. But many are not as lucky — when users fail out of treatment, they can go into an endless relapse cycle.