October 20, 2014 at 4:32 p.m.
Heroin addiction often requires inpatient treatment
Heroin addiction often requires inpatient treatment
For people in Oneida County, there are several options for treatment of heroin addiction. Koinonia treatment center, located at 1991 Winnebago St., has been one of those options since 1974.
Jim Webb, co-director of Koinonia, echoed many others interviewed for this series when he said the spike in heroin use in the Northwoods was preceded by a rise in the abuse of prescription medication.
"I'd say three to four years ago we started to see a spike in the number of people seeking treatment for opiates. As prescription drugs became more controlled, and heroin is cheaper and more readily available, substance abusers switched over," Webb said.
Webb said the thing most heroin addicts fear most is the withdrawal symptoms. Getting over that fear is the first step they must take if they want to control their addiction," he said.
"People who come into treatment who are suffering from heroin withdrawal are going to be sick, but heroin withdrawal won't kill you. Alcohol withdrawal can kill you, but with heroin withdrawal you're going to be very sick," he said.
"There are some non-mood altering drugs that you can get that help ease that withdrawal process, and there are times that we do that to help them through that window of physical discomfort," he added.
Webb said the mental withdrawal is probably more difficult than kicking the physical addiction.
"If they don't (resolve) some of the issues that led to their using, or at least (start confronting them), they're going to have a relapse. The patients here are in cognitive behavioral therapy group. Empirically-validated research shows that this is the most beneficial therapy to use with this patient population. So we use a curriculum that we bought that's used at Riker's Island for hardcore substance abusers who are in institutions. It's really been very beneficial in the year and a half since we implemented it," he said.
Because addiction almost always involves some mental component, therapists at Koinonia are dual credentialed to better work with their clients.
"They have master's degree's in counseling, along with a substance abuse credential, because 60 to 70 percent of the patient caseload that we work with suffer from anxiety and depression along with their substance dependency issues. If you don't try to work on both at the same time, you're going to have poor results, in our opinion," Webb said. "We really try to look at the whole person in their treatment. So there is self-help groups, we can't publicly endorse because it's against their traditions. What we try to do is support people, we don't care what works, whatever works for you is great."
Koinonia patients have a 90 percent follow-through rate with their aftercare providers on continuing care recommendations made upon release from inpatient treatment. Part of that success is due to Koinonia's policy on not discharging patients on Fridays.
"Because that is really stupid," Webb said. "When do people get in trouble? They get in trouble on the weekend. You'd be amazed at the hospitals and other providers that discharge people on Friday. So we'll discharge people on a Monday through Wednesday, usually. When they leave here, they have an appointment the next day with their continuing care therapist, so there is no fracture in their aftercare program."
Webb said treatment is difficult. The average length of stay for a heroin addict at Koinonia is four to six weeks. Because most people come voluntarily, staying is a choice the patient makes.
"It's not a locked facility. Most people successfully complete the course of treatment, although some people leave against the staff's advice. When that happens, we're all concerned, we're talking with the family. Sometimes we see tragic consequences because of that decision. Bad things happen to some of those people," he said. "You have to be honest with yourself. That is the biggest step, facing yourself. It's pretty challenging here. That's why family members are so important. Not everyone who comes to Koinonia because they are in (legal) trouble. We get individuals who come here because they are sick and tired of being sick and tired. It doesn't really matter how you get here, it's what you do once you get here that counts."
Family support is critical to patient success. Webb said the center emphasizes family programing because everyone in the family is affected by the substance abuser's behavior.
"We think that if our patients have family support, the better the outcome. And the research has shown that is true. So we have family groups on Saturdays where the patients and their families participate together," Webb said. "There is almost a spiritual healing that goes on in those groups because families realize for the first time that they are not alone. There are other individuals and families that are going through the exact same thing, and there is a real bonding that occurs. So not only does the substance abuser get well, the family starts to get well with them."
Webb said he has noticed the law enforcement community has changed its emphasis from punishment to treatment.
"Absolutely, the research shows that some of the drug courts, the OWI courts have better success rates than other components of the legal system. I think it's important to realize that there are some people who come to treatment that the best therapists in the world just aren't going to help because they don't want to change. Those individuals need to be held accountable by the legal system. There are other people who are going to come to treatment who, instead of taking from society, are giving back," Webb said. "The best thing you can give someone is a chance, and we give them the best chance we can, but ultimately it is up to the individual."
Still there is the occasional person who enrolls in treatment to look better to the courts but who isn't truly committed to change. Webb said that behavior is going to be reflected in the discharge summary that the judge receives.
"If someone is just coming here to look good for the courts, we are able to sort some of that out pretty quickly," Webb said.
While it is possible to kick an addiction to heroin without the inpatient component, Webb said it's crucial that Northwoods residents have access to this type of intensive treatment.
"I think it depends on the severity of the use. We are contracted through the Human Service Center to provide 16 beds in the Oneida, Forest and Vilas county area. Currently those beds are full and there is a waiting list," he said. "We are fortunate that we have three county boards that believe that people can get better and recover and that not all people should just be placed in jail. They see it as a health issue and a legal issue at the same time."
The Human Service Center works with the county boards in three counties to make sure people battling addiction have access to treatment.
"What's interesting is that at a state level, they talk about regionalization, and Oneida, Forest and Vilas counties have been doing that for 40 years here. We're really lucky," he said.
He added that addicts in the Northwoods are extremely fortunate to have a facility like Koinonia. In contrast to Koinonia, where longer stays are allowed, the average stay for most people in a residential program in other parts of the state can be five to 10 days.
"How do you even get your head clear in five to 10 days when you are dealing with a heroin addiction? For every dollar invested in treatment, and there (are) a number of empirically-validated studies that show this, the community gets back six to eight dollars in benefit. By people not being involved in the court system, people having jobs, getting an education, they start contributing taxes and they just become members of society, they kind of just blend in. And part of what we need to do - and this is because they just kind of fade into society - they say that there are 21 million recovering people in the United States now, but there is no voice," Webb said. "You hear about the individuals that don't get better. Who are they? The Lindsay Lohans and Charlie Sheens, you hear about those people because they get the press. You don't hear about the people who get better and fade away. So the recovering community needs to step up and show that treatment does work, people do get better, because we all know family members, friends who have had a substance abuse problem and they got their life on track. But we forget them."
Even after they leave Koinonia, the former patients continue to benefit from the services it offers
"We have a self-help meeting here on Monday nights. There were almost 50 people here at that meeting," Webb said. "If you're not having fun in recovery, you won't stay in recovery. That's why the Koinonia Alumni Group is so critical. If you go back to the same peer group you were with after you leave Koinonia, you will start using again. You've got to make that separation, you've got to be willing to change.
Webb says that each addict is different. Most of them are just sick of the drug-fueled lifestyle and they want to change.
"They're all unique, individual persons, but I think the vast majority of them are really tired of their lifestyle and they are just kind of beaten down," he said.
He noted the state of Wisconsin is in the process of opening three rural treatment centers which will undoubtedly help many more addicts get clean.
"Hopefully one of those will be in our area of Wisconsin," he said. "There is definitely not a shortage of people who have a substance abuse problem anywhere in the United States, much less here. It's no longer just an urban problem."
Jamie Taylor may be reached at [email protected].
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