Opioid Addiction Treatment Approach

Buprenorphine – Opioid Substitution Therapy

We do not offer Methadone TX and feel for almost all opioid addicts Buprenorphine is a better choice of therapy. The only two treatments that have scientific support are Methadone and Buprenorphine. We believe this is do to both the pain and suffering of acute opioid withdrawal but just as importantly the long term cravings and symptoms of Post Acute Withdrawal the opioid addict struggles with. Fatigue, depression, poor motivation and muscle aches among other things may go on for months after attempts at acute detoxification are made.

So often people are told by those around them including poorly educated doctors that “it’s all in your head just get some will power and snap out of it”. It’s not. Post Acute Withdrawal Syndrome or PAWS is well recognized by those who understand the treatment of opioid addiction and why relapse rates out of even 30 day in-patient programs have been found to be as high as 90% or more after 1 year.

We believe that current science supports the contention that those who have struggled with opioid addiction for any significant length of time and in particular who have failed other treatment programs should be treated with opioid substitution therapy. Methadone or Buprenorphine for an indeterminate period of time are the only two treatments with significant science to back them up in the treatment of opioid addiction.

While absolute abstinence may be preferable for some substance abusers very few of those afflicted with opioid addiction will achieve it at least in the beginning of treatment without the help of medication to relieve the prolonged sickness and cravings of opioid withdrawal, which continue long after addiction has stopped.

Accurate science is difficult to complete in the field of addiction because it relies on self-report and studies those who will participate skewing the results of the study. Depending on the substance some people quit on their own or reduce their use over time. This is least likely in opioid addiction where support groups like AA/NA and behavioral therapy have conflicting or no evidence they improve outcomes without medically assisted treatment and limited support even for those who take Buprenorphine.
We should present accurate information to people and may even express our own beliefs, but we cannot make judgments for our patients knowing it is impossible to answer many questions with certainty. Treatment at Restorative Health and Recovery is highly individualized and dependent on informed consent of the patient and Ohio law.
There are many shades of improvement in every kind of treatment—any improvement should be encouraged and nurtured. Recovery is not an “all or nothing” process for us meaning we do not see only total abstinence from all substances as the only form of “recovery”. Our ultimate goal is to reduce the harm that may come to our patients regardless of any other factors. We measure success on a functional level. This means return to work, healing relationships, improved health and self-care and reconnecting with ones passions in life. Remember there are no good or bad drugs just good and bad relationships with them. This is a complex issue so the focus is on getting your life back not just blindly following a single approach, which is the same for every person. We take a non-punitive approach at our Clinic. Total honesty is difficult but critical.
Informed Consent, Harm Reduction and Patient Centered Treatment are the cornerstones of the program. It is our job to present you with as much information as possible so you can make informed choices including those, which we are required to make according to Ohio law.

Harm reduction therapy attitudes and techniques in relation to addictions:

Accept and respond to improvement.

The standard addiction treatments in the U.S. requires the individual to instantaneously and totally give up all use of the problem substance even in Methadone and Buprenorphine programs. Most programs reject anyone who fails to do so! This is cherry picking of clients, by working only with those who are immediately able to get better. But who then will deal with the vast majority who are not always successful at immediate cessation? What happens if relapse occurs? At RHR we recognize much can be learned with failure. Perfection is not mandatory only complete honesty and the true desire to end ones addiction.

Humility (versus perfectionism) is a skill required by both patients and our staff.

When people say, “I will not tolerate any kind of relapse” they may endanger the lives of their own patients or they must surely have perfect compliance. This is not realistic for all. It’s just that they insisted nothing less than total abstinence, so that any failures were those of their clients, and not their own. While this may comfort therapists or doctors, it is not effective therapy nor does it promote honesty.

Among misbelieves of those in the field of addiction is that addicts depend solely on their therapists, doctors or groups for any advances they make. In fact, most people get better on their own. In part, this involves experiencing and learning from the pain of their mistakes. If not for the pain of opioid withdrawal and its prolonged misery most people would quit on their own as they do with other substances.

Learning to take care of yourself is a skill.

To say one accepts that human beings are imperfect does not mean that you endorse their imperfections, failures or relapses. We want to encourage those we are helping to greater heights and larger successes. But it is the recognition and encouragement of smaller successes that lead to such progress. What we consider substance abuse therapy in the United States consists largely of exhortation—”quit drug taking and drinking!” Real treatment must improve the conditions of a range of those afflicted to be of value to as many as possible. We at RHR believe this starts with honestly accepting this is an imperfect process but one in which we honestly strive for perfection each day.

John Sorboro MD ABPN ASAM
Medical Director