Drug Treatment

Does Treatment Work? Why Outcomes Matter…

Posted on by Christy Weeks
Does Treatment Work

by Dr. Annie Peters: Harmony Foundation’s Chief Clinical Officer

Harmony has been helping people who are struggling with addiction to find recovery since 1969. While Harmony is well-known in Colorado for providing clients and families with support and quality services for many decades, reputation means little without demonstrating that people do, in fact, get better.

Defining what recovery is, and demonstrating that people who use Harmony’s services begin finding recovery, are essential components to the provision of ethical and effective care. Harmony’s mission is to provide the foundation for recovery from the diseases of drug and alcohol addiction. If clients leave treatment and begin re-developing lives of purpose, satisfaction, and rewarding relationships, we know we have helped to provide the foundation for a journey toward wellness.

Harmony contracts with an external research organization, OMNI Institute, to examine treatment outcomes regarding substance use, psychological well-being, and improvement in life satisfaction.
Data collection for the most recent outcomes study performed by OMNI began in March 2015, and the study was finalized in 2017. One hundred and forty eight (148) Harmony clients were assessed upon admission, at discharge, and at 1, 6, and 12 months post-discharge. The percentage of clients who responded at these time points were, respectively, 100%, 94%, 63%, 61%, and 64%. While results cannot be generalized to clients who were unable to be reached for follow up, a number of statistically significant findings can be reported and provide valuable information about the effectiveness of care provided at Harmony.

DEMOGRAPHICS

Understanding the people we serve helps us provide the highest quality of care by tailoring treatment interventions to the specific needs of our clients. In this study, the average age of clients was 38, with a range from 18-65. Sixty-four percent (64%) of clients identified as male, and 36% identified as female. All clients were asked to identify their “primary drug.” The majority of clients (74%) identified this as alcohol, followed by heroin (10%), methamphetamine (6%), other opiates/painkillers (5%), and marijuana (3%).

Clients under the age of 25 typically used more substances – the average number was four. The primary drug differed by age as well; clients under 25 identified heroin or alcohol (38% for each), followed by marijuana (13%).

REASONS FOR DRUG/ALCOHOL USE

Clients were asked about the reasons they used alcohol and drugs, and their responses help us understand how to help people better. Many clients (30%) said they used substances for “self-medication” or emotional pain/mental illness (28%). Other common answers were using for pleasure (22%), to escape reality (15%), habit (13%), or pain (5%).

PREVIOUS TREATMENT AND REASONS FOR SEEKING TREATMENT
About a third of clients had been to a detox treatment before, and about a third reported a prior treatment for substance use. Another third reported never having any treatment for drug or alcohol use.

About half of clients surveyed reported a prior diagnosis of a mental health disorder, with the most common diagnoses being depression (37%), anxiety (25%), ADHD (11%), PTSD (7%), and bipolar disorder (6%).

Most clients said that coming to treatment was a personal decision (71%). Other common reasons given for seeking treatment were a family situation, health reasons, a legal situation, or a job-related reason.

POST TREATMENT OUTCOMES

After leaving Harmony, clients were asked at 1, 6, and 12 months about their drug and alcohol use. They were asked whether they had been continuously abstinent from drugs/alcohol since discharge, and they were also asked if they had been clean/sober for the previous 30 days. As can be seen in the table below, over half of clients at one year post-discharge had been continuously abstinent since coming to Harmony, and 71% of them had been abstinent for the past 30 days.
Follow-up     %Abstinent for      %Continuously Abstinent
     Time            Past 30 Days                   since Discharge
1-month           77% (n=88)                            68% (n=91)
6-month           64% (n=90)                           57% (n=91)
12-month          71% (n=90)                            54% (n=95)

Abstinence since treatment is not the only outcome that demonstrates that clients are recovering and have improved their lives. In this study, we also wanted to determine how quality of life had improved for people who had come to Harmony. So all those surveyed were asked questions about relationships with family and friends, physical/emotional health, and other factors. Clients reported significant improvements over time in their family relationships, friendships, spiritual connection, physical health, emotional health. They also reported significant positive changes in their ability to handle finances and handling problems or conflicts, as well as improvements in self-respect. There were also significant reductions in arrests and other legal problems post-discharge, as well as improvements in employment status.

Because so many of our clients have co-occurring mental health issues, we also asked questions about symptoms of anxiety and depression. There were statistically significant reductions in symptoms such as hopelessness, fatigue, nervousness, restlessness, sadness, and feelings of worthlessness.

WHAT PREDICTS ABSTINENCE

In order to continuously improve Harmony’s services, we wanted to determine if there were factors that were associated with post-treatment abstinence. For example, do older clients have better abstinence rates than younger clients? Is primary drug related to abstinence rates, such that clients who primarily used alcohol do better than clients who primarily used heroin?

Interestingly, the only variable that predicted abstinence was the reduction in mental health symptoms during treatment. In other words, the more clients’ symptoms of depression and anxiety decreased during their time at Harmony, the more likely they were to remain abstinent after leaving treatment.

WHERE DO WE GO FROM HERE

One of the most compelling and recurrent themes in this study was the importance of mental health care and support. As mentioned above, self-medication of emotional pain and mental health issues were primary reasons clients reported for using drugs and alcohol. Half of our clients had co-occurring mental health diagnoses. And the single best predictor of post-treatment abstinence was the reduction in symptoms of depression and anxiety that clients reported during their treatment at Harmony. For the past few years, Harmony has worked to improve the quantity and quality of support provided for mental health issues. We have added mindfulness groups, a trauma coping skills group, and education groups on a variety of mental health topics. Clients can receive both addiction-specific counseling at Harmony and counseling specific to psychological issues. Given the results of this study, Harmony plans to continue enhancing the services provided to help people recover not just from chemical use, but from underlying emotional issues that can increase risk for relapse.

While the results of this study show that Harmony clients do, overall, have improved lives and decreased drug and alcohol use, we want to help more individuals and more families to recover, with more significant reductions in substance problems and more improvement in life functioning. Harmony is committed to continuous improvement in our services to provide even better care and help more people find their way to recovery. Studies such as this one remind us why this work is so important and why we need to always examine ourselves and find areas for improvement.

CLIENT FEEDBACK

At the end of each survey, clients were asked if they had any feedback about the Harmony experience. Common answers were that they appreciated the support provided by staff as well as the community they built with the other clients. While data can provide us with important feedback on who we serve and how we can continually do better at helping people find recovery, it is these comments that remind us why we do what we do at Harmony:

“I have come to better understand myself, my need to use, and what I am struggling with so that I won’t need to turn to drugs and alcohol to deal with my problems.”

“I’m really grateful to Harmony…it helped me a lot… I was in really bad shape. If I would have went somewhere else, I probably wouldn’t still be clean.”

“The staff here was absolutely amazing and seemed to truly care about me and my recovery. They were instrumental to my time here and truly helped me recognize qualities and worth in myself that make my sobriety worth fighting for.”

 

Listening to the Seen and the Unseen

Posted on by Christy Weeks

— Carol O’Dowd, MPA, M.Div, RP President, Colorado Association of Psychotherapists

Recovery, whether from addiction or a difficult situation, is aided by listening to the seen and the unseen. Often, how we listen causes us to not see what is in front of us. Have you ever walked into a familiar room to meet with family, friends or business associates and someone points to a new decoration or a piece of furniture in the room? You sat there wondering, “How did that get there?” Sometimes objects go for days being unseen. Our ancestors go unseen flowing as DNA in our veins while being powerful forces making us, us. Some of us grew up in households where we were trained to be addicted whether to alcohol or other substances. We learned to be pawns in a game with our unseen emotions.

Another option is to listen and notice the messages we hold and consciously choose which ones we want to play with instead of letting them play us. When the voice in our head is an old message from Mom, Dad or a memory of destructive family argument from long ago, we can create space between us and the message. We can take a moment to breathe in and hold in our fist the ghoul of anger, fear, frustration or the voice crying out “Go get a drink.” We can then set down the unseen emotion, unclasp our fist and release it. We can breathe out lovingkindness into our pain and sorrow. We can breathe in lovingkindness that we send to that space in our body where we held the destructive emotion. We can tell that portion of our body to relax. We can breathe out lovingkindness to the ghoul in front of us and tell it, “I do not need you right now. Please stay here. For the next 20 minutes I have a project to do a without you.”

Yes, those unseen emotions and old tapes can be so powerful, they keep returning. The practice is to listen carefully so that you can choose the ones you want to influence you. Seeing them as thoughts or emotions gone awry, you can put them inside a doll, rock, pencil holder or other object. Then pick them up and set them aside. If only for a moment, you can walk away without them. Although they may return, each time, they do so with less force. You can listen instead to acts of kindness from those in your past. In one moment you can listen to messages from the unseen to guide you to see more of the world right in front of you. You can consciously choose to spend time with people, animals and spirit beings who inspire you to live in a world of peace.

Go to www.coloradopsychotherapists.com for the mental health services offered by a wide diversity of mental health professionals.
Contact me at president@coloradopsychotherapists.com if you want to join a group that will be exploring the practice of deep listening on Sunday mornings starting in February.

Continuing Care after Treatment: How to Keep Recovery Moving Forward

Posted on by Christy Weeks

Addressing long term recovery often takes more than one episode of primary residential treatment. While the purpose of residential treatment is to provide a safe, structured living environment to help an individual stabilize, detox from drugs and alcohol and begin the early healthy coping skills necessary to help them on their journey to sobriety, it is just the beginning. A good in-patient residential treatment program does not stop once the client completes 28-30 days of treatment. The introduction of a strong continuing care plan should begin once the client completes detox before they exit in-patient treatment.

What is a continuing care plan? A continuing care plan is a collaborative partnership between a clinical case manager, the client and the therapist to design an individualized plan that provides a safety net of resources to continue their addiction treatment work. This could include Partial Hospitalization, Intensive Outpatient and active 12- step programming and sometimes sober living.

Why is continued “step –down” treatment important for long-term sobriety? According to NIDA, relapse is common in addiction treatment, with relapse rates being between 40 and 60 percent. Preventing relapse must include a continuing care plan that supports the individual in their early recovery. The Journal of Psychiatry published a 2014 review article, “The Continuing Care Model of Substance Use Treatment: What Works, and When Is “Enough,” “Enough?” Findings suggest that the overarching objective of any continuing care model should be to sustain treatment gains attained in the primary phase in an effort to ultimately prevent relapse.

In addition to our early primary addiction treatment offered at Harmony Foundation, we have also included a clinical case management team trained to work in partnership with the client and therapists to identify the “right” plan for each person. With over 47 years of treating individuals with substance use disorders, we have fostered partnerships with external providers to help our alumni be successful. “The most critical aspect of building a continuing care plan with our clients is letting them drive their recovery planning process. Telling them what to do and where to go doesn’t allow them to embrace their recovery.” says Alyssa Hansen, Director of Clinical Case Management.

Fostering this partnership and building a continuing care plan has shown positive results. According to M. Vannicelli , overall, continuing care participation in the first 3 months following discharge from residential treatment appears to be significantly related to fewer days since last drink and lower levels of alcohol-related impairment at both 3 and 6 months. Harmony has seen its own positive results in post-treatment engagement with over 54% of clients staying connected to a continuing care plan after 12 months.

When exploring residential treatment, asking about continuing care is as important as learning about the detox process. Without a solid, compassionate and collaborative continuing care team working with the client to approach life outside of residential team, clients may not be sufficiently prepared for their early journey of sobriety.

To learn more about Harmony Foundation Clinical Case Management, Click Here to listen to the team talk more about their important work in facilitating a recovery direction that is designed to be supportive and engaging, helping clients succeed.

The Dangers of Molly (MDMA)

Posted on by Christy Weeks
Molly Abuse and Overdoses on the Rise at Music Festivals

 

Drugs have developed a reputation in modern society. Alcohol use is thought of as normal, while heroin is generally associated with an addict on the street. While there is some truth to stereotypes surrounding specific drugs, many are false. Molly, or MDMA, has developed a reputation among young adults as a “fun” drug. It is generally typecast as a drug young people do when at a club or music festival. It’s reputation as “fun” is dangerous.

Two young individuals overdosed on Molly earlier this year at the Electric Zoo concert in New York and earlier this month a 21 year old died after ingesting a lethal dose of Molly at the Austin City Limits Music Festival. Molly or MDMA related deaths are becoming a regular occurrence, with young adults overdosing at several festivals over the last few years. These tragedies are, in part, attributable to the general reputation of the drug – thought of as fun, and by association, safe. This couldn’t be further from the truth. Anything from gasoline to baby powder has been found to be an ingredient in Molly.

When drugs have reputations as being fun or safe it is dangerous for everyone, but especially threatening for recovering addicts. The idea that a drug, any drug, is ok in sobriety can be devastating. Some in recovery may feel that if a drug wasn’t their drug of choice, they can take it and not endure the same wrath as they did in active addiction. The age old tale of the addict who thought alcohol was ok to consume after becoming clean off of drugs is an example of this. A positive reputation being associated with a drug is menacing, especially when that drug is killing people. It’s of monumental importance is sobriety to remember, a drug is a drug is a drug – no matter its reputation.

Addiction Treatment After Naloxone

Posted on by Christy Weeks
Photo Credit

California is now following the footsteps of Colorado and other states that allows the use of naloxone or Narcan, an FDA approved, non-addictive drug that prevents heroin overdose.

California Governor Jerry Brown signed Assembly Bill 635 into law, which took effect on January 1st of this year permitting the use of naloxone by non-medical professionals across the state. Just this week, Gil Kerlikowske the White House Director of National Drug Control Policy highlighted the effectiveness of naloxone as one of many attempts to limit the rise of heroin abuse and overdose in the US. Currently, more than 100 overdose deaths occur from heroin abuse in the US each day. The death of Philip Seymour Hoffman last week was one of an estimated 700 that occurred that week.

Naloxone works by preventing both heroin and addictive opiate pills like OxyContin and percocet from binding to receptors that are responsible for recessing breathing. Heroin overdose deaths occur when breathing has slowed down until it has stopped entirely. By injecting patients with naloxone, emergency rooms and emergency workers have reversed an estimated 10,000 overdoses.

Colorado, and now California, have permitted access to naloxone by those most likely to need it where it can prevent overdoses – such as drug users, addiction counselors and family members of addicts. They are allowed to administer the drug without any criminal or civil liability. Colorado Gov. John Hickenlooper signed Colorado’s version of the bill – Senate Bill 14 – into law in May 2013.

Naloxone essentially puts out the fire for those in active addiction on the brink of an overdose. Harmony Foundation’s drug detox and drug rehab program helps heroin and prescription pill addicts extinguish their active addiction in general, so that they no longer live in fear of overdose. If you or a loved one is at risk of an overdose, our Colorado addiction treatment program can help lay the foundation of recovery and abstinence – lowering the risk of overdose or the need for naloxone.

New York’s I-STOP Plan Curbs Prescription Abuse

Posted on by Christy Weeks

New York leads the way with policies that benefit people’s health – such as the public smoking bans enacted over a decade ago and the recent proposals to ban sodas larger than 16 ounces to curb obesity. The state is now shaping policies on prescriptions. New York is one of the few states that doesn’t allow the transfer of prescriptions, especially controlled substances, across state lines. Recently it has gone a step further by creating a policy to help curb the pandemic of prescription pill abuse through its I-STOP (Internet System for Tracking Over Prescribing) Plan.

The central tracking system will allow pharmacies to oversee all of it’s customer’s prescriptions from all pharmacies within the state in order to prevent prescription drug abuse. This monitoring mechanism will make it difficult for those who engage in “doctor shopping” to get multiple scripts for one medication that they either abuse or sell for others to abuse. The concept of doctor shopping is a popular phenomenon in states like Florida, where one patient can see multiple pain management doctors and get upwards of a thousand of prescription pain pills in a month. 
According to the Center for Disease Control, prescription pill abuse kills one person in the US every 19 minutes, which illustrates the need for such tracking systems – especially in New York where the sale of prescription pills like oxycodone have increased ten fold between 2000 and 2010. The I-STOP Plan has already been passed by the New York State Legislature and is just awaiting Governor Cuomo’s signature before going into effect in 2013.
Attorney General Eric Schneiderman praised the I-STOP Plan asserting that it will “save lives.” Whether those saved lives will be just in New York or across the US writ-large depends on if other states follow suit. While other states have enacted laws to curb doctor shopping, the tracking systems either aren’t as comprehensive or have limited mechanisms for enforcement. Schneiderman warns that addicts may continue to get their prescriptions filled in other states and says, “That’s why it’s paramount that other states consider emulating New York.” While a state or even federal tracking system will help curb some prescription pill abuse, it will be most effective in tandem with drug treatment options. If you or a loved one is struggling with prescription pill abuse, there is hope and help.

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Relapse in the Public Eye

Posted on by Christy Weeks

Over the past week the pain of relapse has been in the public eye, with an intervention staged on air for Andy Dick, Kelly Osbourne’s airplane meltdown and Pete Doherty’s cancelled performances and check-in to rehab.


Andy Dick has struggled with several relapses. His most recent relapse was made public when, during the filming of his new Internet show Andy Dick Live!, the CEO of the network warned him publicly “Everybody knows you have been going through your trials and tribulations…I told you the other day, if this continues, we can’t carry on. And if you decide to leave and not do that (check into rehab), I’m afraid that we can’t carry on here together.”  The emotional intervention followed by Dick’s willingness to go to back to treatment has been all over the Internet.

Also widely public was the alleged meltdown of Kelly Osbourne who reportedly got drunk on an airplane and had to be carried off by security. While she denied the incident initially, this week she admitted that her drinking was sparked by the painful feelings associated with her brother’s multiple sclerosis. She admitted, “on the plane I started looking at the website [a fan told her about]. It described how bad certain cases of MS got, and it made me lose it because I’ve sat through my mother having breast cancer, my dad almost dying from a bike accident, and now it’s my brother who’s my best friend.” Kelly Osbourne is in recovery from prescription painkiller addiction but has consumed alcohol since leaving rehab.

Another incident this week was indie–rocker Pete Doherty, co-front man of the Libertines, allegedly checking into a rehab in Thailand rather than performing at T in the Park in Kinross, a music festival in Scotland. Doherty has struggled with substance abuse for several years, and recently admitted being addicted to and using heroin and crack cocaine – deeming his previous visits to rehab unsuccessful.

These public displays serve as a good reminder of the numerous private displays of relapse that occur among those in recovery everyday. Relapse is a common and sometimes necessary part of recovery.  No matter how many times one has sought substance abuse treatment and relapsed, there is still hope. Treatment often plants a seed of how wonderful a life in recovery can be. Despite the devastation one experiences through a relapse, the seedling of hope can bring them back to a place of willingness to try again. Sometimes it is just a matter of getting help to re-focus and re-integrate back into a life of freedom from drugs and alcohol.

Luckily there are wonderful relapse treatment programs that exist for those who have a desire to get hooked back into a life of recovery.  Harmony’s primary goal is for clients to attain a lifetime of abstinence from alcohol and drugs. The focus of our Brief Residential Program program is for the client to be able to identify issues of powerlessness and unmanageability that have led to a relapse.  Hopefully those who have relapsed in the public eye and the many who have privately are able to do the same.

Prescription Overdose Does not Discriminate

Posted on by Christy Weeks
Amy Tryon (USA) on Poggio
Amy Tryon (USA) on Poggio (Photo credit: LarsAC)

We have all heard that addiction does not discriminate, or that drugs are “equally opportunity destroyers” and that becomes more evident as breaking news stories reveal the prescription opiate overdoses of many from actors to uniformed professionals to Olympic medalists.


Amy Tryon, who died of an opiate overdose last month, happened to be both a uniformed professional and an Olympic equestrian medalist.  Tryon rode for the U.S. Equestrian Team at the 2004 Athens Olympics where the U.S. team won a bronze medal. In 2008, she competed at the Beijing Olympics. When she wasn’t training, she worked for Eastside Fire and Rescue in her hometown near Seattle, WA.

Riding took a toll on Tryon as she suffered knee and back injuries for which she was reportedly prescribed pain medication. The medical examiner’s office in Seattle, WA released a toxicology report yesterday indicating that Tyron died of an acute combined opiate overdose, which included Oxycodone.

The percentage of those addicted to pain medications in the US is soaring and deaths from prescription painkillers have now reached epidemic levels. Nearly 15, 000 people die every year of overdoses involving prescription opiates, making the number of overdose deaths from prescription opiates greater than those from heroin and cocaine combined. Access to prescription opiates contributes to the problem, as reports indicate that in 2010 enough prescription painkillers were prescribed to medicate every American adult around-the-clock for a month.

The access to this highly addictive drug and propensity toward accidental overdoses has resulted in numerous tragic stories like that of Amy Tryon. If you or a loved one is struggling with a prescription opiate addiction, there is help. Since addiction does not discriminate, neither does the ability to overcome addiction through drug treatment.
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