Maintaining recovery from opioid use disorder can be incredibly difficult, but long-term recovery is possible. Learn more about what researchers, communities and government agencies are doing to treat opioid use disorder and support individuals in their recovery journey.
Emily Reddy (Narrator) – After someone who’s addicted to opioids quits, continuing to stay off drugs can be the really tough part. I’m Emily Reddy. And you’re listening to Overcoming an Epidemic: Opioids in Pennsylvania, a WPSU podcast looking at what researchers, communities and government agencies are doing to try to prevent and treat opioid addiction.
Today, I’m visiting Caron Treatment Center in the picturesque hills of eastern Pennsylvania ten miles west of Reading, to search for answers about how recovery works and how to make it stick.
Kyra Denlinger – “Patients are housed on both sides of campus. They are pretty spread out. So up on this side, past Hewitt hall. . .”
ER – Kyra (KEER-uh) Denlinger, a marketing and communications specialist at Caron, walks me to the middle of the campus and points out maybe a dozen buildings on the sprawling grounds.
KD – “I don’t know the exact like mileage or footage or acreage or anything like that, but it is big. If you walk the loop of campus it would take you a good half hour, 45 minutes.”
ER – Earlier in the day, when I pulled into the parking lot, a family was dropping someone off, standing behind their car amid an assortment of suitcases, bags and boxes. Caron takes private insurance and gives out millions in financial assistance, but without insurance or financial help the cost of treatment starts around 39-thousand dollars for a 28-day stay.
Dean Drosnes – “Most people who get to this level of care have already tried and not succeeded or succeeded for a little bit of time at a lower level of care before they come here.”
ER – Dean Drosnes is the associate medical director at Caron. We’re talking in the Grandview Mansion, a giant old Gothic-style house on the grounds.
At Caron, patients choose from a number of different types of therapy to work through their addiction. There’s therapy focused directly on the addiction, but there are also therapies that work on overcoming past trauma, addressing issues like depression and anxiety, and treating chronic pain.
About five years ago, Drosnes says Caron added medication-assisted treatment – or MAT. You might remember MAT from the episode on warm handoff.
DD – “We offer those medications to all of our patients with a severe opioid use disorder. And with rare exceptions, people want to be on a medication-assisted treatment. Once in a while we have somebody who for some reason is not agreeable to be on medication-assisted treatment for their opioid use disorder, and we find other ways of treating them appropriately.”
ER – Erin Deneke, Caron’s research director, chimes in. . .
Erin Deneke – “I think we have to recognize that, you know, this is a disease that costs lives and you need to give people the best tools available out there so that they can maintain their recovery once they’re out of treatment, where they’re back facing the same pressures they had before coming into treatment. And medication-assisted treatment, it’s an extra tool in the toolbox to help them maintain their recovery once they leave.”
ER – Without MAT, relapse rates are extremely high for people with opioid use disorder. For someone using heroin, the relapse rate is over 90% if they don’t use medications.
Drosnes says, in the past the goal of addiction treatment was complete abstinence from any medications.
DD – “What we recognized was that while that may be an achievable goal, it’s a long-term goal. Our job is to get them A) stabilized and B) to start to embrace a lifestyle of healthy choices. And for some people for especially with opioid use disorder, most people that requires being on medication for a period of time while the brain is healing.”
ER – Caron patients with a severe opioid addiction are usually on MAT for at least a year. Drosnes says after they started using the MAT they saw a real improvement in the number of patients who were able to stay in treatment. Before they just couldn’t stand the physical pain.
DD – “Their bodies were just not cooperating with them, to use a quaint phrase. And they were so uncomfortable that it was really difficult for them to stay in treatment.”
ER – After a year on MAT, patients should be reevaluated to see if they’re ready to come off it. Some Caron patients take part in a “My First Year of Recovery” program and have regular contact with treatment center staff. But Drosnes says all of them get connected with the services they’ll need to stay off opioids back in their hometowns.
DD – “So when people leave here, we want them to get psychosocial treatment, whatever that looks like, we want them to get medication, we want them to get family support, we want them to get everything that we think is going to to maximize their chance of maintaining abstinence, diminishing the risk of relapse, and allowing their brain actually to heal to the point where they’re able to make decisions about what’s best for their health going forward.”
ER – They also connect patients with support groups. Deneke says those can be really helpful.
ED – “Just one advantage to the 12 step and other recovery support groups is it provides a healthy social outlet, a sober… a recovering environment.
ER – Drosnes says there can be a stigma against MAT in 12 step programs. That sometimes keeps people from going to those meetings, but things are changing.
DD – “What has happened over the years, is that that there has been a sprouting of medication-friendly 12 step meetings throughout the country, and in certain areas, particularly Washington DC, and a bit in Philly, Baltimore, New York, in areas where there’s high concentrations of recovering people from an opioid use disorder, these meetings have become successful, because they’re not ostracizing people on medications they’re embracing people on medications. They understand that some people this is how they do really well.”
ER – Deneke, the Caron research director, has been working with Penn State researchers to experiment with new treatments to try to stay on the cutting edge.
ED – “For me, the biggest gap in the treatment, if you will, is the gap between research and treatment.”
ER – One of the research projects Caron has been hosting is meant to help determine when people are ready to leave rehab. The 28-day timeframe was created decades ago and isn’t based in science. Currently, there’s no real way to know whether patients are ready to leave after 28 days, or if a longer – or shorter – stay would work better.
Scott Bunce is trying to change that. He’s an associate professor of Psychiatry at Penn State College of Medicine and the Hershey Medical Center. His research tests the brains of patients near the end of their stays to gauge their risk of relapse.
Scott Bunce – “So the the technology is called functional near infrared spectroscopy. And basically, we’re using light to measure brain activity. It’s like a little headband – and we put that on. And then we have you look at images of, in this case, opioids.”
ER – The brain reacts to the pictures by sending oxygen to different areas in the prefrontal cortex. The machine then maps the areas with oxygenated blood in red and the areas where the blood doesn’t have oxygen in blue. Then, Bunce says, they compare the brains with past participants.
SB – “And what we’ve done is we’ve mapped these onto the brain responses of individuals who have later gone on to either maintain their sobriety or those that have relapsed within 90 to 120 days.”
ER – They were able to predict with about a 90% accuracy who was going to relapse.
Right now, treatment centers have to rely on patients to say that they’re ready to be released. Bunce says one patient in the alcohol version of the study seemed to be doing really well…but he relapsed and died of alcohol poisoning just a few months after leaving rehab.
SB – “So we went back, and we looked at the numbers out of the study, and we found that he reported his craving as being zero. Said he didn’t have any craving. But the three measures of his brain together, put him in the highest quartile to 10% of people who had relapsed. And so that information can be used with the patient to say, ‘Okay, I know you feel like you’re good. Your brain is telling me that you’re not.’"
ER – Since the study is still in the research phase, they couldn’t have given the man his results. Bunce says they’re still looking for funding for a clinical trial.
Eventually, Bunce hopes his research might help overcome another important hurdle. He hopes it will get insurance companies to pay for inpatient treatment beyond 28 days.
SB – “There’s nothing that they have in terms of research that tells them that with objective data, we know that more or less than 28 days makes a difference. Until they have that data, they don’t have any reason to change what they’re doing. This could provide an objective measure that when it’s at a certain level, people are at this risk for relapse, that would allow them to make really data-informed decisions about who needs further treatment and who doesn’t.”
ER – Next I go to Bellefonte in Centre County, to a storefront right across from the county courthouse to talk to Tom Dann at the quilt shop he owns with his wife Barb.
ER – “Hi. Knock, knock.”
Barb Dann – “Hi, come on in.”
ER – “Hi, I’m Emily.”
BD – “Hi, Emily. I’m Barb.”
ER & BD – “Nice to meet you.”
Tom Dann – “Hi, Emily.”
ER – Dann figures he’s told his story of addiction – and recovery – hundreds of times. Today, Dann’s agreed to tell his story to me at the quilt shop. When I get there, he’s ironing triangles of fabric for a quilt that he’s making.
TD – “My wife gave me a promotion to I don’t know what the title is going to be. But I’m actually making a real quilt this time instead of a t-shirt quilt.”
ER – Making quilts is very different from Dann’s previous career…. as a sergeant in the State College Borough police department.
It was a cascade of physical issues – surgeries on both hips, three herniated discs and a shoulder surgery – that got him hooked on the opioids prescribed by his doctor.
Because of all the surgeries, the police department gave him desk jobs…including being in charge of the evidence lockup. Several months into that assignment prescriptions from his doctors had run out.
TD – “I remember for the better part of three days negotiating with myself. Because I knew there were there were drugs in the evidence section that were all, you know, they’ve already been through the court system, and were waiting to be destroyed. I mean, there’s pills in there… No one’s going to miss them. It was like the, you know, the devil on one shoulder and the angel on the other and, you know, back and forth, back and forth. And eventually the disease won out and I convinced myself to go and get, I’ll just get a couple, just get a couple pills to hold me over. Well a couple turned into six and then go back and it turned into 12. And then it turned into 134. And you know, and it just it just kept steamrolling. I tried to stop, I don’t know how many times. I’d throw things away, you know, this is it. And, you know, within 10, 12, 14, 16 hours, right back.”
ER – “Was there ever a time in there where you said, ‘You know what, I, I need to just tell someone about this and get some help?’”
TD – “At the height of the addiction, I was more afraid of going through withdrawal than I was of getting caught.”
ER – But he did get caught. And he lost access to the pills. Dann detoxed on his own. Cold turkey. Then he went to a 28-day rehab center in the Poconos, paid for by his police health insurance. Afterward, he was sentenced and served 61 days. The jail kept him in solitary confinement, since he was a police officer. He’s been in recovery for more than four years now.
I ask Dann what recovery means to him. . .
TD – “Changing how you look at things is saying, instead of saying ‘I have to,’ ‘I get to.’ Example: ‘I have to get up, go to work this morning, I don’t feel like it.’ Well, no. ‘I get to go up, get up and go to work this morning ‘cuz I’m healthy, and I have a job that my bills and finances my hobbies, and puts, you know, a roof over our heads.’ And it just changes your mentality a little bit from being a victim of something into having a blessing for something.”
ER – Dann is now a part of the Centre County HOPE initiative, which stands for Heroin & Opioid Prevention & Education. He’s working with HOPE to bring down the barriers to recovery that he experienced. For one, he’s trying to get more Narcotics Anonymous meetings in jail.
And he testified to a state congressional committee that taking away someone’s driver’s license for a drug crime, whether it involved a car or not, was a bad idea because then recovered users couldn’t get to NA meetings. Not long after, the state changed the law.
TD – “So it was kind of rewarding that, you know, I guess in some small way, I may have helped change that law a little bit. I don’t know.”
ER – The state of Pennsylvania recently announced it’s seen a decline in opioid overdoses. But addiction researchers aren’t ready to announce a victory. They’re already seeing the next epidemics on the horizon: fentanyl, Methamphetamines, Marijuana, Kratom (KRAY-tum), and E-cigarettes. In response, researchers at Penn State, and elsewhere, have shifted their mindsets. Instead of moving from one crisis to the next, they’re focusing on finding tactics to prevent and tackle all different kinds of substance abuse.
This has been Overcoming an Epidemic: Opioids in Pennsylvania, a production of WPSU. Reporters on the project include Anne Danahy, Min Xian, and me, Emily Reddy. Thanks for listening. You can find more resources on the opioid crisis and what to do if you or a loved one need help at wpsu.org/opioids. For WPSU’s Overcoming an Epidemic, I’m Emily Reddy.
Recovery centers offer patients many different therapy options for working through an opioid use disorder. Beyond addiction, many therapies are targeted at overcoming past traumas, addressing issues like depression and anxiety, or dealing with chronic pain. Medication assisted treatment (MAT) is also one of the tools being employed. “You need to give people the best tools available out there,” says Erin Deneke, Caron Treatment Center's (Wernersville, PA) Research Director, “so that they can maintain their recovery once they’re out of treatment.” Without MATs, relapse rates are extremely high for people with opioid use disorder. For someone using heroin, the relapse rate is over 90% if they don’t use medications.
After leaving a treatment center, patients connected with recovery support groups—particularly new medication-friendly 12-step meetings that are helping to decrease the stigma around MATs—are finding success in a more healthy recovery environment.
On the research side, Scott Bunce, associate professor of psychiatry at Penn State College of Medicine and the Hershey Medical Center, is investigating the science behind recovery times. Utilizing infrared spectroscopy to measure brain activity, his team is able to predict with about 90% accuracy whether people will relapse after recovery. This research could someday provide the tools necessary to not rely on the historical artifact of a 28-day rehabilitation timeframe (settled on in the 1950s), but to tailor treatment to the individual.
Collegiate Recovery Community
A Penn State initiative called the Collegiate Recovery Community is helping students recover from substance use disorders by providing resources, meetings, and a support network of peers to encourage and reinforce a healthy lifestyle. The program was launched in 2011 and has proven to be successful. According to the program coordinator, members have very low relapse rates and hold higher GPAs and graduation rates than the average student on campus.
The idea of collegiate recovery programs began in 1977 at Brown University, and the concept of providing specialized support to students in recovery has since spread nationwide. A professional organization, The Association of Recovery in Higher Education, even provides a network for both establishing and supporting evidence-based collegiate recovery programs. As programs become more widespread, campus cultures that run counter to the prevailing story of alcohol and drug experimentation and abuse on college campuses become available to help students in recovery succeed.