The holidays are often difficult times for clients and their families. All the pressures of holiday celebration, that come to bear on average folk, are even more pronounced in the lives of early recovering clients and their families. The pressures are many and may include everything from limited resources to traumatic memories. The recovering person with a family may be faced with increased levels of guilt and shame (fellow travelers of addiction) during the holidays. If you add to that hard financial times, the holidays can become a time of deep despair and even relapse.
 
Recovery from addiction is a family business and including family members in every aspect of treatment makes it much more likely that the business will be successful. One of the difficult hurdles to this inclusion of family in treatment is the idea that exposing, particularly children, to the recovery process is in some way unsavory or lacking in moral standing. This belief is often expressed in not wanting children to know anything about the how the addictive process unfolded even after the recovering person has started on the road to health. Statements like, “I would never take my kid to an AA or NA meeting” or “kids don’t belong at a methadone clinic”, suggest a separation of family and treatment that we at Sacred Heart would like to bridge.
 
This holiday the Sacred Heart staff of the Adult Residential Opiate Treatment Program held a party for the children and other family members at the Richmond facility. The party was made more festive by the participation of several community organizations as well as numerous unaffiliated individuals. These groups and individuals contributed approximately seventy wrapped Christmas presents ranging in price from five to fifteen dollars making it possible for every child of an Opiate Treatment Program client to receive a gift.

The gifts were under a tree decorated by both clients and Sacred Heart staff and when children arrived they were given the presents by clients who volunteered to be elves. There were treats and wrapping paper every where. Newborn babies were seen sporting new blankets and knitted caps. The blankets and hats were made by children who were given an explanation of the importance of the idea of the Gift as a spiritual part of the holiday festivity.

The message that the Sacred Heart staff of the Adult Residential Opiate Treatment Program was trying to send is that this program is family friendly. A client coming to us is welcome and so is his family. The idea that you can’t do recovery alone means that the staff of Sacred Heart, the community at large, your AA and NA bothers and sisters and your loved ones will join you in this journey. You are not alone.

-Sacred Heart Therapist

Methadone replacement therapy works because it fulfills three basic requirements of any program of recovery from drug and alcohol addiction. The program, to be effective, must
(1) reduce access to drugs and alcohol. It must provide a
(2) supportive structure as well as make the client
(3) accountable to dependable persons other then themselves.
 
The first requirement is that access to drugs (in this case opiates) is limited. A methadone maintained client loses his craving for opiates because the methadone sticks to the opiate receptors in the brain and won’t let any other opiates get by them. While the methadone is playing spoiler, it activates the receptors thus reducing the desire for opiates (sort of like when you don’t want to eat because you are full) at the same time that it prevents the sickness of opiate withdrawal from occurring. This process occurs slowly so that the intoxicating effects on the nervous system are minimized. In this way, the first requirement of a program of recovery is fulfilled as far as opiates are concerned. Other drugs and alcohol continue to have to be avoided to prevent active addiction on top of methadone maintenance. The primary goal for all other drugs of abuse and alcohol, while in methadone maintenance, is complete abstinence. As a client is stabilized on methadone, opiate intoxication no longer occurs. This leaves the client, who greatly misses the intoxication effect, vulnerable to the abuse of other drugs and alcohol to replace the loss of his usual opiate high.
 
The second requirement of a program of recovery is supportive structure. An addict whose life has been dominated by chasing drugs needs to replace the old order of things with a new order of things. In a methadone maintenance program, structure is maintained by the need to acquire the methadone as well as a schedule of mandatory therapeutic services. In the early stages of recovery, the structure is implemented by requiring that a client attend the clinic daily to pick up the medicine. The intensity and frequency of therapeutic services is high for the first 90 days to a year. Participants may be required to attend groups and individual sessions weekly, but as the client is in the program longer services may become less frequent. At first, the methadone clinic may be the sole source of structure for the client, but as time passes other sources begin to emerge such as deeper involvement in the 12 step program, work, healthy exercise and family involvement. As normal life structure begins to develop the methadone clinic reduces its role in the client’s life. The ultimate goal of a therapist is to do away with the therapist.
 
The third requirement of a program of recovery is accountability. A new client needs to find ways to make her self accountable to dependable outside authorities. The nature of recovery from addiction is to realize that when an addict is left to his own devices he will not be able to keep himself straight. He needs guard rails. The methadone clinic provides these guard rails by providing a regular monitoring service. Clients are tested for drugs and alcohol so that when the clinic staff and the client say that the client is free of illicit drugs, the evidence is objective.  The client is also required to bring in any prescriptions for evaluation in order to prevent the client from abusing licit drugs. It is much harder to use or abuse drugs or alcohol when you are in a relationship with an objective and observant person and that person has the ability to manage positive and negative rewards to keep you on track.
 
For any program of recovery to be successful these three aspects of a TX program, limiting access, providing structure and accountability must be implemented along with encouragement to find a more effective philosophy of life.

-Sacred Heart Therapist

I should begin with a confession. My first contact with methadone maintenance therapy was when I was invited two years ago to participate in the development task force that created the Sacred Heart Opiate Treatment Program. I suspect that that the reason I was invited to participate in the task force was to provide a sobering influence on the committee since I was brought up in the 12-step abstinence model.
 
Secretly, I felt a like a poison pill. Up until this point in time, “I HAD ALWAYS SEEN METHADONE MAINTENANCE AS UNACCEPTABLE. THE TRUTH IS I HAD NEVER REALLY GIVEN IT MUCH THOUGHT BEYOND AN OFF-HAND DISMISSAL.” I began my work on the task force by plowing through research study after research study. I was really looking for evidence that the methadone medication-assisted model was not good practice. I didn’t find it. The preponderance of evidence supports methadone maintenance. There is solid evidence for the practice of methadone replacement therapy that has accumulated over a very long period of time that can be found even by an old skeptic like myself.
 
The evidence for methadone maintenance therapy shows reduction in illicit drug use, criminal activity, needle sharing, risky sexual behavior, suicide, and overdoses as well as improvements in health conditions, productivity, retention in therapy and cost-effectiveness.
 
The body of evidence that supports these conclusions is based on matching the client to the appropriate treatment and providing that client not only with medication but also structure, accountability and therapy.
 
My second contact with methadone medication assisted therapy was when I was asked to be the program therapist for the Sacred Heart Opiate Treatment Program. I discovered in the clients of the Sacred Heart Opiate treatment Program confirmation of the evidence provided by all that research. “EVERYDAY I SAW MIRACLES. MEN AND WOMEN, WHOSE LIVES HAD BEEN RAVAGED BY HEROIN OR PRESCRIPTION DRUG ADDICTION, BECOMING HEALTHY, GOING TO WORK AND TAKING CARE OF THEIR FAMILIES.” I saw these individuals at various stages of their recovery.
 
Pregnant women whose maternal instinct was to protect their babies, but who could not escape the overwhelming power of their addiction, stabilized on methadone, bringing them and their fetus into a medically controlled support system.
 
New clients would come into the clinic beat down by their disease after many fervent attempts at quitting. Most had undergone more than one detoxification episode only to return to illicit use because they never really felt normal without some sort of opiate augmentation in the same way that a diabetic never really feels normal without insulin.
 
Truly, methadone maintenance is a program of progress not perfection, but through medication assistance and persistent therapy, science is transmuted into life.

-Sacred Heart Therapist