For decades, the fabled Hazelden Foundation in St Paul MN has relied on group therapy, individual counseling and other nonmedical approaches to help tens of thousands of people recovering from drug and alcohol addiction. But several years ago Hazelden realized that too many of its opioid-addicted patients were dying of overdoses after dropping out of the traditional 12-step treatment programs. It was time to try a different approach.
Breaking nearly 70 years of tradition, Hazelden in 2013 began offering patients in its 12-step program two addiction medications, buprenorphine and Vivitrol, to reduce their drug cravings. Three years later, the preliminary results are so promising they could prompt many medication skeptics to shift course.
Hazelden offered the medications to 500 opioid addicts who participated in an intensive outpatient program between 2013 and 2015. Historically, about a quarter of patients quickly drop out of Hazelden’s 12-step program to go back to using drugs. But among the 500 people studied, that figure dropped to 5 percent. Approximately two-thirds of the patients in the program opted to try the drugs.
“This is dramatic new evidence,” said Dr. Robert DuPont, a Maryland-based addiction specialist who served as the first director of the National Institute on Drug Abuse. “It’s revolutionary because it’s coming from Hazelden, which has always been a proponent of drug-free programs.”
For years, national detox chains and residential rehab programs, some led by recovering addicts who conquered their own addictions without medication, have resisted using the drugs, despite research showing their effectiveness. More than two-thirds of U.S. clinics and treatment centers still do not offer them, and only about 1/5 of the people who would benefit from addiction medications are getting them.
But Hazelden’s willingness to offer the medications and publicize the results could make a huge difference. “For the many mom-and-pop recovery programs out there who have modeled themselves after Hazelden, this is a game changer,” said David Gastfriend, a medical adviser to the Treatment Research Institute. “They’re not willing to take the scientists’ and the federal government’s word for it. But they can believe that medication works if they hear it from Hazelden.”
Dr. Marvin Seppala, Hazelden’s medical director, emphasized the need for further study. Hazelden’s Butler Center For Research plans to follow 200 of Hazelden’s medication-assisted patients for a year to determine which medications worked best for which patients and how both medications compared to abstinence. The study, Seppala said, will examine the differences among the three groups — no medication, buprenorphine and Vivitrol — in length of time in treatment, relapse rates, readmission to treatment, length of time on medication, and overdose deaths, among other factors. “What we’re hoping to find is that certain personal traits determine which medication, or no medication, a patient may choose and which medications work best for certain patients,” Seppala said. “There are places that say everybody should be on medications and places that say nobody should,” Seppala said. “People are going to try these medications. If you had predictors for choosing which medications to use for which patients, we would have a better chance of success.”
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