Heroin, opioid detox just the start of recovery, not the cure

For all the benefits of making medically monitored detox more readily available, the process means nothing if the patient leaves and takes a pill, snorts a line or shoots up again, experts say.

“Detox is only the beginning,” said Dr. Jeff Johnson, an addiction medicine specialist at Northwestern Medicine Behavioral Health Services in Winfield. “It's not a disease cure. It's getting them clear of the drugs and medically stable enough to make some decisions.”

The biggest decision after detox is where to go next. Insurance can limit the choice, as coverage often defines the length of stay in a residential facility or which locations are covered.

Philosophy also plays a role. Drug users can choose between abstinence, as favored by many in the 12-step recovery community and some treatment centers such as Serenity House Counseling Services in Addison, or medication-assisted treatment that uses controlled doses of methadone, an opioid; the partial opioid buprenorphine; or the opioid blocker naltrexone, as used by other treatment facilities such as Gateway Foundation.

“What detox does is treat the physical symptoms of addiction,” said Jim Scarpace, executive director of Gateway's Aurora treatment center. “All the work to change the risk of relapse and get clients on the road to recovery takes weeks of therapy and medication and treatment.”

Downsides of detox

Drug users often enter detox when they're desperate. Yet it's risky to begin on a whim, said Kathie Kane-Willis, director of policy and advocacy at the Chicago Urban League.

“The more helpful supports you can add to it, the better it's going to be,” Kane-Willis said. “It's really important for people to think about their treatment plans and not just jump in.”

For detox patients who lose motivation to continue, a heightened overdose risk arises once there is no longer a base amount of the drug in their system.

“Three-day detoxes, in and of themselves, if not followed by treatment, are extremely dangerous and should not be done because of the chance of a fatal overdose following the detox,” Kane-Willis said. “It's better to get off of a drug slowly.”

Yet she knows why people try detox: It sounds like a quick fix.

“What could be more seductive than three days and it's out of my system?” Kane-Willis said. “But 'out of my system' is not the same as treatment.”

A medical detox unit at Advocate Good Samaritan Hospital in Downers Grove helps patients avoid such risks by introducing them to a discharge planner and a recovering drug user who participates in a 12-step community, such as Heroin Anonymous, Alcoholics Anonymous or Narcotics Anonymous.

Karen Fergle, a registered nurse certified in addictions and leader of the detox unit, said the discharge planner goes over options such as residential stays, full- or half-day outpatient programs, weekly counseling and 12-step meetings, all of which can help build a base of sobriety.

Visiting drug users in recovery, such as Jason — who asked that his last name not be used to respect anonymity within the 12-step community — give a glimpse of what can be ahead.

“The person that's in the detox bed knows that I've been where they've been, yet somewhere I've found a way out. And that begs the question, 'How did you do it?'” Jason said.

“We just go up there and share our own experience, if that person cares to make use of it.”

'Nothing is wasted'

Efforts to connect Good Samaritan detox patients to further treatment succeed 18 percent of the time, which is considered a good rate, Fergle said. A liaison follows up with patients who leave detox and choose not to pursue further help.

“Not everyone who comes into the hospital is ready to give that (addiction) up, but we offer that opportunity,” said Matthew Cross, Good Samaritan's director of behavioral health. “They have to hit their rock bottom — and that's different for everyone.”

Jason said he had to detox and relapse three or four times before enduring a final detox followed by his period of recovery, which has lasted roughly seven years. Although those early detoxes may seem failures, Jason said they chipped away his excuses.

“Nothing is wasted. Every stop along the way, some seed was planted,” he said. “I needed to go through it every time that I did to finally be able to accept the help that people around me had been offering me all along.”

National Recovery Month

September is National Recovery Month, a time when the Substance Abuse and Mental Health Services Administration works to increase understanding and awareness of substance use and mental health disorders and celebrate those who recover. The theme this year is “Join the Voices for Recovery: Strengthen Families and Communities.” SAMSA encourages people in recovery and their relatives to share their stories and encourage others along their path. The administration also offers a <a href="https://www.recoverymonth.gov/toolkit">toolkit of resources</a> for starting conversations about substance use and mental health. For details, visit <a href="https://www.recoverymonth.gov/">https://www.recoverymonth.gov/</a>.