Combining What Works: Medication-Assisted Treatment for Opioid Addiction

Let's Talk: Addiction & Recovery Podcast
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In the midst of the nation's opioid addiction epidemic, advancements in treatment that combine evidence-based psychotherapies along with use of certain medications offer patients and families cause for real hope. As a clinical innovator in the field of addiction treatment, psychiatrist Marvin D. Seppala, MD, joins host William C. Moyers to explain why medication alone isn't an effective solution in treating such a complex, chronic condition.

There’s a real problem in the country with physicians providing the medication without anything else.

Dr. Marv Seppala

0:00:16 William Moyers
Hello and welcome to Let's Talk, a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues related to addiction, treatment and recovery. I'm your host William Moyers, I'm the Vice President of Public Affairs and Community Relations for Hazelden Betty Ford. I've been with the organization since 1996, but on a personal note, I was a patient at Hazelden almost 30 years ago and so I have a keen personal and professional perspective on the issues that bring us here today. Our guest today is none other than the Chief Medical Officer of the Hazelden Betty Ford Foundation, Dr. Marvin Seppala. Marv, welcome and thanks for being with us.

0:00:53 Dr. Marv Seppala
Thanks a lot William glad to be here.

0:00:54 William Moyers
We're here today to talk specifically about the opioid epidemic and the treatment of it. Marv there has been tremendous innovation in the area of treatment for opioids. Tell us why we need to be innovative as a—as a community in the treatment of opioids. 'Cause isn't a drug is a drug is a drug?

0:01:15 Dr. Marv Seppala
You know the research associated with addiction is advancing consistently and we have to keep up with that. And as we do and as we did in regard to the opioid use disorders we recognized that if we could combine evidence-based practices like the psychotherapies, cognitive behavioral therapy, motivational interviewing, Twelve Step you know practices, Twelve Step facilitation, abstinence with the medications that have come along for opioid use disorders we might be able to get better outcomes. And it looks like that’s been the case from the research we've been doing. And—and it's the same I believe for any addiction. We just have to consistently watch what's going on in that research so that we can continue to improve the outcomes of the people that come to us for help. It’s especially true for those with opioid use disorders with the high death rate associated with this crisis.

0:02:08 William Moyers
And so we’ve done that at Hazelden Betty Ford through our COR-12® programming. Just describe briefly what that’s all about.

0:02:16 Dr. Marv Seppala
It's a comprehensive opioid response with the Twelve Steps. So we took our—our foundational activities with Twelve Step oriented treatments and facilitation so people would seek Twelve Step programming after treatment. To be—to address this chronic illness. You know so any chronic illness in medicine you wanna have a long-term response to. And it's really hard to work that out without an excessive cost. And yet in the addiction field we've got a built-in you know disease management system in those Twelve Step programs all around the world. So that people basically at no cost can leave our treatment programs and walk in to long-term care with support from, you know, millions of people basically.

0:03:06 William Moyers
So our COR-12 program which we offer in our residential sites and in an outpatient basis having great success in treating our opioid patients and that’s been a good response to this opioid epidemic. At the same time, we’ve seen not only greater awareness but we've also seen treatment being delivered for opioid-dependent patients in doctor’s offices. Some would say there's nothing wrong with that, others would say I'm not so sure. What do you think?

0:03:33 Dr. Marv Seppala
You know, if those doctors are prescribing the same medications we are which is usually the case, it seems like that would make sense and be fine. And if they are aligned with a treatment program where the patients can actually get outpatient care and really good outpatient treatment like an intensive outpatient program, the day treatment program, whatever. That could work out well. But unfortunately, there's a real problem in the country with physicians providing the medication without anything else. And making an assumption that somehow medicine alone is enough for this really complex illness. And you know the American Society of Addiction and Medicine uses some terminology that we're familiar with long-term, but it's fairly new in their definition of addiction. They call it a bio-psycho-social spiritual illness. And—and if you look at it from that perspective biological's the only thing the medicines can help with. And so that's only a quarter of the illness itself. A quarter of the issues facing that person. And—and so, even if someone starts the medication either Buprenorphine or extended release Naltrexone or methadone, and they're able to remain abstinent, they still bring along all that shame and guilt.

0:04:48 William Moyers
The baggage.

0:04:49 Dr. Marv Seppala
Yeah all the baggage of their addiction, all the destroyed relationships you know all of the difficulties that—that on that path they took in the course of their addiction that they don't even wanna address or talk about. And they need more. And—and especially with opioid use disorder, it—it's a life or death issue, addiction. But it's so obvious with opioid use disorders 'cause there's such a high death rate. Almost all our patients that come in at—that are under 35 will tell us that they know someone who died of an opioid overdose. It's just so commonplace. And with that I see it as a spiritual malady as well, be it life or death, it's all that shame and guilt there's the questions of what am I here for, you know. Is it just to, you know, waste away getting high every day or is there something more for my life? And as persons in recovery we know there's so much more that can be had out of life without continued use of these substances. And yet, if you're only providing a medication and ignoring the rest of that, I don't believe that's an adequate treatment at all of this really complex illness.

0:06:02 William Moyers
So—so people could go to a prescriber who's licensed to prescribe for Buprenorphine. They may not get what they need—what—what else they need from a doc, but they could find those other services in the community, right? The most important thing is to get on the medication to prevent the overdose.

0:06:23 Dr. Marv Seppala
True. It is. So, we want people getting on the medicine, we want 'em engaged in treatment long-term, and that—that’s our focus. Keep people engaged. But if they only take the medication, one of the issues in the research is that most people stop the medication. Buprenorphine over 50 percent stop within the first few weeks. So if you don’t have anything else to hang your hat on—

0:06:45 William Moyers

0:06:45 Dr. Marv Seppala
You know, some other tools, some other support, it's a very bad place to be.

0:06:51 William Moyers
Well we know that addiction is an illness of isolation. And the antidote to it is community or group—

0:06:55 Dr. Marv Seppala
It is.

0:06:56 William Moyers
And so, your emphasis is take your medication, but be with others.

0:07:02 Dr. Marv Seppala
Yeah. Ours is take your medication and do everything else, you know.

0:07:04 William Moyers
And do everything else.

0:07:05 Dr. Marv Seppala
That you would with any kind of addiction treatment. Certainly in our system. I call it the kitchen sink model. [Both laugh] We kind of throw everything we have at people, you know. The psychotherapies, the group psychotherapies, the Twelve Steps, you know, the medications, anything that's been shown to work because I see it like—like a cancer that we don't have a cure for yet. Where there's a couple of chemotherapies that may actually do something and help. Well often in that circumstance you combine 'em just to see if you get a little more out of it. And that's basically what we did just combine all these therapies to try to address this crisis in any way possible. And you know the folks that are just giving out medication are not seeing it that way. And—and somehow relying on that medicine to do way more than it's capable of doing. And there's even concern in some states and by the DEA and perhaps even the FBI that some of these docs are handing out way too much Buprenorphine. And there's people abusing it and they—they’ve kind of shifted from pill mills to Buprenorphine mills just to make a buck, right?

0:08:10 William Moyers

0:08:12 Dr. Marv Seppala
And I shouldn’t say a buck they're making—

0:08:14 William Moyers

0:08:15 Dr. Marv Seppala
Lots of bucks, yeah. [laughs]

0:08:18 William Moyers
Well it seems like the epidemic continues to take a terrible toll on people across this country. But organizations like ours and others are—are stepping up and doing what—what we can to—to address not just the problem but to promote the solution. So do you have—do you have hope?

0:08:35 Dr. Marv Seppala
I do have hope. You know, the biggest part of this problem was established by exposing people to opioids in the medical setting by prescribing these medicines. And the prescribing of prescription opioids is down by about twenty percent from its peak, which is fantastic.

0:08:50 William Moyers

0:08:51 Dr. Marv Seppala
But the death rate continues to go up because of illicit Fentanyl and the drug supply chain and the use of heroin. So you—when we start to be able to address this illness earlier in people's lives and more successfully by not just focusing on one type of treatment but you know and I would say not focusing just on Twelve Steps for the expectation that it's gonna work, or just focusing on medication but combining all that will-will get better outcomes and more people will get into recovery and more will survive this epidemic.

0:09:25 William Moyers
Dr. Marvin Seppala, thank you for bringing your professional expertise and your remarkable personal passion. Not just to the problem but to—to the solution and to do this—so through our podcasts, thanks for being here today.

0:09:39 Dr. Marv Seppala
Glad to.

0:09:40 William Moyers
Thanks to all of you for joining us for another edition of Let's Talk, a series of podcasts by the Hazelden Betty Ford Foundation under the direction of our Executive Producer Lisa Stangl and the great crew that helps us to do–carry the message of hope and help and healing through these unique medium of podcasts. Thanks to all of you for joining us and we'll see you another time.

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