Resisting the Tide of Opioid Addiction
NEW YORK—America is mobilizing to curb its opioid blight.
Federal and state governments are investing hundreds of millions into addiction treatment, while the surgeon general is encouraging restraint among doctors prescribing painkillers. Nasal sprays that can reverse an overdose are becoming more widely available. And the federal government is placing tougher controls on the southern border, aiming to stem the flow of heroin.
In 2015, about 2.6 million people in the United States were addicted to opioids, but only about one third of them received treatment, according to the Substance Abuse and Mental Health Services Administration’s (SAMHSA) 2015 survey.
With health care expenses projected to outpace economic growth over the next decade, the health care system is chasing a remote goal of healing all of the addicted.
But a powerful healing force, capable of defeating a disease as stubborn as addiction, already exists throughout society—the addicts themselves.
Mutual Recovery Groups
Addicts in recovery have proven surprisingly effective in helping other addicts to quit and stay clean. Groups like Narcotics Anonymous (NA) have utilized this resource for decades, and recent research indicates it works just as well as professional psychological interventions, if not better.
While scientists would still prefer more data on the effectiveness of mutual help groups, the urgency of addressing the opioid crisis is prompting experts to call for more attention and support for this approach.
So far, scant attention has been paid to the role recovery organizations such as NA are playing, and what more they could do, in the national response to opioid addiction, wrote a group of veteran addiction researchers in an article published in October in the journal Alcoholism Treatment Quarterly.
“The potential reduction of social costs related to opioid addiction is substantial, given NA’s contribution to long-term recovery outcomes, its geographical availability, and its 24-hour accessibility at no cost to the government or private insurers,” wrote the authors.
There are over 27,000 NA groups holding meetings across the United States, free of charge and open to anybody with a “desire to stop using.”
Narcotics Anonymous is based on the 12-step recovery approach developed in the 1930s by Bill Wilson and Robert Smith for their mutual help organization, Alcoholics Anonymous (AA).
The 12 steps, combined with other materials, provide a structure that helps addicts organize meetings to discuss their efforts to stay clean.
AA and other 12-step groups have been sometimes characterized as religious, notably for their invoking of “God as we understood Him” in their materials. But both NA attendants and external researchers say the meaning is broader than religion.
Less than one third of NA members described themselves as religious, while almost two thirds described themselves as “spiritual but not religious,” according to a 2013 study published by the American Society of Addiction Medicine.
“Spirituality in our program basically means defining something that’s greater than yourself,” said Wilvena G., a volunteer for Narcotics Anonymous New York who has been clean for 30 years.
“When you first come in here, that could just be the group,” she said. It just needs to be “something that’s loving and caring.”
In practice, only a minority of 12-step group members, usually those with more severe problems, find their way out of addiction through spirituality, according to John Kelly, professor of psychiatry and addiction medicine at Harvard Medical School.
Most members benefit because the groups mobilize the same mechanisms used by professional therapists, he said.
“It helps people to change their social network to one that’s more conducive and supportive of sobriety and abstinence. It helps build coping skills, it helps build … their confidence in their ability to stay sober, it builds their motivation, it reduces craving and impulsivity. All of these things now have been found to be empirically supported [therapeutic] mechanisms,” Kelly said.
In addition, addicts in recovery can offer something a training can’t—shared experience.
“The credibility of Narcotics Anonymous is [shown] when I hear somebody tell [his life story that’s similar to] my story. If this person is able to do it, then I can do it,” said Wilvena. “I wasn’t willing to listen to someone that had a degree in addiction, because they didn’t do what I did.”
Paying It Forward
Moreover, helping others is an integral part of recovery in 12-step programs.
“The spiritual core of our disease is self-centeredness,” Wilvena said. “Reaching out to others is what helps keep us spiritually fit and glad to be alive.”
Decades of research have confirmed that “helping other people helps us,” said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University.
“It seems to be in our nature, that there’s something about that experience of connecting with another person by helping them that is good for us,” Humphreys said.
Lauren R. found help at Dunkin’ Donuts.
Lauren, who described herself as “way Jewish, upper-middle-class,” didn’t see herself as an addict. After all, at 21, she had a car and an apartment and a college degree—she wasn’t one of the people on the street.
But she couldn’t stop using drugs. While on a cigarette break during her job at a restaurant, she broke down in tears telling her colleague she doesn’t want to go home. “If I go home, I’m gonna use because I have stuff there. And I don’t know what else to do,” she remembered saying.
But wanting to quit and actually quitting can be a universe apart. She went home and used drugs again.
Over the next few months, she met a young man who worked at Dunkin’ Donuts and visited the shop many times just to talk to him. “I think he knew that I was using,” she said.
One day, he said, “There’s a [Narcotics Anonymous] meeting on Friday night. You should come.” She did.
“If you had told me that that would be the last day that I used, I wouldn’t believe you. But it was,” Lauren said.
She has been clean for five years.
The young man helped her, and now Lauren is helping others by volunteering for NA.
Finding Treatment Options
Joe McKinsey struggled with drug and alcohol addiction all through the 1960s and ’70s. At 13, he tried marijuana. By 16, he’d added pills to his routine. At 17, he added crystal meth, and later, just whatever he could get his hands on.
As a result, he missed many life opportunities. He could convince many job interviewers of his good qualities, but, sooner or later, the addiction would ruin his ability to do the job well.
In 1984, McKinsey was offered a highly lucrative position. To celebrate, he bought booze and cocaine and got high for two days. At 5 a.m. on the day he was supposed to show up at his new job, he broke down. “I hit bottom,” he said. “I couldn’t drink away the vision of what I’d become.”
He went into rehab for three weeks and ended up as one of only a few, in a group of 40, who remained sober. After rehab, he committed to show up at work every day and attend a 12-step meeting every day.
“The main ingredient in life is showing up,” McKinsey said. “I just became a worker, I just became a dad again, I just became a man.”
Thanks to being “not very anonymous” about his recovery, a lot of people came to him asking for help. “Can you help my brother, my sister, my mother, my father, my employer, my employee,” they’d ask him. “I would help them, you know, as part of my recovery program,” he said.
McKinsey was recommending treatment to people, figuring that most would need a period of stabilization out of home, just like he’d had in rehab. But the treatment options covered by insurance companies didn’t seem individualized enough, and he wasn’t impressed with the results.
A lot of the people he helped could afford to pay for better treatment, so he found private treatment centers on the West Coast for them.
One day, he went to pick up a friend in New York to send him to a treatment center in California. When McKinsey arrived, the friend had locked himself in the house to smoke crack.
“There should have been an easier way to do this,” McKinsey thought. “There should have been some place closer.”
He decided to create one.
Building a Rehab Center
One of them was Nicholas Kardaras, a clinical professor at Stony Brook Medicine. A recovering heroin addict himself, Kardaras took a different road to helping others.
Kardaras grew up in Queens, but his career took off in Manhattan, where he worked his way up through the hospitality industry after college and eventually emerged, in the late 1980s, as an owner of a few restaurants and nightclubs.
His work placed him in constant contact with the city’s nightlife—and the alcohol and drugs that permeated it. In the early ’90s, after some legal transgressions, his liquor license was revoked, and he had to close down his businesses.
As he lost his sense of identity, his addiction took over. He overdosed on heroin and fell into a coma for a week. At one point, his heart stopped beating for an hour, but the doctors brought him back.
Kardaras doesn’t remember having a near-death experience, but he wasn’t quite the same after waking up. “I was really thirsty … to find out more about the nature of not only addiction, but the nature of what it meant to be human,” he said.
He went to graduate school and became an expert on the psychology, sociology, and physiology of addiction.
Kardaras became the executive director of The Dunes, a residential addiction treatment center in East Hampton that McKinsey founded in 2010.
The Dunes offers a meticulously structured program in the soothing East Hampton countryside, not to mention the center’s rustically luxurious mansion.
Yet, even here, the 12-step program is embedded in the recovery process. At The Dunes, every weekday starts at 6:30 a.m. with a trip to a nearby AA meeting. Only afterward comes breakfast.
The rest of the morning is filled with meditation and exercise, while afternoons and evenings are spent in individual therapy, group sessions, and an in-house 12-step meeting. The 12 steps are even framed on the wall in the main room, near a large fireplace and the robust kitchen manned by a gourmet chef.
The point is to offer the clients every possible effective method for combating addiction. Even for clients paying $50,000 to $75,000 a month, mutual help groups remain one of the recovery methods of choice, in addition to personal therapy, yoga, meditation, arts, walks through the woods, and, of course, helping others.
“When people first come in and they’re broken and they’re really down in the dumps, someone reaches out their hand and says, ‘Here, let me show you how it worked for me,'” said Carolyn Liot, clinical director at The Dunes. “That’s the way it is. It’s a ‘pay it forward’ type of thing.”
Helping others also helps to mend one’s character, which becomes distorted by addiction.
“There’s all kinds of stuff going on in the mind of an addict that is very self-absorbed, that is sneaky, that is dishonest, that is calculating, manipulating, all in service … to maintain the addiction. And not because that’s what they want, but because they’re in bondage now,” Liot said. “All those neural pathways, they all have to be rewired.”
This is not a metaphor. Extensive research shows that repeated drug use rewires the brain’s reward system. This system breaks down over time, and addicts experience an overall reduction in the sensitivity of the reward system, states a 2016 report from the U.S. surgeon general.
Users lose the sense of pleasure they once derived from other activities, like watching a movie or eating tasty food.
Drug use also activates the part of the brain that helps us develop habits. And it suppresses the part that helps us with self-control. It even activates stress neurotransmitters that make users feel bad when not high.
But once people have an experience of recovery, they naturally feel the need to share it—their thinking switches from selfish to selfless, often without their realizing it, Liot said.
“If you’re lucky enough to find your way out, what kind of person would you be if you didn’t help other people get out of it too?” said a former client at The Dunes, who wished to remain anonymous.
Although the 12 steps are only one part of The Dunes’ approach, Liot recommends all her clients give them a try.
“Even though it does have that, sort of, old-fashioned feel to it, there’s also something very timeless and universal about it,” she said.