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Psychiatry Newsletter - You and me against the (drug) world
You and me against the (drug) world
Date: March 30, 2011
A community contact can turn users around.
Most places, you just get your ‘juice’ (methadone) and go, and it’s see you later,” says Frank Harmon,* a wiry, intense man who’s been no stranger to a mix of heroin and cocaine.
Harmon, who spoke recently at Psychiatry’s Grand Rounds, enrolled this year in Hopkins’ outpatient addiction treatment program, which uses what’s called a Motivated Stepped Care (MSC) approach for patients on methadone therapy.
“It isn’t like others,” Harmon told the faculty and students.
MSC relies heavily on required counseling at various intensities—the different “steps”—as one way to urge patients to keep coming to sessions and stop using opiates and other drugs. Studies show that most patients in the proven program lower drug use and attend psychotherapy. They seek out employment more.
But what Harmon sees as MSC’s saving grace sat beside him at the Rounds.
Louis Beaudet,* his more laid-back shadow, is Harmon’s community support person—a monitor who also, it seems, has become a friend. Harmon recruited him, and Beaudet soon became committed to the program within the stepped care program.
The need for community support is clear, says psychologist Michael Kidorf. He can’t count how often he’s heard: I just hang out with the wrong people. “Time and again we’d have good meetings with substance users; we’d make headway,” says Kidorf, “but then we couldn’t help picturing their returning home to a vast network of people and situations connected with drug use.” Kidorf’s research confirms that drug users’ social support systems are flimsy. Most of their contacts are other users. And their functioning within society as a whole is poor: lots of divorce and broken relationships.
“But we know healthy social connections help patients stay in treatment and lower the risk of relapse to heroin or other drugs,” says Kidorf. So a decade or so ago, his group stepped in: They required the 10 percent of patients with the most trouble staying drug-free—those stalled at Step 4, MSC’s highest-counseling stage—to recruit a community support person. The chosen partner had to be drug-free and willing to act both as a monitor and as a bridge between the patient and the “clean” community. Beaudet, for example, went from once being Harmon’s coworker on a factory line to someone who took him bowling, fishing, grocery shopping and to church as well as
to the weekly required check-in that CSPs and patients attend.
“Patients initially grumble about the program” Kidorf says. But a study confirmed its value: partnered patients attended some 70 percent of scheduled group sessions; 78 percent ultimately “graduated” from Step 4 after a full month of drug-clear urine samples.
Attitude is important, says Kidorf. “We know what we’re doing is an intrusive move so we keep it positive. We focus on each patient’s strengths and what’s accomplished, and that keeps it therapeutic.”
Harmon—improved after four months with Beaudet—calls him “a tough older brother.” When Harmon slipped from a long—for him—abstinence, Beaudet quickly knew. “He gave me a rough time,” Harmon said. “He wrote out the definition of the word useless and told me to keep it in my pocket when I was tempted. I really felt bad. But he’s still with me…and I want more than ever to quit. I don’t know what I’d do without him. I’d be awful upset.” n
For information: 410-550-0006.
* for privacy, we’ve changed names and some details.