In September’s column we highlighted the importance of evidence-based programs (EBPs) and why they are relevant to our Island community. EBPs are generally health-related, offered to the public, and based on rigorously tested trials derived from data. This means they have a track record of providing participants with successful outcomes. EBPs are commonly offered by healthcare agencies, town departments, and clinical partners as part of a community health strategy. We are fortunate that several of our Island health and human service agencies offer EBPs, including a robust lineup for those struggling with the disease of addiction. EBPs are proven to be effective in increasing treatment retention, program completion, lengthening abstinence, decreasing substance use during program engagement, reducing encounters with law enforcement, and improving rates of employment.
During my recovery I used the Matrix Model, which is based on the tenets of cognitive behavioral therapy. It emphasizes processing negative thought patterns to change behaviors and develop healthy coping skills. Ten years ago, I went through the program twice, until I realized I didn’t have a “drinking disease,” but rather a “thinking disease.” By changing my thoughts, I was finally able to get a handle on my addiction. A craving lasts seven minutes, and through “urge surfing,” I learned to not cave in.
Self-Management and Recovery Training (SMART), like all EBPs, is rooted in scientific evidence. It focuses on self-reliance rather than powerlessness, fostering a person’s independence from their addiction. Its playbook contains tools and techniques to achieve a balanced life: building and maintaining motivation, coping with urges, managing thoughts, feelings and behaviors, and living a balanced life. Personal accountability is a linchpin ingredient to SMART’s “secret sauce.” If you like homework, this one’s for you!
On the surface, less is more. But harm reduction is so much more. Abstinence is not everyone’s goal in seeking recovery treatment. For those that still use, harm reduction helps them do so more safely, and meets them where they are, with kindness and respect. Harm reduction empowers individuals to make their own choices and to develop personal goals. In doing so, it destigmatizes the notion that addicts and alcoholics are bad people and beyond hope. Narcan, fentanyl test strips, and needle exchange programs are safety measures encouraging users to take great care in what they are doing. Anecdotally, as a recovery coach working in the trenches, I once had a client who went from mainlining cocaine every night to taking a few hits of pot so he could get to sleep. Wasn’t he reducing the harm to which he was exposing himself? You do the math.
Medication-assisted treatment (MAT) entails a combined methodology to treat substance use disorders. While medications are an indispensable element of MAT programs, they aren’t the only component. MAT uses pharmacological treatment as an adjunct to behavioral therapy, tailored to a patient’s unique needs.
A great many lives have been saved through this patient-centered approach. Its focus allows patients to minimize cravings, block the effects of certain substances, and decrease continued substance use behavior. FDA-approved buprenorphine products approved for the treatment of opioid use disorder include Suboxone, Sublocade, and naloxone. When used as prescribed and in collaboration with a behavioral therapist, persons saddled with a disease for which there is no known cure have a fighting chance.
Contingency management is a behavioral strategy commonly used in substance use disorder treatment. It focuses on engendering positive behavior change, such as abstinence, by introducing reinforcement when treatment goals are met and withholding them or introducing a reprimand when undesired behaviors surface. By promoting self-efficacy and rewarding healthy decisionmaking, the contingency approach effectively incentivizes one’s recovery arc.
As a personal aside, 12-step meetings saved my life. Every day, in every way, I am fortunate to be surrounded by people just like me who are trying to stay away from a drink or a drug. Never underestimate the power of one addict talking to another. When you get a roomful of them? That’s when the magic happens. And that’s all the empirical evidence I need to know that they work.
If you are an older adult, now is the time to review your Medicare coverage. Each Medicare beneficiary receives an annual notice of coverage by Sept. 30, which includes important information regarding Medicare costs and benefits. Open enrollment is Oct. 15 through Dec. 7, and state-certified SHINE counselors will be available by appointment to help you understand healthcare coverage, review cost increases, and find out what’s new with Medicare. For more information or to set up an appointment, call your local Council on Aging.
Brian Morris is mental health/substance use disorder access coordinator at Island Health Care.
Dukes County Health Council meetings occur on the third Thursday of the month from 7:30 to 9 am. They are open to the public. Agendas are published on the Health Council’s website at dchcmv.com.