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Medication-Assisted Treatment and Other Changes in the Addiction Field: A Q&A with Maia Szalavitz, Part III

Tuesday, April 16th, 2013

Opioids (heroin and prescription pain relievers) are powerful drugs that act on specific receptors in the brain that are important in regulating pain. While prescription opioids can be highly beneficial if used as prescribed, as a class of drug, they have a high potential for abuse. In fact, the National Institute on Drug Abuse estimated that 1.9 million people in the U.S. were addicted to prescription opioid pain relievers in 2010 and 359,000 were addicted to heroin.

Medication-assisted treatment for opiate dependence generally refers to the use of the medications buprenorphine, methadone or naltrexone to treat opiate dependence, in combination with counseling and recovery support services.  

In this, Part 3 of a 4-part series of my Q&A with award winning journalist Maia Szalavitz, Ms. Szalavitz shares her views on the dominance and effectiveness of traditional AA/12 Step based rehab programs, as well as the changes she has seen in the addiction field with a special emphasis on medication-assisted treatment for those struggling with opioid dependency.

JERRY OTERO: What’s been the biggest change in the addictions and treatment field since your book, Recovery Options  publication in 2000? What are the implications for teenagers?

MAIA SZALAVITZ: The biggest change is the widespread use of buprenorphine for opioid addiction treatment and the acceptance of the need for maintenance medication in some cases by abstinence-focused providers like Hazelden.  There has also been a decline in harsh and confrontational treatment, but unfortunately, some is still out there.

I wish there had been more changes though:  it’s still hard to get care that doesn’t present the idea that the 12-steps are the best way and that really meets people’s needs.

Teen treatment is unfortunately still very problematic, particularly in programs that sell themselves as “troubled teen” programs, i.e., emotional growth boarding schools, boot camps, therapeutic boarding schools, behavior modification programs and wilderness programs.  None of these have any controlled evidence supporting their effectiveness for addictions or other teen drug problems and yet lots of teens with drug problems are sent to them.  These programs tend to use tough, harsh tactics that are known to be harmful.

JERRY OTERO: What are your thoughts on medicated-assisted treatment (such as methadone, suboxone, vivitrol) for patients with opioid addictions? What are things parents should know about this treatment for their older teens/young adults?

MAIA SZALAVITZ: For opioid addiction, medication-assisted treatment is the safest and best option, the one most likely to preserve life and health.  It’s trickiest to determine when it should be used with young people:  obviously, it’s preferable not to have to be on lifelong maintenance of anything, whether blood pressure medication or buprenorphine.  So, young people should be aiming for abstinence at first, but maintenance should not be ruled out or seen as failure and parents should not pressure kids who are doing well on maintenance to come off, simply because they feel that drug-free is better.

Stay tuned next week for Part lV of our Q&A “How Can We Makes Things Better?”

To learn more about prescription medicine abuse, please visit The Partnership at’s The Medicine Abuse Project.

And look for The Partnership at’s free Medication-Assisted Treatment e-book coming out next month.

Maia Szalavitz is a health writer at and writes about addiction-related issues for The Find her on Twitter at @maiasz. She is co-author of Born for Love: Why Empathy is Essential — and Endangered, (Morrow, 2010), The Boy Who Was Raised as a Dog and Other Stories from a Child Psychiatrist’s Notebook: What Traumatized Children Can Teach Us About Loss, Love and Healing (Basic, 2007), and Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems (John S. Wiley, 2000) and the author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006).

Posted by  |  Filed under 12-Step, Addiction, Books about addiction, Dealing with an Addicted Child, Finding Treatment, getting help, Heroin, Medication-Assisted Treatment, Substance Abuse, Treatment, Twelve Step, Uncategorized, Writing About Addiction

2 Comments on “Medication-Assisted Treatment and Other Changes in the Addiction Field: A Q&A with Maia Szalavitz, Part III”

Rebekah Smith says:
May 1st, 2013 at 9:44 am

Hello, my name is Rebekah and I am an addict. Those words opened a door for me that I never thought possible…BUT I needed more help…a safety net if you will. I was the repeat offender…the perpetual relapser…the failure at recovery. That’s where methadone came in. After 10 long years of heavy heroin addiction (the last 3 of those 10 was IV use), I hit bottom. I was running on empty…couldn’t die, couldn’t quit. I was a broken, emaciated, spiritually dead shell of my former self. The athlete, the daughter, the sister, the MedSchool graduate…you know the drill. I was an episode on Intervention…only I had wronged everyone around me so much, there was no one to “call TLC and save me”. I was hated in the community that I once thrived in…my name was in the papers, local news media, etc….and my family and friends who once fought for my recovery, had retreated into their own lives, convinced death was the only thing that would end my pain. They weren’t cruel…it was the only way they could cope without going mad. Enter the year 2008. I had gotten in MAJOR legal trouble for stealing money from various people and agencies in order to support my habit. I was apprehended after a month on the run and tossed in jail. In severe withdrawal, I was placed in the medical unit to be kept under observation. Thirty six hours passed, and no one had even looked in my cell, let alone tended to me medically. I had 2 seizures in that 36 hours…and by the time I made bail, I was in cardiac arrest. (No…I wasn’t bailed out by a friend, but a using friend who was afraid I would “rat” on his only source of dope). It’s a cruel game. He drove me to the hospital and I never saw him again. A doctor happened to be on call that was a family friend…and she swooped in like an angel. She got me stabilized medically, and then arranged for me to attend a treatment program in Galax, VA called “The Life Center”. She only did this to save the sanity of my poor grandmother, who she loved dearly. No one thought I’d succeed.
I had been to this place before, but the doctor there had different plans for me this time. See, I was conflicted. I loved everything the 12 steps stood for, I loved the meetings, loved recovery…but my brain was just too imprinted with my addiction. As soon as I was out of the rooms of recovery and on my own, I’d lose all my coping skills. The doc knew this. She knew I was ready to be free of heroin and the life it handed me…but cold turkey and 60 odd days just wasn’t gonna be enough. She put me on a methadone regimen immediately. Over the next 52 days I saw a world I thought I’d lost. I was able to soak up the recovery like a sponge because the methadone allowed my mind to rest enough to make space for thoughts that weren’t about getting and using heroin. I thrived, I felt alive, I felt like I was beginning to recover.
That was almost 5 years ago. I haven’t used heroin since July 23rd, 2008. I still go to a meeting a day whenever my work allows it, and I am on methadone maintenance. I truly think its a matter of being “ready”. My life was ending before my very eyes. I hated my addiction and I hated heroin. I was ready to live again…and that has allowed me to take my methadone responsibly and live a responsible recovery program. Sure there are people who abuse it, sell it, divert it, etc. but that is just the way things are. We are creatures of excess…and it usually takes something on an apocalyptic level to remind us how fallible we are. It was when I realized its not a game anymore that I was able to respond positively to maintenance meds. What sucks? There is a stigma with these meds….especially methadone. The uneducated onlooker likely imagines dark dirty clinics full of shaking, skinny, greasy addicts standing in miserable lines to get their “fix” for the day. That couldn’t be farther from the truth. The majority of people at my clinic are like me. People who want their lives back…to thrive and be healthy. Of course, you have your group of folks who are there to get their rocks off, or get a buzz…but how is that different from the ER at the average hospital? It’s so much easier for the layperson to believe an addict will always be bad…and that’s why these meds get the wrap they have.
Today I have a family, a job, a house, even friends! Today I go to work, care for my family, pay all my bills, do charity work, spread the word of recovery….and today I am alive. I take my methadone every day and I’ve worked to a point where I only have to visit my clinic once a month. Some people love to point out the fact that addiction is NOT a disease like diabetes or hypertension, therefore methadone can’t be viewed like insulin or nitroglycerin…but if it was THEIR life this “horrible” medicine was saving, I’m sure they’d think differently. Thank you for allowing me to share my story…keep in mind, this is the SHORT version!

Patti Herndon says:
May 1st, 2013 at 11:22 pm

Thank you, Rebekah…for reminding us all that people recover everyday -no matter the level of challenge they face regarding their addiction… that MEDICALLY ASSISTED TREATMENT WORKS…and that we encourage, support, serve those who have a substance use disorder ‘best’ by beginning with a consistent, genuine demonstration of our belief in their innate ability to make healthy change, little by little!

‘You’ are the angel of service, here, encouraging us all toward expanded views/perspectives about what effective treatments, healthy recovery, and better lived moments looks like.

Addiction is the journey. Recovery is the destination.

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