FRN Research Report February/March 2012: Treatment Outcomes for Prescription Drug Addiction at Michael’s House
While the use of illegal drugs like cocaine and heroin is falling, more people are using prescription drugs non-medically. The rate of prescription drug abuse in the United States is now second to marijuana, and the Obama administration calls the non-medical use of these drugs an epidemic. Researchers have found that availability of comprehensive treatment and access to effective treatment options have not kept up with this growing need. Few studies have documented outcomes resulting from comprehensive evidence-based treatment services designed to address the unique clinical challenges associated with the treatment of prescription drug abuse.
Michael’s House Treatment Options
Michael’s House treats men and women, ages 18 and older, who need help with substance use and often co-occurring mental health disorders. The center is in the foothills of the San Jacinto Mountains, where staff members offer integrated treatment programs and a comprehensive approach through detailed assessment, evaluation, and individualized treatment planning.
The treatment center’s approach is ideal for addressing complex prescription drug abuse and co-occurring mental health disorders. Individuals who use these drugs non-medically often abuse other substances, most commonly alcohol. Meanwhile, opioids (drugs synthetically derived from opium, such as OxyContin) are the most abused type of prescription drug. One treatment option for opioid addiction is drug-replacement therapy, but the effectiveness of this treatment needs more study. While different treatment options are available, the most promising approach is a combination of options and interventions that address multiple clinical issues (chronic pain, trauma, psychiatric disorders, etc.).
Michael’s House offers the following programs:
- Medical and psychiatric care
- Group and individual therapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavior Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- DBT skills groups
- Experiential outings
- Challenge therapy
- Family programs
- Equine therapy
- Primary and extended care programs
The treatment programs at Michael’s House address the following:
- Drug and alcohol addiction
- Co-occurring mental health disorders
- Issues related to sexual orientation
- Emotional trauma
Prescription Drug Addiction
Prescription drug abuse is a significant health issue in the United States. The number of Americans who use prescription drugs for non-medical reasons is rising, with a high rate of growth over the past two decades. The number of emergency room admissions and overdose deaths due to abusing prescription drugs is also on the rise.
In the United States, individuals who use prescription medications for non-medical purposes usually get the drugs from physicians, even if it’s through an indirect route. Nearly 80 percent of people who reported that they got a drug from a family member or friend said the source person got it from just one doctor.
Commonly Abused Prescription Drugs
Prescription drugs fall into several categories; the reasons people use them vary depending on the medication. The National Institute on Drug Abuse identifies three classes of drugs with the highest rates of non-medical use:
Drugs in the opioid class include hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza), codeine and similar drugs. Just one large dose can cause respiratory distress or death. The effect is even more serious when combined with alcohol or another depressant. More people are addicted to opioids than any other prescription drug class.
CNS depressants include two categories: sedatives and tranquilizers. The sedatives commonly include a class known as benzodiazepines, such as diazepam (Valium) and alprazolam (Xanax). These drugs are often prescribed to treat anxiety and panic attacks. Other benzodiazepines, such as triazolam (Halcion) and estazolam (ProSom) are prescribed for short-term treatment of sleep disorders.
Less addictive depressants include non-benzodiazepine sleep medications, such as zolpidem (Ambien), eszopiclone (Lunesta) and zalepon (Sonata).
Barbiturates (or tranquilizers), such as mephobarbital (Mebaral), phenobarbital (Luminal Sodium) and pentobarbital sodium (Nembutal) are prescribed less often because of their higher risk of overdose compared to benzodiazepines. Rapid withdrawal after long-term use of barbiturates can be life-threatening and cause seizures.
Drugs in the stimulant class include dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin and Concerta). With the increase in stimulant prescriptions over the last 20 years, abuse rates have risen, particularly for drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD) like Concerta and Adderall.
Reluctance to Seek Treatment
A 2008 analysis of individuals addicted to prescription drugs found that many people were going without treatment because they believed they needed to be “strong” to overcome the addiction or felt the problem would go away on its own. The researchers also found that a majority of individuals using prescription drugs had additional substance use disorders (as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders). They found that treatment programs were underused even as the number of people addicted to prescription drugs rose dramatically in the analysis period, from 1991-1992 compared to 2001-2002.
Prescription Drugs and Co-Occurring Mental Health Disorders
Mental health disorders also play a significant role in prescription drug addiction. Researchers often examine the link between diseases such as depression and mood disorders when looking at usage rates. A study of more than 6,400 individuals in 1998 and 2001 found that people who had common mental health conditions (major depression, dysthymia, generalized anxiety disorder, or panic disorder) were more likely to use opioids. The findings applied to both initial use of the drugs and continued use. The researchers also noted that patients with psychiatric conditions also reported more pain symptoms, which could also lead to higher prescription drug use.
Reasons for Abusing Prescription Drugs
It can be difficult to determine the exact motive for abusing a prescription medication. A South Florida based research study found three main reasons people gave for taking drugs non-medically. The three most common reasons were a) to get high, b) to sleep and c) for anxiety/stress. Researchers also found that an individual’s pattern of abuse was related to his or her reported reason for using the drug.
The Treatment Philosophy of Michael’s House
Michael’s House offers Dual Diagnosis treatment that addresses drug addiction and mental health issues as part of one program. Since it is common for individuals with a prescription drug addiction to also abuse alcohol or other drugs, this is an effective approach that takes underlying issues into account.
Our Findings: Treatment Outcomes for Prescription Drug Addiction
This study examined post-treatment outcomes among patients admitted to residential treatment at Michael’s House. The sample of patients for this study included those who reported prescription drug abuse during the 30 days prior to treatment admission. Prescription drugs in this paper include opiates, sedatives, barbiturates and amphetamines.
Participants in the study included 203 patients who reported prescription drug abuse and enrolled in treatment services at Michael’s House from November 2008 through November 2011. Study participants completed follow-up assessments throughout the year following treatment, including 1-month, 6-month, and 12-month follow-ups.
Our Findings: Outcomes by Drug Class
One year after enrolling in treatment at Michael’s House, similar abstinence rates were achieved across prescription drug use categories. Far more patients reported use of opioids (67.5%) and sedatives (51.0%) than the other categories during the 30 days prior to enrolling in treatment services. However, 12-month abstinence rates were above 90% even for opioids (92.7%) and sedatives (92.1%). During a 30-day period, the average number of days patients reported using the drugs fell from nearly 13 to one, a 92 percent drop.
Patients using other prescription drugs had lower initial usage rates and saw less dramatic change. Individuals using sedatives went from an average of nine days usage to one day a month, while amphetamine usage went from three days a month to less than one day. Barbiturates, which were the least common of these prescription drug classes, fell from an average of nearly two days a month to close to zero days.
Our Findings: ASI Composite Score Data
Composite scores from the Addiction Severity Index (ASI) were used to measure outcomes over time among key domains: alcohol use, drug use, psychiatric issues, legal issues, family/social relationships, medical issues, and employment. Composite scores are mathematically derived from multiple items within each domain in order to represent problem severity from 0 to 1 with higher scores indicating greater problem severity.
A comparison of baseline and 12-month ASI composite scores indicate significant overall improvement. There was an overall 82 percent drop in drug composite scores and a 71 percent drop in alcohol composite scores. Scores for legal problems fell 72 percent while scores for family problems fell 61 percent, medical problems fell 57 percent, psychiatric problems fell around 52 percent, and employment problems dropped 13 percent.
Addiction to prescription drugs, particularly opioids, is at an epidemic level in the United States. Abuse of prescription drugs presents multiple unique challenges including the common perception that prescription drugs are safer, and many people are less likely to seek treatment for prescription drug abuse. When used for non-medical purposes, prescription drugs can be deadly, and their growing popularity has led to an increase in emergency room visits and overdose deaths. Now, more advocate groups and government agencies are spreading awareness about the necessity of getting help for addiction and seeking treatment immediately.
Just as with any drug addiction, prescription drug addiction requires patients to examine all aspects of their need to use drugs—psychological, physical and spiritual. At Michael’s House, a multidisciplinary clinical team uses an individualized approach to provide evidence-based interventions designed to engage patients in treatment and promote recovery from substance use and co-occurring mental health disorders. Patients receive tailored treatment that does not follow a one-size-fits-all approach but rather addresses the specific needs of the individual. This comprehensive and individualized approach is ideal for treating unique clinical considerations associated with prescription drug abuse.
Patient participation in our research gives us the opportunity to help all addicted individuals find greater happiness and success. If you would like to speak with a recovery professional today or if you would like to learn more about our research methods and programs, please visit us online at MichaelsHouse.com or call us directly at 615-490-9376.