Nefarious. Greedy. Unconscionable. Fraudulent. A few weeks ago on CNBC, the Florida substance abuse treatment industry was dragged through the mud.  This was one of many media blasts showing the industry owners as being nothing but monsters and charlatans. Over the past several years the press has been dedicated in their efforts to expose despicable owners and substandard professionals in the addiction treatment business and sober living in particular. Politicians more interested in votes than in truly decreasing addiction rates and overdoses make the problem worse by spouting popular slogans or ideas without fact checking.

Yes, there are bad players in this industry and they need to be exposed. There are also thousands of social workers, doctors, nurses, mental health counselors, behavioral technicians, and house managers working in reputable businesses that are trying 24 hours a day, 7 days a week, to stop the death, the suffering, the epidemic. We are the ones driving someone to treatment, answering a call from someone begging for help, comforting a family member, or administering Narcan for an overdose, while doing a sternum rub and praying that they come back to life. Sometimes they don’t.

One of our clients recently returned to treatment following a relapse, or as we say “recurrence of substance use”. For the first two weeks of treatment, it was like meeting an entirely new person. She was motivated, receptive to feedback, and invested in her own treatment. She explained that just before coming into treatment she had been revived from an overdose after several doses of Naloxone. When she came to, she was lying next to her own body bag. The paramedics had already given her up for dead.

As this is written, she is leaving treatment against medical advice. She refuses all offers to transfer her to another facility or allow us to arrange for continuing care through sober living and outpatient therapy. Why would she do this? How could she have already forgotten the consequences?

How can tens of thousands of Americans continue to use the opiates that will ultimately kill them?

Opiate users are more likely to leave treatment early and more likely to need to return to treatment [1].  Our own research has shown that clients who primarily use heroin have been to treatment almost twice as many times as clients that primarily use alcohol. Over two thirds of our clients have been to treatment before. This might lead some to conclude that treatment doesn’t work.

The truth is that ethical, effective treatment does exist in South Florida and these facilities are necessary. The 2015 National Survey on Drug Use and Health (NSDUH) determined that 21.7 million people aged 12 or older needed substance use treatment in the past year. In other words, 1 in 6 young adults (age 18-25) and 1 in 14 adults (26 or older) are in need of treatment.  Unfortunately, almost 90% of these people won’t receive the help they desperately need [2].  Even for the 10% that do receive treatment, the question remains: is that treatment effective?

The efficacy of “Florida Model” has come under particular scrutiny.  This term refers to a way of structuring treatment with transitioning levels of care, a structure used by most South Florida treatment facilities.  In the Florida Model, clients initially reside in programs with on-site, daily clinical programming in addition to medical monitoring.  After a period of time, clients progress to a less structured program where they still receive daily treatment but reside at a different location, usually a “sober home” where they are surrounded by others beginning their journey of recovery.  They have more access and interaction with the outside world and begin the process of re-integration.

This focus on integration becomes critical when we consider the epidemic we are currently facing and the specific needs of these clients.  The truth is: heroin and other opiates are different. Like most drugs, they damage the pre-frontal cortex of the brain. This significantly impacts the ability to make decisions, consider risks, and stop impulsive action [3, 4, 5].  Unlike other drugs, this damage doesn’t seem to heal. Studies have found that after months or even years of abstinence, opiate users are still more impulsive and they still make poorer decisions [3, 4, 5]. These deficits in executive cognitive functioning place these clients at particular risk for recurrence.

Recognizing this, the logical conclusion is that opiate users need more time to learn new skills for coping with these deficits, more time in a secure environment where they are safe from these often fatal impulses. Research consistently supports that more time in treatment leads to higher rates of abstinence [6,7].  A client that uses heroin must learn to navigate life not only without substances, but with an impaired ability to make sound decisions and resist impulses. By utilizing the Florida Model, clients are able to slowly acclimate to this new life. They are able to begin putting new skills into practice while continuing to receive support and ongoing therapy.   This means that the Florida Model is actually ideally structured for addressing this epidemic.

As our female client walks off property, it is easy to feel defeated, but we must remember that it doesn’t always happen this way. We have countless alumni celebrating 5, 10, and 15 years in recovery. They are doctors, lawyers, deputies, and fireman. They are mothers, daughters, fathers and sons. They are politicians, actors, athletes, and religious leaders. What do they all have in common? Many of them left treatment prematurely and came back to treatment multiple times before finally understanding that they needed to want to live. Once they understood that their life was worth it, they accepted the support, integrated back into society and continued to follow the structure that would enable them to stay on the right path. Why did they finally do this? Well that is the million dollar question. We never know if it will take one time in treatment or multiple times in treatment but what we do know is that today, one use of heroin could and very well may be their last. We are talking about life and death. Every life matters.

We hope that none of you will ever need the services we offer, but the odds are against you. We hope you never get the call that your loved one is dead. We hope the statistics never become personal for you like they are for us. However if, and likely when, someone you know (your relatives, your spouse, your child)needs help, then you may have a different opinion of us. Let’s hope w’re still here to answer that call.