Cost and value of opiate detoxification treatments

Addiction Recovery Bulletin

IT’S SIMPLE & IT’S COMPLICATED – 

April 23, 2021 – The difference is still clearly evident when comparisons are made of the full detoxification treatment packages. In our calculations, the costs of a 3-week in-patient detoxification programme are nine times those of an 8-week out-patient programme.

A more informative calculation of the relative cost-effectiveness of the detoxification in the two settings can be made by adjusting the costs of the treatment packages according to their observed success rates. The costs of the in-patient detoxification programme should therefore be divided by 0.81 to adjust for the 81% abstinence rate of patients treated in this programme, and the costs of the out-patient programme could be divided by 0.17 Gossop et al, 1986). When adjusted for successful achievement of abstinence, the difference is greatly reduced ± the in- patient treatment costs less than twice as much as the out-patient treatment.

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Is fear of opioids leaving patients in pain?

Addiction Recovery Bulletin

DOCTOR’S DILEMMA – 

April 23, 2021 – We heard from someone who has reached the end of his rope: “In June, I will have suffered from severe chronic pain for 28 years. I will be dead before then. My doctor has cut me back from 180 mg of methadone and 75 mcg of fentanyl to 80 mg of methadone, along with Robaxin. When I was first put on methadone and fentanyl after 13 years of pain, I was pain-free for nearly 14 years.

“My doctor wants me off all opioids. I have three different types of severe pain.

“I also have dysphagia [trouble swallowing], which led to COPD. There is a possibility of improving the dysphagia, maybe even eliminating it altogether. Instead, it looks like it might be my way out. I have already talked to my pulmonary doctor about discontinuing my nebulizer treatments so I could die without committing suicide. Since 2003, I’ve had eight bouts of pneumonia. It wouldn’t be hard to get another one.

“He told me that he would make me as comfortable as possible if I chose to go into the hospital. I’m sick of hospitals, so I’d rather die at home.

more@SWOKNews

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New Yorkers ‘Just 4/24’ holiday to ‘celebrate in the name of sobriety’

Addiction Recovery Bulletin

LITTLE LATE for 2021, but GREAT IDEA! – 

April 20, 2021 – “Just for 24 is a day to celebrate your recovery and support your friends in recovery by having fun in the name of sobriety,” she added.

She said that the festivities on Saturday, April 24 will begin at 10 a.m., with a trip to the Lower East Side’s booze-free bottle shop Spirited Away “to load up on booze-free beverages” she said, “then off to Brooklyn for some roller skating [at Pier 2] and wrapping at PS Kitchen with an event with prizes from REVA Recovery Support, Soylent, Athletic Brewing Company and Monday [alcohol-free] gin.” 

It’ll be live-streamed from 4 p.m. on Duke’s Instagram and the Just for 24 account. 

“Come join the event and celebrate sobriety and make new friends!,” said Duke.

Duke and her online cohorts recently did battle with juice brand Tropicana over a series of ads encouraging parents to drink in secret to combat COVID-related stress.

more@PageSix

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Macklemore talks about his 2020 relapse to Dax Shepard: ‘The disease of addiction is crazy’

Addiction Recovery Bulletin

WATCH – BACK TO BASICS – 

April 20, 2021 – “I really, really resonated with the episode,” the 37-year-old songwriter expressed, adding how amazed he was by Shepard’s ability to be “vulnerable and honest” with his fans.

“It was within two months of my COVID relapse, and the disease of addiction is crazy,” said Macklemore, whose real name is Benjamin Haggerty. The Grammy winner furthered that speaking about the struggles with sobriety “lets other people feel that they’re not alone.”

“It made me feel, as someone that had relapsed again, like a month or two before, that I’m not alone,” he said. Macklemore, who revealed he first was sent to rehab in 2008, praised Shepard for helping him realize that a relapse is not a sign of failure and, because of that, he no longer counts how long he’s stayed sober.

“I’ve spent most of the last 11 years in recovery, and it’s made me who I am,” he said. “I’ve compromised my life and other people around me, I’ve done things that I’m not proud of, but I do have that foundational level of 10 years of recovery, and I’m f—— proud of that.”

Macklemore revealed last week that he and wife Tricia Davis are expecting their third child, who is due to arrive this summer. They share daughters Sloane Ava Simone, 5, and Colette Koala, 3.

more@ABCNews

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West Virginia overdose deaths set new record amid pandemic

Addiction Recovery Bulletin

WHEN WILL IT STOP? – 

April 22, 2021 – Data analysis published in the American Journal of Public Health, which analyzed overdose deaths across 31 states, found West Virginia’s increase during that month to be significantly higher than any other state.

“I wish I could say I’m surprised, but I’m not,” said Jon Dower, the executive director of West Virginia Sober Living and an adjunct professor at West Virginia University. “People lost in-person services and they lost stability.”

The deaths, according to the data provided by the West Virginia Department of Health and Human Resources, were driven primarily by an increase in overdoses linked to fentanyl, a synthetic opioid.

Last year, 955 deaths, about three of every four in the state, were linked to the drug.

Fentanyl, which is cheaper than heroin and can be more deadly, is linked to a spike in overdoses nationally. Just this year, the federal government changed rules on funding to allow grant money to be used to buy fentanyl test strips to help combat the crisis.

The test strips allow people with substance use disorders to test their drugs before using, and some cities across the country have pushed to make the strips more accessible in an effort to decrease overdose death rates.

In West Virginia, harm reduction programs — including syringe exchanges — have played a major role in supplying the strips, along with the overdose reversal medication naloxone. But rather than working to increase access to these life-saving tools, West Virginia’s lawmakers put in place a greater barrier.

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One saleswoman’s journey to sobriety and entrepreneurship

Addiction Recovery Bulletin

IMAGINATION – 

April 19, 2021 – From the outside, she said, she was keeping it all together, but internally, she said she realized she was “not doing so good.”

But Taylor, who now considers herself in recovery, realized when she stopped drinking how integral it had been to both her social and business lives. She was inspired to learn about drink options for people in recovery that would still allow them to feel included, and came up with a few nonalcoholic “mocktail” recipes while researching business options. Taylor also wondered, after working for years in tech, if she was ready to end her career without the chance at working for herself.

A real-life test came in 2017, when she was invited on a trip with some friends, and brought along what is now called the Cranberry Cosmo.

“At first I felt weird,” Taylor said. “They opened up their stuff and made drinks, but I had mine, and I poured my own drink and had this internal spark like, ”This is really special.’ I’m still participating but on my own terms.”

Shortly after, Taylor launched Mingle Mocktails, a line of alcohol-free bottled cocktails with the goal of inclusion in social events for folks who are sober, taking a break from alcohol, are pregnant or who are too young to drink.

[email protected]

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How One Man Overcame His Drug Addictions by Faith

Addiction Recovery Bulletin

HIGHER POWER WORKS – 

April 22, 2021 – At the age of 20, Barr was held down by a group of friends while they injected heroin into his veins, which started his 22-year drug addiction. At the height of his addiction and during his darkest hour, his father came to him. He didn’t start preaching at Barr, telling him that he needed to quit. He didn’t talk about the hurt and the pain that Barr was causing his family. He didn’t even tell Barr about the damage that he was doing to himself. He just opened the Bible to a certain scripture, gave it to Barr, and told him to read that scripture every morning before he left home. The scripture was Psalms 121.

He comments, “One day after work, I also overdosed on heroin but was lucky I wasn’t alone when it happened. There were a few of us in my apartment at the time. I pressed the needle into my vein and allowed the heroin to take over. My legs became weak as I fell back against the wall. The next thing I remember was waking up on the couch. Someone said Poopy shot some salt in my arm to bring me out of it. I never would’ve thought that a guy named Poopy would be the one that God used to save my life.”

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Lindsay Lohan’s father Michael arrested for steering patients to rehab firms

Addiction Recovery Bulletin

WATCH – ALL IN A DAY’S WORK – 

April 23, 2021 – Said Aronberg, “Mr. Lohan was investigated by our Sober Homes Task Force and he’s being charged with receiving kickbacks for referring patients to drug treatment. Patient brokering corrupts our health care system because decisions are motivated by greed instead of a patient’s needs. This is our Task Force’s 117th arrest and will not be our last.”

Heidi Perlet, Lohan’s attorney, did not immediately respond to a request for comment.

According to the charging documents, an investigator spoke to Lohan on April 8, 2021, when he denied being involved in patient brokering.

South Florida is sometimes known as the “recovery capital of the world.” Thousands of addicts arrive here each year from all over the U.S., hoping that at one of South Florida’s many drug treatment centers, they’ll find recovery. And some do.

more@NBCNews

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Leslie Jordan once hated himself for being gay

Addiction Recovery Bulletin

5.7 MILLION FANS LOVE HIM FOR BEING GAY & SOBER – 

April 26, 2021 – He now has 5.7 million followers. Fans, old and new alike, were cheered by his quirky posts delivered in Jordan’s distinctive Southern drawl. Jordan’s newfound reach has meant he’s also been able to indulge in his love of Christian hymns with an album called “Company’s Comin.’”

The “American Horror Story” star says that when he first arrived in Hollywood in 1982, he was hungry for fame.

“I didn’t care about the money or work, I wanted to be famous” he detailed. “I remember reading that Hugh Hefner had a mansion with seven blonde Playmates that lived with him, and I thought, ‘Oh I want to be the gay equivalent of that! I want to have a mansion with seven blond boys all giggling around the pool.’”

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Courtenay Baylor

By bob k

If for no other reason, Courtenay Baylor should be of interest to modern AA members for being the first recovered alcoholic to work as a professionally paid addictions counselor. He set the precedent for the tens of thousands in the modern world who have gotten sober and then entered the field of guiding others to do the same. There are additional reasons to know about Baylor, most particularly for the secularist.

As his alcoholism progressed, Courtenay Baylor (1870-1949) found that he had become an insurance agent who spent a good deal more time drinking than discussing indemnity plans. In 1911, he came to Boston to consult with Elwood Worcester about his problematic drinking. Five years earlier, the Emmanuel Church had entered into co-operation with the local medical community in setting up a tuberculosis clinic in the building’s basement.

Among those seeking treatment for “TB,” there were many alcoholics. Others arrived displaying symptoms of a variety of nervous disorders falling under the general category of “neurasthenia,” a term popular at the time. Reverend Worcester and his associate rector, Samuel McComb had doctorates in psychology. They began helping people with their emotional disorders and assisted a number of alcoholics in achieving sobriety.

Courtenay Baylor was among those who were able to achieve sobriety. Instead of returning to what had been a successful business career overall, he felt that he had acquired a new life and a new attitude. His emotional rearrangement prompted him to take a position as a “friendly visitor” on Worcester’s staff. Elsewhere, he is described as being hired as a supervisor of the Social Services department.

Perhaps he intuited that such a path of service might insure his long-term sobriety.

Baylor stayed with Worcester out of a desire to help others as he had been helped. Worcester apparently never regretted accepting his offer. In his autobiography, he praises Baylor for “his originality, his psychological insight, and his extraordinary ingenuity as a teacher.” He adds: “His strength lies, partly, in his ability to impart his wholesome philosophy of life so unobtrusively as to arouse no opposition. In a short time, the pupils begin to announce his own principles as their own convictions.” (The Road to Fellowship, Richard Dubiel, p. 36)

Although neither a clergyman nor a medically trained professional, Baylor did bring the unique perspective of an intimate, “insider’s knowledge” of the malady. The former insurance agent stood before his “patients” as proof positive of his own solution – a living example that an alcoholic could be rehabilitated.

Re-published in 2017 – almost a hundred years later – Remaking a Man.

This was not a mere theory.

Real results were being attained, and Baylor’s developing therapeutic ideas and practices were given a broader audience with the publication, in 1919, of Remaking a Man. Physicians and some of those who had been “cured,” picked up on his techniques. Increased numbers were reached as the lay therapy movement grew. The progressive Christian ministers had incorporated religious practices like prayer along with what was more properly called “psychology.” Baylor focused on secular therapies.

His claimed “cure rate” of 65 percent gains credibility from the fact that his critics assailed not his numbers, but the possibility that the remarkable degree of his successes was due more to Baylor’s tremendous personal charisma than his methodology. However, similar numbers were achieved by his followers. One reason for the high percentages stemmed from the procedure of strictly “pre-qualifying” potential clients for motivation. Little time was wasted on the “wishy-washy.” “First and most importantly was a real desire to be cured.” (The Psychology of Alcoholism, G.B. Cutten, p. 283)

Alcoholics Anonymous in the 1930s operated much the same way.

Alcoholic Neurosis

Baylor thought that most alcoholics suffered from an alcoholic neurosis. He began with the assumption that the condition to be treated was the same whether it was the cause or the outcome of drinking.

Although a detailed analysis of Baylor’s techniques lies beyond the scope of this short essay, it’s worth taking a look at some comments from William L. White.

(Baylor) emphasized the necessity of working primarily, not upon the surface difficulty, but upon the condition behind it and upon the cause of the underlying condition… He taught techniques of relaxation that today would go by such names as thought stopping, progressive relaxation, self-hypnosis, autogenic training, and guided visualization.

Baylor’s therapeutic style involved teaching, encouragement, and a high degree of mutual self-disclosure. Because of Baylor’s emphasis on self-disclosure, his treatment contract required a mutual commitment to confidentiality. Baylor tried to cultivate in the client the development of a new focus in life. To Baylor, sobriety required a purpose, a philosophy, and a plan. He spoke not of recovery, but of ‘reconstruction’.

Slaying the Dragon, First Edition, William L. White, p. 101

Famous Clients

Courtenay Baylor had two clients who were notable from the perspective of Alcoholics Anonymous. In 1922 he treated Richard Peabody (1892-1936), who went on to become the most famous of the lay therapists. The one-time American aristocrat had suffered depression, institutionalization, divorce, and disinheritance – all by the age of 30. In 1931 (sometimes reported as 1930), following several years of private practice, Peabody published The Common Sense of Drinking, a book that influenced Bill Wilson as he wrote AA’s Bigga Booka later in the decade. Phrases from Peabody’s book appear in Alcoholics Anonymous almost word-for-word. “Halfway measures are of no avail,” and “Once a drunkard, always a drunkard” come to mind but there are many others.

Baylor’s other interesting client is described on page 26 of AA’s book as a “certain American businessman.” Rowland Hazard (1881-1945) was another black sheep from a wealthy and prominent family. His Rhode Island ancestors date back to the early colonization of America.

Hazard’s story, as crafted by Bill Wilson, is used to demonstrate that the money-is-no-object quest for sobriety proved useless. We are told in conference-approved literature that Hazard went to Switzerland to be treated by the great psychoanalyst, Carl Jung. We are informed that the therapy was of a year’s duration and that it took place in 1931. Relatively recent research by the Rhode Island Historical Society demonstrates conclusively that both claims are false. The treatment period was no more than eight or nine weeks, and most likely occurred in 1926.

This seems to be a classic example of Bill Wilson’s predilection for myth-making – a full year of expensive, expert human power treatment and no result. The official AA version of the tale has Jung advising Rowland to seek a spiritual experience, and Rowland finding that solution with the Oxford Group. The truth compounds a simple tale.

What happened during the seven intervening years from 1927 to 1934?

For one thing, there was a lot of drinking interspersed with institutionalization and periods of sobriety of varying lengths. Despite having no particular objection to a religious solution, Hazard did not pursue that option with “the desperation of drowning men.” Perhaps Jung’s recommendation never happened. In any case, the Rhode Islander didn’t connect with Buchman’s group until 1933.

Did the religionists save Rowland Hazard? Perhaps, but he was being treated by Courtenay Baylor at the same time.

IF Hazard told Bill Wilson in some detail about Jung’s alleged recommendation that he seek a spiritual experience, it seems unlikely that he would misreport the timing by five years. Did Rowland fail to inform Bill that he continued to seek other therapeutic solutions? Did he forget to mention that he was being treated by Baylor at the time he got sober?

Of course, we must remember Bill Wilson’s mission. When pitching the inefficacy of non-mystical approaches, it’s probably unwise to cite examples of recovery through human power means.

Courtenay Baylor helped many drunks to reconstruct themselves. He seems to have helped AA’s famous “American businessman.” He helped the atheist, Richard Peabody, with methods that required no kneeling. The lay therapy movement had a nice run, well into the 1950s.

The pitch of the AA fundamentalist that “probably no human power could have relieved our alcoholism” is contradicted at many junctures.

Alcoholics Anonymous was not the only therapy for alcoholism that flourished in its time. Other approaches to treating alcoholism, although they derived from sources very different from the influences that impinged upon AA, used similar methods and even incorporated some of the same ideas that a forgetfulness of history leads later thinkers to associate with Alcoholics Anonymous. In particular, the approach of Richard R. Peabody…not only preceded in time Wilson’s own sobriety but was well into the fifties accepted and endorsed by many doctors and clergy much more enthusiastically than was Alcoholics Anonymous.

Not-God: A History of Alcoholics Anonymous, Ernest Kurtz, p. 158

AA member and sobriety activist Marty Mann also described the lay therapy movement as having “considerable success.”

AA history and pre-AA history frequently contradict the pronouncements of AA fundamentalists, and that’s good fun for secularists.


Key Players in AA HistoryIn Key Players in AA History (2015), bob k covered the lay therapy movement in a single chapter. It deserves much more.

In the upcoming The Road To AA: Pilgrims To Prohibition, six chapters are devoted to this interesting AA predecessor. Also in the offing is a work of biographical fiction The Secret Diaries of Bill W.


 

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