Addressing Drug Addiction: Exploring Treatment Options

By Katlin Swisher

With substance use disorder affecting thousands of West Virginians and their families, access to treatment continues to be a necessity. Unfortunately, the treatment landscape is complex and can be challenging to navigate.

“There’s a broad continuum of care available, but when we say treatment, it gets very confusing because there are a lot of different types of treatment. This includes clinical and peer-based services,” says Frankie Tack, clinical professor and coordinator of the addiction studies program at West Virginia University. “On the peer support side, we have 12-step-based programs as well as peer recovery coaches and specialists. Those aren’t treatments, though—those are peer based support group models. The clinical side has a continuum of services and levels of care that become increasingly intensive.”

There is not a one-size-fits-all solution for treating substance use order.

“The most effective form of recovery or treatment is the one that works for the individual,” says Reggie Jones, executive director of Recovery Point West Virginia, a nonprofit organization offering recovery services at no cost to clients. “Some people need multiple attempts to find the program that works for them, such as abstinence-based, medication-assisted or religious. It is all about finding the right fit for the individual.”

Like with many health issues, there are a variety of factors that determine which treatment will be the most effective for an individual, according to Christina Mullins, commissioner of the West Virginia Department of Health & Human Resources’ (DHHR) Bureau for Behavioral Health.

“For example, an individual who has a cold might choose to take medicine to address the symptoms or decide to get more sleep to improve their health, but an individual with other serious health problems such as a compromised immune system who gets a cold might be advised to go immediately to the hospital,” she says.

Medication-Assisted Treatment

For opioid disorders, evidence from the American Society of Addiction Medicine and The Pew Charitable Trusts supports the use of medication assisted treatment (MAT). MAT combines psychosocial needs assessment, supportive counseling, links to existing family supports and referrals to community services with medication. It is offered in both inpatient and outpatient settings.

“Medications approved by the Food and Drug Administration (FDA) for treating opioid use disorders help reduce cravings and withdrawal symptoms and allow the individual to focus on recovery, work, education and family,” says Mullins. “The medications that are approved by the FDA for opioid use disorders are methadone, buprenorphine and naltrexone. Research indicates that 12 months of MAT is believed to be the minimum needed for effective treatment.”

Medications used as part of MAT are highly regulated at the federal level, and additional regulations have been enacted by the West Virginia Legislature. These include requiring medical offices to register with and follow the DHHR’s Office of Health Facility Licensure & Certification oversight as well as organizational, programmatic and clinical requirements. For example, methadone must be prescribed through a regulated opioid treatment program, and the DHHR has limited the number of these programs to nine in the state.

Medication to treat substance use other than opioid substance use is more limited, although it does exist for some alcohol and tobacco use disorders.

Public Behavioral Health Services

Broadly, West Virginia’s publicly funded community-based behavioral health system is anchored by 13 comprehensive behavioral health centers operating full service and/or satellite offices. Public behavioral health services provided by these centers are available for all populations and all ages at risk for or who have a diagnosis of mental illness, substance use disorder, intellectual or developmental disability or a co-occurring disorder. Individual, group and family therapies are available at the comprehensive centers.

In addition to the community-based system, outpatient therapy providers include a variety of licensed behavioral health centers, federally qualified health centers and private practices.

In 2017, West Virginia was approved for a 1115 waiver from the Centers for Medicare and Medicaid Services to provide a broader range of services for individuals with a substance use disorder. That same year, the West Virginia Legislature created the Ryan Brown Addiction Prevention and Recovery Fund, which supported expansion of treatment availability.

“Thanks to the Ryan Brown funding, the DHHR anticipates that West Virginia is close to doubling the number of residential treatment beds in the state,” says Mullins. “Another example of funding used to make treatment more accessible across the state will be the DHHR’s support that will be released in the near future for loan repayment for new therapists in order to recruit and retain them in West Virginia communities. The DHHR continues to monitor and make continuous improvements to the way West Virginia measures the need for additional treatment capacity to allocate funding when it becomes available in a way that is most effective to support access to treatment for West Virginians.”

Recovery Residence Programs

In addition to the changes and expansion of residential treatment, there has been an increase in recovery residence programs in recent years.

Recovery residences can vary in terms of the types of services provided and expectations of residents. In 2018, the DHHR’s Office of Drug Control Policy partnered with the West Virginia Alliance of Recovery Residences, Inc. (WVARR), the state affiliate of the National Alliance for Recovery Residences, to support recovery residences across West Virginia.

Recovery housing is intended to provide safe, healthy and drug-free living environments that support individuals in recovery from substance use disorder. However, that isn’t always the case.

“These structured living settings are generally led and managed by people in recovery,” says Tack, who serves as the secretary of the WVARR. “There are efforts underway by the WVARR to begin looking at the credentialing of recovery residences because anybody can open one. With the opioid crisis, this has become a real problem. Some of it is taking advantage and exploiting people. Some of it is just well-meaning people who don’t know what they’re doing. And then there are people who do know what they’re doing and have great facilities.”

The WVARR will serve as the first certifying agency for recovery residences in West Virginia to ensure national recovery residence standards are applied consistently across the state. It will also serve all recovery residences that are seeking certification throughout West Virginia with advocacy, training, start-up assistance, compliance issues, accreditation offerings and data collection. The WVARR is developing a system aligned with standards and objectives set by the National Association of Recovery Residences to provide accreditation for West Virginia recovery residences.

“Recovery residences came about with the understanding that sometimes people in early recovery need to be with other people in recovery,” says Tack. “They need a highly structured environment. They need that strong accountability and support from their peers. Sometimes the places people live when they get into recovery are detrimental to recovery, so they need somewhere else to go. We need to do something about this because it’s not okay that recovering people are being exploited in this way when they and their family members are desperate. Even though it’s not clinical, it’s about being as recovery-oriented and therapeutic as possible.”

According to Mullins, the latest estimates for the number of individuals who can live in recovery residences at any one time in West Virginia exceeds 1,800.

One example is Recovery Point, which offers long-term residential recovery programs. With locations in Bluefield, Charleston, Huntington and Parkersburg, its services include peer recovery support, individual counseling, mental health and substance use disorder assessments, case management and group therapy services.

“Our clients are a combination of people from off the streets and those who are court ordered,” says Jones. “Potential clients can show willingness by being placed on our waiting list and calling daily to check their status or bed availability. Those coming from the criminal justice system have a structured intake process that involves detailed communication and scheduling with court-appointed attorneys, prosecutors, judges, probation and parole officers and others. We also accept referrals from other treatment and recovery providers who have clients who might be a fit for our specific type of programming.”

Clinical Assessments

To receive treatment for substance use disorder, patients are encouraged to contact a clinical professional for an assessment.

The DHHR prioritizes assessments and treatments that are evidence based, individualized and provided by trained and qualified treatment providers, according to Mullins. In West Virginia, substance use disorder residential treatment providers that bill Medicaid are required to perform American Society of Addiction Medicine assessments to help determine the recommended level of care for each patient they serve. However, the stigma surrounding substance use is often a barrier for patients.

“It’s complex, but that’s true of other medical conditions. We just don’t think of other medical conditions as something we need to figure out and fix ourselves,” says Tack. “If you were having a racing heart, you wouldn’t be in the phone book trying to figure it out. You’d call your doctor and get the needed tests. If you needed anything further, such as a specialist, your doctor would then link you to those things. Why should addiction be any different? We have addiction specialists who can move your care forward just like a cardiologist would for a heart condition.”

The DHHR’s Bureau for Behavioral Health is currently rolling out a statewide stigma reduction campaign designed to change perceptions of opioid use disorder and encourage MAT awareness and participation in West Virginia.

Telehealth Resources

Across the state, the Help for WV line is a one-stop telehealth resource a patient can call or text for help.

“Individuals who are seeking treatment for substance use disorder can call the helpline at 844-HELP4WV,” says Mullins. “The helpline provides referrals to agencies that have been approved by the DHHR.”

Even with these expanded services, access is still a challenge in West Virginia as a full continuum of treatment is not available in every county.

“Ideally, a treatment center would be available within about an hour’s drive of anywhere a person lives. I don’t know that that’s going to be feasible in our state just because of the lack of density and populations of some areas and the geography. And there are other barriers, like transportation,” says Tack. “There are a lot of different things being worked on around access. I think there’s a great focus on building that continuum of care. It’s very much a work in progress.”