Answer Addiction

Tag: medication assisted recovery

  • SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    SAMHSA Voice Awards Honor Walter Ginter’s MARS™ Project

    Many people on MAT feel unwelcome at meetings, and this sense of alienation and rejection often leads to relapse. That’s where MARS™ comes in. We want people on MAT to be embraced and accepted in recovery.

    Held at Royce Hall on the UCLA campus in Westwood, the 13th annual SAMHSA (Substance Abuse and Mental Health Administration) Voice Awards recognized an essential figure in the national battle against the opioid epidemic. As the founder of the Medicated Assisted Recovery Support (MARS™) Project, Walter Ginter was honored with a Special Recognition Award for his efforts in combating the opioid epidemic and helping people who use Medicated-Assisted Treatment (MAT) stick to the path of recovery. In the greater recovery community– ranging from treatment centers across the country to 12-step groups—many people have a negative view of MAT which has led to a lack of support for people trying to overcome opioid addiction. 

    SAMHSA has been at the helm of national efforts to destigmatize the medications typically used in MAT such as buprenorphine, methadone, and naltrexone. Beyond supporting physicians and researchers, SAMHSA has tried to reduce the negativity associated with traditional perspectives on opioid recovery. According to many loud voices in Narcotics Anonymous (NA), if a person is on medication that has been prescribed to help them overcome opioid withdrawal symptoms or to refrain from using heroin or other illicit opioids, then they are not really clean. In contrast to this judgmental perspective, the SAMHSA website states: “Medicated-Assisted Treatment (MAT) is the use of FDA- approved medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”

    Indeed, a “whole-patient” approach is what is needed to stem the tide of what has become the greatest drug epidemic in U.S. history. With the introduction of fentanyl and other powerful prescription narcotics to the illegal drug trade, the stakes are higher than ever before. According to the National Institute on Drug Abuse, “Every day, more than 115 people in the United States die after overdosing on opioids.”

    Given such a devastating statistic, Arne W. Owens hopes the SAMHSA Voice Awards can raise awareness by bringing the recovery community together with the entertainment industry. As the Principal Deputy Assistant Secretary, Owens was the highest-ranking member of SAMHSA at the Voice Awards Show on August 8, 2018. Asked by The Fix how the Voice Awards can make an impact on the opioid epidemic, Owens said, “We hope to incentivize more positive portrayals in film and television of treatment and recovery for substance use disorders. We believe hearing positive stories about treatment and recovery helps to inspire others, shifting negative attitudes. For example, it would be good to see writers and directors positively represent MAT in film and television. Beyond raising awareness, such representation would help to reduce stigma.”

    Walter Ginter is an ideal example of someone who has dedicated his life to reducing stigma and raising positive awareness about MAT. Dedicated to improving the recovery community, Ginter has been a board member of both the National Alliance for Medication Assisted Treatment and Faces & Voices of Recovery. In collaboration with the New York Division of Substance Abuse, Yeshiva University and the National Alliance for Medication Assisted (NAMA) Recovery, Walter Ginter became the founding Project Director of the Medication Assisted Recovery Support (MARS™) Project.

    MARS™ is designed to provide peer recovery support to persons whose recovery from opioid addiction is assisted by medication. To be in a MARS™ group through the Peer Recovery Network PORTAL™, a person has to be in a MAT program. As Ginter writes on the MARS™ website, “The Peer Recovery Network was created as a way for peers in recovery to more effectively organize their community, to communicate with each other, and to have a stronger voice for advocacy efforts.”

    In 2012, Ginter helped create the Beyond MARS Training Institute at the Albert Einstein College of Medicine. With a variety of models and options, Ginter created a curriculum where opioid treatment programs and recovery professionals can be trained to implement MARS™. The original MARS™ project has expanded from its beginnings to include 17 programs across the United States and two in Haiphong, Vietnam. Ginter believes this is just the beginning of the expansion, both nationally and internationally.

    On the red carpet before the Voice Awards ceremony, Walter Ginter spoke with us about the struggles he has faced as an early advocate of MAT, revealing both an innate decency and a keen sense of humor. With a smile, he mentioned how people always ask him why MARS™ uses the trademark symbol. Some of them even think that he’s trying to corner the name of the planet for profit.

    But MARS™ has a trademark for a particular reason, Ginter explains. In the vast majority of cases, the organization does not mind when people use the name. They do enforce the trademark, however, when people who are not certified as trainers try to set-up MARS™ groups and conduct MARS™ trainings. In most cases, rather than follow the protocols, they are hijacking the name to do what they want and make a profit. As an organization with a mission that envisions “the transformation of medication-assisted treatment (MAT) to medication-assisted recovery (MAR),” Ginter believes that protecting the integrity of the organization must remain a priority.

    Sitting inside, away from the hot Los Angeles sun and the red carpet, Walter Ginter went into more detail about the early struggles that MARS™ faced. “Very few people come to MAT as their first course of treatment. In the vast majority of cases, they’ve already been to 12-step meetings, particularly Narcotics Anonymous. Although they initially felt welcomed at those meetings, those feelings shift after they start to work a program that includes medication-assisted treatment. Suddenly, you no longer feel welcome at the meetings, and this sense of alienation and rejection often leads to relapse. To fill in the resulting hole, we want MARS™ to give the same type of mutual support that 12-step provides. We want people on MAT to be embraced and accepted in recovery.“

    We asked Walter Ginter to detail this rejection in context. Scratching his chin, he said, “Look, telling people that they are not in recovery is evil. People on MAT were told that they couldn’t share in NA meetings since they weren’t really clean. By not allowing people to talk in meetings, they become alienated. However, it’s worse than alienation because it undermines what they’re doing to get well. The thought process goes something like this: If taking the medication that I need means I’m not in recovery, then why should I act like I’m in recovery? What does it matter if I do a line of coke on the side or have a drink?”

    Walter Ginter saw too many people on the verge of getting well through medication-assisted treatment subvert their recovery with this line of thinking and some other thought processes as well. Not wanting to take any chances, he set up MARS™ as a viable alternative both to treatment centers hostile to MAT and non-supportive recovery support groups like many NA meetings. In the past several years, MARS™ has had remarkable success with people on MAT. It has helped them find true recovery, a fact that has left initial opponents quite frustrated.

    In fact, Ginter ended our talk with a description of one of these encounters. As he told the following story, Ginter’s smile appeared again. “One day an opioid treatment counselor from a local New York rehab burst into my office and banged her fist on my desk. She said ‘What kind of voodoo are you doing here?’ Surprised by such an accusation, I replied “Excuse me?” She went on to explain: “Well. I have a client that wouldn’t stop doing coke. She would get off the heroin, but she always tested positive for cocaine. Since she’s joined your program, now she’s not only off the heroin, she’s no longer testing positive for coke or any other drug. How did you make that happen?’”

    Ginter shook his head as if he’d gone through the same rigmarole many times before. He describes how he sat the recovery counselor down and explained to her quietly: “There’s no magic or voodoo or anything else. We simply gave her medication that worked while telling her that she was now in true recovery. We gave her a vision of medication-assisted recovery, then let her make her own choice. She realized on her own, ‘Well, now I really can be on medication and in recovery. However, I can’t be in recovery if I’m still doing other drugs on the side. Today, I like being in recovery and the future it promises, so I’m going to stop doing the coke. Indeed, I will embrace this path that is set before me.’” 

    Given the promising picture that he painted, it makes perfect sense that Walter Ginter was honored with the Special Recognition Award at the 2018 SAMHSA Voice Awards. After all, how many people are dedicating themselves in such a precise fashion to saving lives by shifting perspectives and offering a viable alternative like Medication Assisted Recovery Support (MARS™)?

    View the original article at thefix.com

  • Language Matters: A Recovery Scientist Explains the Impact of Our Words

    Language Matters: A Recovery Scientist Explains the Impact of Our Words

    If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset and believe they cannot improve or change?

    Over 21 million Americans have substance use disorder and fewer than 3.8 million individuals receive treatment each year. 28 percent of the individuals who need treatment, but do not receive it, report stigma as a major barrier to accessing care. If we want to destigmatize addiction — a highly stigmatized disorder — then we need a unified language.

    The words we use have been shown by researchers to not only negatively influence our attitudes toward people in recovery and people who use substances — to the extent of suggesting that a health condition is a moral, social, or criminal issue — but they also impact access to health care and recovery outcomes.

    This article isn’t a mandate for everyone to start policing language, but it was motivated by a genuine desire to look at the evidence: how we speak to someone with substance use disorder matters. In the midst of a public health crisis, we can’t dismiss the use of language as just semantics, trivial, or being overly politically correct. We don’t have that luxury when 64,000 Americans die from drug overdoses each year and over 88,000 die from alcohol-related causes.

    Building upon an already existing foundation of work in this field, recovery scientist and researcher Robert Ashford and colleagues conducted a larger study of the general public measuring both implicit and explicit bias elicited by certain common words and phrases, which was published in June. I was fortunate to speak with him about the study, the impact of language, and how we can apply this information to help fight stigma.

    The Fix: Let’s say you’re among peers in recovery and you refer to yourself by a term which your study has shown to be a derogatory, like “addict,” “alcoholic,” or “substance abuser.” How does that contribute towards the stigma those in recovery face?

    Robert Ashford: This is an interesting question, and one from an evidence perspective, we don’t have exact answers on. Anecdotally, we believe that even though it is probable that this type of language has an impact on things like self-stigma, self-esteem, and a sense of self-worth, it is more important that people have the right to label themselves as they choose, especially as it concerns the recovery community. The fact is that the use of pejorative labels has had a decades-long place in popular mutual-aid programs like AA and trying to tell the mutual aid recovery community what to do isn’t a goal, nor should it be in our minds. At the end of the day though, it is important for people in recovery to understand that the use of such labels may become internalized over time, leading to decreases in self-esteem and such. However, without more evidence, it is merely hypothetical at this point.

    In what ways does it impact their lives? For example: their access to, and quality of, healthcare?

    Generally, the use of terms such as “substance abuser,” “addict,” and others have been found to be highly associated with negative attitudes (i.e. bias) in the general public, among behavioral health professionals, and in medical professionals. These negative associations ultimately lead to all types of stigma (social and professional) and ultimately to very explicit discrimination. On a personal level, we know that just over 25% of individuals with a severe substance use disorder don’t seek treatment each year due to the belief that they will be stigmatized or discriminated against by their friends, neighbors, or employers. Additionally, this type of bias has also been found to decrease the willingness and efficacy of medical services delivered to patients that have a severe substance use disorder. Access and the quality of treatment in the United States has many barriers and enhancing those barriers through the use of language is an easy fix – just by changing the way we talk!

    What would be an alternative, less-stigmatizing term?

    Any term that puts the focus on the individual as a human is bound to be less stigmatizing. For example, individuals are not “addicts” or “substance abusers,” but rather, “people with a severe substance use disorder” or a “person who uses substances.” Language changes constantly, but the one commonality in terms of bias and stigma seems to be that when we can restore or focus on the humanity of an individual through our language, we will be speaking from a better place.

    How might that term be more empowering to the individual, and in what ways?

    As a person in recovery, I can speak personally that when using terms that are rooted in humanity, I get a better sense of myself and the conditions that I have either lived with or am living through. Often times when we are in the midst of a severe substance use disorder, faced with a constant barrage of language that is meant to disempower and dehumanize, we began to internalize those labels. While it is possible in certain settings that these terms are used as a reminder of a previous identity – intending to provide some sense of catharsis in the recovery process, or a mechanism for not returning to a previous state – I think it is equally plausible that we can be reminded and have that benefit by using terms that don’t immediately degrade our very essence as people.

    I’m curious how a growth mindset versus a fixed mindset might inform our choices of words? Corollary, how does each mindset inform how we interpret what we hear from others?

    This an interesting question, especially in applying the growth and fixed mindset theories from childhood development and education to the field of substance use and recovery. The theory suggests that those who believe they can improve or change (growth mindset) are more likely to engage in activities that allow them to grow, and those that believe they cannot improve or change (fixed mindset) or less likely to do so. In the context of recovery and substance use, this has immense potential to inform how language truly does impact individuals in or initiating recovery. If a person has internalized the negative stereotypes associated with being “an addict,” are they more likely to have a fixed mindset? While there are surely myriad reasons for the challenges faced by people with a severe substance use disorder, mindset may indeed be a big part of it.

    You’ve done an incredible amount of work in educating both those in recovery and clinicians about the importance of the language we use. Some of your research features infographics about negative language and presents a positive alternative (below). For those who may need further clarification, what is the difference between pharmacotherapy (or medication to treat substance use disorders) and medication-assisted recovery?

    The infographics we made from our results have sure inspired a lot of conversation – which is exactly what we hoped for as scientists! One of the constant topics has been around “medication-assisted treatment,” “pharmacotherapy,” and “medication-assisted recovery.”

    Pharmacotherapy is the use of medications to treat a disorder/disease/ailment – specific to our field, this would imply treating a substance use disorder with medications. The term had significantly more positive associations than a similar term, “medication-assisted treatment” from our tests and we wanted to make the suggestion to use it instead.

    “Medication-assisted recovery” on the other hand can be considered the use of substance use disorder medications, combined with the use of recovery support services such as MARS recovery meetings, engaging with a peer recovery support specialist, utilizing a recovery community organization, or attending a MAR-friendly 12-step meeting. The biggest difference is that not everyone who uses substance use disorder pharmacotherapy wants, or would consider themselves, in recovery. Keeping the two terms separate gives people an option, and from a research prospective, both terms are associated with the positive and their use isn’t likely to elicit implicit bias among the general public.

    Figure: Suggested Recovery dialects


    View the original article at thefix.com