At Gateway Rehab, New Medications Offer Additional Hope to Those Struggling with Addiction

By Nancy Kennedy

Several new medications for the treatment of persons with addiction are advancing the highly regarded addiction treatment program at Gateway Rehabilitation Center. Gateway has always been in the forefront of addiction treatment, as both a regional leader and as a nationally recognized center of excellence. Now, says Neil Capretto, D.O., F.A.S.A.M., an addiction medicine specialist and Gateway's Medical Director, the treatment team has additional, highly effective "weapons" with which to help the people who seek their expertise. Those medications – naltrexone (Vivitrol) and buprenorphine (Suboxone) – are transforming the treatment of addiction, as overdose deaths are soaring. "Untreated, addiction can kill you," says Dr. Capretto. "In 1985, when I was starting out in this field, there were 22 overdose deaths in Allegheny County. In 2014, there were 306. That's five times the number of traffic fatalities. In the surrounding counties, the rates of increase are even higher." Nationally, overdose deaths from heroin increased 300% between 2003 and 2013, and overdose deaths from prescription opioids such as Vicodin have increased 92% (Centers for Disease Control).

At Gateway, addiction is viewed holistically, as a "biophysical-social-spiritual disease." Such a complex, multifaceted condition demands a treatment approach that recognizes this and matches it, by bringing together a range of services within a comprehensive program. According to Dr. Capretto, Gateway's addiction treatment program addresses the whole person and the intricate factors – genetics, environment, mental health, physical health and family history among them – that converge to create it. Dr. Capretto regards addiction as a chronic, lifelong condition that must be managed on a daily basis: "We don't cure addiction. It is a chronic disease. You have to follow up and you will have to deal with it every single day by working an ongoing program of recovery. And, those who do describe the rewards of recovery as being a very positive, life-transforming experience."

Addiction treatment is too often fragmented, Dr. Capretto says. "Although one piece of it may be helpful, the best outcomes are achieved when the various elements are combined." Gateway's program includes individual counseling, group counseling, and family therapy; detoxification services and medical care; problem-solving skills training; and optional pastoral counseling. Suboxone is part of that treatment program, when indicated, but is not a stand-alone treatment. "When we are asked, 'Do you have a suboxone program?' the answer is no, we have a comprehensive addiction program and suboxone may be added to an individual's treatment when we believe they could benefit from it. Suboxone is a partial opioid and has many benefits: it can help with recovery and help the person maintain recovery. It is used to detoxify addicts and it can decrease overdose deaths. People with opioid addiction who have a tolerance to opioids do not get high on it. A dose closes off receptors and blocks other opioids, such as heroin and oxycontin, from working. If you are taking it regularly, it normalizes you."

Another tool utilized at Gateway Rehab is naltrexone, an opioid blocker. Dr. Capretto describes it as a long acting form of Narcan, the medication that reverses the effects of narcotics. Compliance was initially poor because the drug had to be taken daily and didn't last long. "A better form, called Vivitrol, came out. It's an injection that lasts one month. It quiets cravings by dulling the receptors and also blocks opioids from working. Before starting Vivitrol, the person must be off opioids for 7-10 days first. Vivitrol is transforming the treatment of opioid abuse. We have doubled or tripled our rates of success with it."

Dr. Capretto says that the problem of addiction is worse than ever before: "Addiction, especially addiction to opiates, is everywhere, in every community. It doesn't discriminate. Everyone today knows someone who died of an overdose; few families are unaffected. Unfortunately, the stigma of shame persists and is a formidable obstacle to treatment. No one wants to develop the disease of addiction. I've talked with thousands of individuals with addiction and never met one who wanted to be addicted.

"Addiction is a complex problem and it is extremely powerful. Drugs are more potent today and they are more available. It's extremely hard to stay away from drugs when you are surrounded by them. What we do at Gateway is set people on a course to manage addiction, for the rest of their lives. It's an uphill battle but now, when we enhance our treatment recovery tools with new weapons, including these medications, there is more reason for hope."

To learn more, visit gatewayrehab.org.