I want to share with you a remarkable music video by very talented musician Rick Hale, titled Descending, about his younger brother’s struggle with heroin addiction.
Make sure you watch it to the end as his brother Ryan makes a courageous appearance, putting his life in the public eye in hopes that his story may motivate others to avoid succumbing to the misery of heroin addiction.
In the past decade, overdose deaths from pain medicines and heroin have topped deaths from motor vehicle accidents in more than two dozen states.
With about 100 people dying each day from pain medicines and heroin, the need for solutions is greater than ever. The Food & Drug Administration that regulates prescription drugs (including opioid analgesics) has taken action in the form of Risk Evaluation and Mitigation Strategies (REMS) that I wrote about and posted on a friend’s Addiction Blog. If you have never heard of REMS, it’s worth reading the post. But REMS are risk management plans for drug companies that make pain medicines, and have nothing to do with heroin or addiction treatment. In fact, there is evidence that as pharmaceutical companies better control risks of pain medicines, including introducing more abuse-deterrent formulations, those hooked on pills will shift to the cheaper substitute of heroin. So how do we help those who struggle?
Overcoming Heroin Addiction
I have worked with numerous clients hooked on heroin and every case is a bit different. That said, my overarching treatment template remains the 5 Actions that I utilize for all addictions. This is because those who struggle with heroin/pills – perhaps more than other addictions due to the risk of overdose death – necessitate a holistic intervention approach. There are no simple solutions, one-size-fits-all treatments, or single programs or clinicians that can do everything necessary to help someone ascending out of the hell of heroin addiction. Instead, what is needed is a well coordinated team approach, involving at minimum the following intervention components:
- Housing and Food. Treatment makes no sense if basic needs are not met first. When I worked in a community-based treatment clinic I had numerous patients that lived on the street, and who would show up for help when the consequences of their behavior became too great. The work – often for weeks – was simply to help them secure safe housing, food, and a place where we could begin to add some structure into their life. I was a treatment professional, but my role at this stage of intervention was purely case management.
- Addiction Medication. For most with daily heroin use, the first-line treatment is methadone. While some still believe use of methadone is trading one addiction for another, this could not be further from the truth. A review by the prestigious Cochrane Group is worth reading if you have any doubts. That said, methadone is the most regulated drug in the U.S., which means patients have to jump through a number of hoops to obtain and stay on this medication at therapeutic doses. An alternative to methadone are buprenorphine products that can be prescribed from a physician’s office. The first to be approved by the FDA – Subxone® and Subutex® – are both now generic. The National Alliance of Advocates for Buprenorphine Treatment maintains a helpful website listing all the available buprenorphine alternatives and a nice brochure on using buprenorphine. You might be wondering which is better, methadone or buprenorphine? Check out this review, again from those helpful Cochrane folks, if you want to know the answer.
- Psychiatric Medication. While some programs that prescribe addiction medications also prescribe psychiatric medications, not all do. Yet most who struggle with addiction to heroin have other co-occurring mental health disorders that can benefit from pharmacological intervention. Although you may be tempted to skip this team member and have these medicines prescribed by your primary care physician, they are not specialists in psychiatric medications, and for this reason, I almost always use psychiatric nurse practitioners or psychiatrists that have the most knowledge of these medicines.
- Primary Care. Abusing drugs is hard on the body, and I make it my practice to ensure that all clients I work with have a primary care physician that can coordinate all necessary medical care. Many who struggle with heroin have infections, chronic pain, and other serious medical conditions that must be addressed for treatment to be successful.
- Dental Care. Often overlooked, dental care is critical to holistic healing from heroin addiction. One tooth infection can result in significant pain that can lead to relapse. What does the wise Ben Franklin say? An ounce of prevention is worth a pound of cure!
- Counseling. I know that counseling is involved in the above interventions, but here I am referring to long-term relational counseling that provides the necessary container, support and therapy for successful outcomes. Medications are critical, but so too is good therapy that resolves past traumas, provides developmental catch-up, and reduces shame. It’s counseling built on a therapeutic relationship that evolves over many months, and usually years. It’s core aim is what Freud said years ago, to get someone to engage deeply in the love and work of life.
In addition to the above list of intervention components, there are other things that I might add depending on the client, including a focus on: career, spirituality/faith, parenting, legal issues, money, and the list goes on…. The key point in all of this is that if we are to help someone successfully overcome heroin addiction, what is required is a lot of teamwork, multiple interventions over time, and someone who can optimally coordinate the entire shebang! Often this case management work falls on the primary counselor, but connecting the intervention dots really is work that should be shared by all stakeholders in treatment.
Unfortunately, this systems approach to care often does not occur. Releases of information never get signed, team members don’t talk with one another, and those who struggle with addiction end up experiencing the revolving door of treatment. The primary reason is that often no one person takes responsibility for coordinating the intervention components because it’s a lot of work, work that often is never billed (or insurance wants to pay for).
In sum, Rick’s song says it so clearly…
How much further can I fall
Getting higher as my life’s descending
Somethings taken over me
I’m not the man I used to be
I can’t take it if it’s never-ending
If we are serious about helping those who struggle with heroin addiction, and doing what we can to prevent overdose death, then it’s time we take treatment to another level.
I appreciate the addition of housing and food, as it is such an important element. I agree that treatment makes no sense if basic needs are not met first. My sister and brother-in-law are recovering addicts and I have seen the sacrifices that they have made in order it get drugs and almost always food and housing come last on their priority list- completely forsaking what a basic necessity it is.
Heidi M. says
I am wondering if the coordinated team approach would ever incorporate CAM therapies? I know that the scientific community generally discredits forms of alternative therapies such as acupuncture and transcendental meditation, but there is some promising research in terms of pain management and specifically acupuncture is becoming more respected as a healing art form. Is there research in what these therapies can do for someone fighting heroine addiction? I’m not sure meditation is useful in the early days of detox, but what about for someone that is on a therapeutic dose of methadone and is stabilized? I would like to think these “alternative” therapies could add another dimension to the coordinated approach.
John Fitzgerald says
Yes, basic needs always must come first. It’s crazy that still today there are many government agencies that withhold basic needs when addicts relapse, not realizing they are part of the problem. Thanks for you feedback!
John Fitzgerald says
Heidi, I believe strongly CAM must be incorporated into our approaches of helping people heal from addiction. You are also right that timing is important, and when to use particular approaches. Your feedback reminds me to write more about CAM beyond the posts I have done on mindfulness. Thanks!
I thought the music video did a great job shedding some light on the effects of addiction, not just on the addict but those around him as well. I found it interesting that Subxone as well as psychiatric medication was a good method for recovering drug addicts because I would expect that it would be best to get off of any dependency on drugs/medication, also the side effects associated with those drugs. But I’m sure it’s harder for heroine addicts to recover because their bodies physically become dependent on it compared to someone recovering from alcoholism for example.
I think the focus on basic necessities is essential to ones recovery, almost like starting a new life. I’ve heard of sober housing for those who are trying to recover from addiction, but I don’t know too much about it. I hope that the government or maybe non-profit organizations could provide help for those who would like to recover.
The music video does a great job of showing the consequences of addiction but I think it would have been great if they could provide a link in which Ryan can explain how he recovered from his addiction so that viewers could be more educated.
Cathy Steele says
Very powerful video, thanks you for sharing this with us. The United States is so buried right now with ignorance in regards to drugs and drug use, it becomes overwhelming.
In 1988, laws came into effect to punish those with position of illegal drugs. This has caused the United States prisons to overflow and with fear of imprisonment, people do not call for help when they are with someone who has overdose, in fear that instead of riding in back of the ambulance with their buddy to the hospital, they will be riding in back of a police car. So, it’s death of an overdose. We have to stop the insanity that these laws have brought upon us. Dr. Carl Hart on TEDMED has a video that he talks about what should be done. We have to give alternatives to drug use-Pull those out of poverty, giving them good jobs, Educate those who elect to use recreational drugs on the dangers of mixing other drugs and alcohol together- This is what causes the overdose’s of Heroin Decimalization illegal drug use – With decimalization and using education, we will save lives. I encourage everyone to watch this video.
John Fitzgerald says
Thanks for the comment and the video link! Good stuff
Abhinesh Phal says
This is true that we need to get serious about drug addiction. For instance housing and food it the basic necessities that we need in our life to move forward. If these needs are not met then how do we work on the problems which we are struggling within ourselves. The video is pretty powerful, and sends out a great message to help people who needs it the most. When there is no help out there and there is a mass amount of addicts who needs help are homeless and hungry. If these issues are not addressed first, the addiction portion to cure may be delayed.
WOW, the video that Rick made is phenomenal!!! Watching that video touched home way too much. I have a younger brother who has been fighting to stay in sobriety for the last 2 years and it has been a major struggle. I am going to show him this article and video to show him that he isn’t alone in his fight ( something I tell him everyday because I am here to help in anyway possible). John you said it perfectly in your article, “what is required is a lot of teamwork and multiple interventions over time.” Definitely there needs to be team work in helping anyone overcome any type of addiction. It can’t be a one person team there has to be several involved to help someone with such a hard process. Thanks for sharing this John, it was a great read and very insightful.
Sara Peterson says
This video was so true to the real world. What made it really hit home is that is the story of real people, not actors. I think people don’t understand that stuff like this really does happen.
John Fitzgerald says
Thanks for the feedback! The video is great :)
Shamsa Mohamed says
Words can’t explain how great the video was in my opinion. The video really touched my heart because addiction comes with consequences such as families separating. Families are unable to help in many ways for the most part due to the limitation that they have. As showed in the video families don’t have control over what happens outside of the house. John you did great describing the basics needs; such as house and food. I mean how do we expect people that are abdicate to get their life together if they don’t have a home to go to and food to eat, that’s like saying get to point B without having point A which is impossible. I also found your team work strategy very fascinating due to the fact that with team working together to help anyone is better than an individual.
Thank you so much for sharing
John Fitzgerald says
Yes, it’s a great video! Thanks for your nice comment.
I must say it was a great movie and yet sad ending. In my opinion, once a person got addicted, it will be hard for them to come out clean and the most important thing is family. Family need to be by that person’s side to help and support them. It is heartbreaking to see the family leaving that person without taking care of them. But overall, the movie was breathtaking and thank you for sharing it.
I really appreciated the music video because it created a sincere connection with me personally. My aunt had experience with the struggle of addiction and being a distributor for others. This addiction that she possessed happened after the destruction of her family life. Her husband developed abusive behavior towards her and her five kids were taken away from her. The feeling of a lack of support and love in her life caused her to go down hill. Even at the end of her addiction she was so depressed she attempted to commit suicide multiple times. Even though addiction did not take my aunts life I strongly believe that it helped contribute to her hitting rock bottom. This ultimate low she reached resulted in her passing three years ago. I truly wished that my aunt could have had treatment such as the system you have provided to help save her life. I really hope that this form of treatment can be executed successfully so many other lives may be saved and provide hope to those who struggle with their addiction. Thank you for sharing your story. It greatly touched my heart.
Watching this video literally made me tear up for two reasons. Firstly, I’m a new mom and it scares the hell out of me thinking that no matter what you do as a parent, you can’t always protect or guide your children to do right. The music video element with showing baby family clips was a phenomenal idea and made it that much more emotional. Secondly, my brother struggles with addiction. He’s had an ‘addictive personality’ ever since I can remember. He’s out of the military now, but struggles deeply with PTSD and tries to drown out his emotions with drugs and it kills me to see. I can’t believe the alarming fact that “overdose deaths from pain medicines and heroin have topped deaths from motor vehicle accidents in more than two dozen states. ” I had no idea. I like your 5 steps to overcoming addiction and absolutely believe it takes a village. Unfortunately, I see too many village members bail out because they don’t have the patience, education, or understanding that this is an ongoing process and not a one time fix it ordeal. Sadly, those dropouts tend to be more family members than not.
Thanks again for sharing your wise words and incredibly touching music video.
John Fitzgerald says
Thanks for your comment. It’s true that it takes a village, and that to keep family and other stakeholders – even treatment professionals – engaged, they must understand the big picture and how all the pieces fit together over time. It’s not easy, but maybe it’s not supposed to be.
Tyler Pemberton says
This video is an extreme eye opener of what many individuals are going through day in and day out. The fact that as a parent you can do everything in your power to raise your kids up to be respectful beings and make smart choices, however when it comes to making the correct choices parents have no control. After all individuals make their own choices. Not to mention the effects this has on families is devastating. I hope I never have to go through such a predicament. It is sad and scary all together.
Nasser Alandas says
It is so nice to have a guideline for addicts to follow, because serious heroine addicts need someone to guide them to the right way and show them the path to get over such horrible addiction. I really liked the list you have so far an I would love to see an expansion to such list. The idea of having housing and food as an element. Some people might think that this isn’t important but once you’ve become a heroine addict I feel like your life starts falling apart and you start living in a trashy environment so once an addict cleans themselves up and show that they are taking care of themselves is a huge step towards sobriety.
Richard Valenzuela says
This video really hit home with me since I have cousin (Who grew up like my brother) dealing with Heroin addiction. Family members including myself have tried to help him but in the end he seemed to have burned to many bridges with most family members. Just like in the video, my cousin has come to me for help and I have helped him out in the past. He has not come to for help lately because I know he thinks he is past help. I tell myself that if he did come for help but I would not help him but I know that I could probably help him. Just like in the video, I to find myself driving around the bad streets in my city looking for him when he has not been heard from in weeks.
This video is great in helping educating young people about the road that Heroin will lead you down.
Alex Bigus says
Though I saw the mention of both the classic methadone and newer partial agonists such as Suboxone, I’d be interested to know the writer’s feelings toward Vivitrol, the injectable naltrexone/naloxone mix. Having worked directly with all three of these medications in the field, the effects of Vivitrol were startling (though the cost of a single shot is equally startling). Was it left out due to its price and lack of widespread use? Naltrexone pills on their own, inexpensive as they are, still leave a wide open door for further use by just simply discontinuing the medication. Having made my career in addiction counseling, I can say that we in the trenches really hope to see more about this option and whether it is more than just smoke and mirrors.
John Fitzgerald says
Thanks for the comment. Perhaps I should have mentioned Vivitrol, so thanks for bringing it up! I do think it’s another good tool for some people, but as you point out it is not cheap. Some have suggested such meds create a two-tier system, where those with money can afford Vivitrol, but those with less funds are left using generic products like naltrexone, bup products, and methadone. But I know drug companies are often willing to work with folks on price if contacted, so that is always an option. While meds do help many people, overcoming addiction still requires a comprehensive intervention approach like the 5 actions that I outline on this site.
This is truly a very powerful video that can have a huge impact on todays society. I like how this is a story based on real people that have lived through this horrible experience instead of using actors. This video was very emotional for me and it really gets you thinking makes you not want to try drugs at all, because addition destroys everything and with it comes consequences of families separating. This is truly an eye opener of what many individuals in the world are going through day to day.