Two young men sit in a car outside a church or union hall where they just attended a Narcotics Anonymous meeting. Both men are addicted to heroin. But they haven’t used the drug since they finished a residential treatment program a week or so earlier.
“This happens a lot, there’s the two of us sitting together,” says Jeremy Wurzburg, a thin, pale 21-year-old who became addicted to heroin two years ago.
“We both," Wurzburg pauses, "we’re not sure whether we’re going to use or not and someone makes like a half joke: ‘We could just go out and drink right now’ or something and the other one’s like, ‘Yeah, let’s do that, sounds good.’ And then it’s off."
That moment, for Wurzburg, could lead right back to his drug of choice, heroin. Most recovery programs, he says, don’t — and maybe can’t — prepare patients in early recovery to fight that urge alone.
“Once I got out of treatment into the real world, it was a big shock,” Wurzburg says. “It’s easy not to use while you’re in rehab. It’s not put in front of you or anything. But then once I got out into the real world, it’s like, I had the knowledge of what to do, but I didn’t have the, those skills yet, or the tools to say 'no.'”
Of patients addicted to heroin who stop, 40 to 60 percent relapse within the first year. For many it happens soon after finishing a recovery program.
'Custom-Tailored' Recovery Help
The next time Wurzburg walked out of a treatment facility, he stepped into a new young adult recovery program. It's a one-year pilot project at Gosnold, which runs a network of addiction treatment services on Cape Cod.
Wurzburg agreed to live in a sober house, attend daily 12-step group meetings and get individual counseling. Participants can download a smartphone app that has a panic button, a list of addiction services and GPS tracking if patients want their coaches to know when they are near common heroin sale and use sites. There are group trips to ski, hike and listen to the symphony. Perhaps most importantly, Wurzburg has help daily, sometimes hourly, from a recovery coach.
"[We show patients] how to manage their emotions, how to fill out job applications, how to go to meetings, how to take care of themselves, how to go back to school," says Wurzburg's coach, Kristoph Pydynkowski, who calls himself a "cheerleader, beacon of hope."
Pydynkowski himself has been off heroin for seven years.
“Our job is to replace the old positive feeling about getting high with a new positive trigger point for recovery.”Coach Kristoph Pydynkowski
He ticks off the list of things he and Wurzburg do together. There are the visits with Wurzburg’s parents. Pydynkowski helps Wurzburg manage his mom’s to do list: find a doctor, get your car inspected. Pydynkowski flew to Los Angeles with Wurzburg for a reunion with Wurzburg’s twin brother. The two men meet often at 6:15 a.m. for coffee before a 12-step meeting. They go fishing, hiking and kayaking; Wurzburg loves the outdoors.
"Our job," Pydynkowski says, "is to replace the old positive feeling about getting high with a new positive trigger point for recovery." He glances at Wurzburg and smiles. "There is life after drugs."
Pydynkowski helps the 10 patients he manages create and follow a weekly recovery treatment plan.
"This is really hands on," he says. "It’s really custom-tailored for the patient and their needs at the time."
Gosnold director Ray Tamasi says this aggressive approach is paying off. Tamasi compared the medical records of 54 18- to 28-year-olds one year before, and one year into, the pilot program. There was an 83 percent reduction in admissions to rehabilitation facilities for the one-year-in group. Emergency room admissions went from 16 to one. There were no new legal offenses.
Several foundations (Tamasi did not want to name them) funded the Gosnold program at a cost of $310,000. Tamasi says the program saved 37 percent because fewer people spent time in rehab.
"Think about the cost benefit," Tamasi says. "If at 19, you're cycling in and out of treatment, but there's an alternative — going back to school and living life."
He looks across a desk at Wurzburg and 19-year-old Brittany Pimental, who is also in the program.
"This makes sense economically, and it makes sense simply from the value we place on the human life," Tamasi says.
And it may make more sense than just increasing the number of beds in recovery facilities, he says, "because you can’t just keep people in beds all the time. They have to come out at some point."
Pimental, a small woman with long dark hair, had one relapse before joining the young adult recovery program. "I thought I could do it [recovery] on my own," she says. "It didn't work out."
Pimental, who is from Falmouth, is trying to create a drug-free life in the same town where she had a network of friends and a boyfriend who used heroin. Pydynkowski, she says, really helps. He stops by her sober house. She sees him at the gym. He's in touch with Pimental's mother.
Treat It Like A Chronic Disease
Recommendations out this week from a task force on opiate abuse include more peer support and home-based counseling. Health insurers and state Medicaid leaders say they will look at funding for recovery coaches, but there is no plan to do so right now.
Across the country, there’s growing interest in using recovery coaches to help heroin users stop, says Robert Lubran, director of the division of pharmacologic therapies at the federal Substance Abuse and Mental Health Services Administration. At least one state, New York, is paying for coaches to help treat addiction through its Medicaid program.
"This is an evolving field," Lubran says. "[We are] learning more and more about the best ways to treat addiction and certainly the use of peer counselors, or peer coaches, has become more and more widespread."
The use of coaches is built on the idea that addiction is a disease patients will deal for life.
“We [in the substance abuse community] certainly see addiction to a whole set of substances as a chronic condition,” Lubran says. “There’s a growing body of evidence that it is not an acute condition, so much as a long standing chronic disorder that requires lengthy treatment.”
But that may not be true for all patients.
“Only about 30 percent continue to have problems for years and years,” says Dr. Richard Saitz, chair and professor of community health sciences and medicine at the Boston University School of Public Health. The other 70 percent will have one episode, “which may last for a few years, and then they’ll be in recovery,” says Saitz.
“Men and women with a strong family history for substance abuse are at higher risk for the chronic form of this disease,” Saitz says. For these patients, he says it’s important to call addiction a chronic disease so that it will be treated by primary doctors in a general medical setting, not just in rehabilitation facilities.
“We should be looking at [addiction] just like other conditions that we manage,” he says.
These days, when doctors and nurses are often on a budget, and urged to keep patients healthy to save money, they have a financial incentive to consider addiction along with everything that affects a patient’s health.
Pydynowski is teaching his patients, Wurzburg and Pimental, to treat addiction as they would hypertension or diabetes.
"[It's like] taking insulin, watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill, making sure I’m taking care of myself," Pydynkowski says. "This is the same thing."
Wurzburg is managing his recovery one day at a time and making headway. He’s applying for jobs at gardening centers and planning to go back to college.
"[My focus now is on] learning life skills and feeling like a productive member of society," Wurzburg says. "I didn't get clean to just live in a sober house, use food stamps and welfare. I want to feel like a productive member of society."
Wurzburg tugs at his fingers and shifts in his chair.
"I'm just trying to keep doing a little better than I did yesterday," he says.