What happened at the end of you stay at rehab?
Very likely you had a graduation ceremony. It may not have been an elaborate affair. While you did not walk across a stage when your name was called to receive your rehab diploma, you may have had one final group session where graduation coins were handed out. These coins are similar to the yearly coins given out in 12-step groups to mark multiple years of recovery. The bigger question is, did you see a doctor before leaving? Did a doctor provide medical treatment to be continued after leaving rehab?
Naltrexone is safe
Naltrexone is an opioid receptor blocker. It does not in any way stimulate the opioid receptor. Therefore, it does not cause any sort of high feeling. Naltrexone is a non-addicting and non-controlled medication. Yet, it is known to be highly effective in treating both alcohol addiction and opioid addiction. The limitation in starting naltrexone for opioid addiction is that the patient must be opioid-free for a week or two before starting. In a residential rehab program, where the patient has been detoxed, this is a perfect setting to initiate naltrexone treatment.
Naltrexone is effective
Naltrexone has a success rate of at least 50% in treating opioid addiction. This is compared to success rates around 10% for traditional rehab abstinence-based treatment. The high success rate of naltrexone in medication-assisted treatment for opioid addiction is on par with buprenorphine, the ingredient in Suboxone. Buprenorphine is quickly becoming the gold standard of opioid addiction treatment. This is because it can be started more easily in a regular doctor’s office. Studies of naltrexone for alcoholism have had outcomes as high as 78%. For patients in rehab who are in a long-term controlled environment, why not use naltrexone instead? Patients leaving rehab need to be seen by a doctor. This option must be discussed with patients who may benefit from it.
Naltrexone is cheap
It is important to note that naltrexone is available as a generic tablet that costs about $30/month for patients who take it daily. The monthly injectable form, Vivitrol, is very expensive and often patients are unable to continue it for a long enough time period if they can even get it in the first place. Naltrexone tablets are more accessible and they work about as well as the shot. A patient can take naltrexone every day for less than the price of a cup of coffee.
Naltrexone is available
Nearly all pharmacies carry naltrexone. Filling a prescription for naltrexone is no more difficult than filling a prescription for an antibiotic or blood pressure medication. Since it is non-controlled, some of the additional procedures of filling controlled prescriptions, such as Suboxone, are not required. Doctors should have no problem prescribing naltrexone to patients where there are no contraindications and pharmacies should have no problem filling this affordable and readily available prescription medication. In fact, there has been activity in Washington, D.C directed towards making naltrexone an over-the-counter drug.
Naltrexone works. It is a real evidence-based medicine.
Naltrexone is a proven therapy that has been studied for decades. Patients who are given this effective medical treatment do better in staying clean and sober. This does not mean that support groups cannot help as well. And, it does not mean that therapy should be avoided. Psychological therapy provided by an experienced psychologist is an important component of evidence-based treatment.
Why didn’t your rehab offer Naltrexone after graduation?
There are many reasons why rehabs are not providing this safe, affordable, and effective medical treatment after rehab. Unfortunately, in the US, there is a strong culture of relying on the Alcoholics Anonymous 12-step, abstinence-based protocol. This can be misguided. There are proponents of the 12-step philosophy that will say that even taking aspirin is a relapse. While most 12-step members would not agree with that, they would generally agree that medication should not be used to treat addiction. The fact is that in many cases, medication provides the best chance for success. Naltrexone is no more dangerous than aspirin. Just like a daily baby aspirin can prevent a heart attack or stroke, naltrexone can reduce the chances of a deadly relapse.
Ask the medical director of your rehab if you will be getting a prescription for naltrexone. If not, why not?
It is time for patients and their families to become educated and proactive. There are excellent books on the subject of addiction treatment, written by scientists and medical doctors. Two excellent books written by M.D. psychiatrists are The Sober Truth, by Lance Dodes, M.D., and Overcoming Opioid Addiction, by Adam Bisaga, M.D. Patients and their loved ones can start to ask educated questions of the rehab staff. In fact, the best time to ask these questions is before admission. What kind of therapy is provided specifically? What medical treatments are provided? How often will the patient see a psychologist? A psychiatrist? A family practitioner or internist? What medications are prescribed to patients when they leave rehab? What medical follow-up plan for continuity of care is provided?
Aftercare should be more than just group meetings.
Most rehabs provide aftercare. This means going to regular group meetings at the facility. What about medical aftercare? Do they provide followup doctor visits? Even if this would be cost-prohibitive, the rehab programs could at least work with medical doctors in the community and psychologists to ensure ongoing care. Even if your rehab does not provide this sort of full aftercare solution, this does not mean that you cannot get ongoing medical care for addiction. There are many psychologists experienced in addiction treatment and medical doctors who can provide medical therapy for alcoholism and addiction. In fact, if you are looking for a doctor to prescribe naltrexone, it does not have to be a psychiatrist or addiction specialist. Any doctor who prescribes basic medications can prescribe naltrexone.