The first time Jeremy Wurzburg left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. But one week later, the skinny, pale young man was hanging out with a guy who was also in early recovery, experiencing what Wurzburg, now 21, has come to realize is a typical turning point for recovering addicts: two guys sitting casually in a car, poised to use drugs again.
"We're not sure whether we're going to use or not," he says, "and someone makes like a half joke – 'We could just go out and drink right now,' or something. And the other one is like, 'Yeah let's do that. Sounds good.' "
From that first drink, Wurzburg was quickly back to heroin, his drug of choice. Most recovery programs don't — and maybe can't — prepare freshly discharged patients to fight that urge on their own, he says.
High Relapse Rate In First Year Of Recovery
"Once I got out of treatment into the real world, it was a big shock," Wurzburg says.
Of patients addicted to heroin who are able to quit their habit, 40 to 60 percent relapse within the first year — often within the first weeks of finishing a treatment program, studies show.
Wurzburg is now in a new program aimed at young adults. It's a one-year pilot project run by Gosnold, a network of addiction treatment services on Cape Cod.
As part of the program, Wurzburg agreed to live in a household that doesn't allow the use of drugs or alcohol. He agreed to attend daily 12-step group meetings and to get individual counseling. Perhaps most importantly, Wurzburg now has help daily — sometimes hourly — from a recovery coach.
Coaches in the Gosnold program get much more involved in the lives of the people they're mentoring than the typical sponsor in a Narcotics Anonymous program would.
The recovery coaches show patients "how to manage their emotions," says Wurzburg's coach, Kristoph Pydynkowski — "how to fill out job applications, how to go to meetings, how to take care of themselves, how to go back to school." Pydynkowski, who also calls himself a "cheerleader, a beacon of hope," quit using heroin seven years ago.
Much More Than A Sponsor
Pydynkowski ticks off the list of things he and Wurzburg now do together: visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother, fishing and 6:15 a.m. trips to a coffee shop before attending NA meetings. Pydynkowski helps each of the 10 patients he manages create and follow a weekly recovery treatment plan.
Ray Tamasi, the director at Gosnold, says this aggressively supportive approach is paying off. His evidence? A comparison of medical records collected during the year before the program's inception to records collected in the year after its start. The comparison is striking. Fifty-four young adults (ages 18 to 28) who participated in the coaching program saw an 83 percent reduction in admissions to rehabilitation facilities during their year of intensive coaching. Emergency room admissions also dropped — from 16 in the year before the program, down to one during the year of coaching.
Coaching Costs Save States Money
Because fewer people had to be readmitted to rehab centers, Tamasi says, the program saved the state an estimated 37 percent in total outlay.
"Think about the cost/benefit," he says, "if at 19, you're cycling in and out of treatment, but there's an alternative — going back to school and living life."
The program makes sense economically, he says, "and it makes sense simply from the value we place on the human life."
And it may make more sense to state legislators than simply 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."
Gov. Deval Patrick's administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. A task force report recommended more peer support and home-based counseling. Health insurers and state Medicaid leaders have said they will look into funding for recovery coaches, but there is right now no plan in place.
New York and Tennessee pay for peer coaches to help treat addiction through Medicaid — something Massachusetts is taking a look at. The use of coaches is built on the idea that addiction is a disease that patients will deal for life, a disease that will be treated by primary doctors in a general medical setting, not just in rehabilitation facilities.
Pydynkowski is teaching his patients to treat addiction as they would hypertension or diabetes.
It's just like taking insulin, he says, "watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill — making sure I'm taking care of myself."
This story is part of a reporting partnership among NPR, WBUR and Kaiser Health News.
ARUN RATH, HOST:
You are listening to ALL THINGS CONSIDERED from NPR West. I'm Arun Rath. 40 to 60 percent of heroin addicts who stop using relapse within the first year. Many within weeks of finishing a rehab program. A treatment center on Cape Cod in Massachusetts says it is breaking the cycle by treating heroin addiction as a chronic disease that can be managed but not cured. From member station WBUR, Martha Bebinger reports.
MARTHA BEBINGER, BYLINE: The first time Jeremy Wurzburg, now 21, left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. One week later, he was hanging out with another person in early recovery, in what he came to realize is a typical turning point.
JEREMY WURZBURG: You know, this happens a lot. There's the two of us sitting together - like in my car after a meeting or something. And we're both kind of - we're not sure whether we're going to use or not, and someone makes like, a half-joke, you know what I mean? Like, oh you know, we could just go out and drink right now or something. And the other ones like yeah, let's do that - sounds good. And then it's off.
BEBINGER: From that drink, Wurzburg, a skinny, pale young man was quickly back to his drug of choice - heroin. Most rehab programs he says don't, and maybe can't prepare patients for that moment in the car.
WURZBURG: Once I got out of treatment it's the real world. It was a big shock because you know, it was really easy not to use when you're in rehab - it's not put in front of you or anything - but once I got out into the real world it's like, I had the knowledge of what to do but I didn't have that - those skills yet or the tools to say no.
BEBINGER: The next time Wurzburg came out of treatment, he graduated into the Young Adult Recovery Program - a one-year pilot project run by a network of addiction treatment services called Gosnold on Cape Cod. Wurzburg agreed to live in a sober house, attend a daily 12-step group meeting and get individual counseling. There's a smartphone app with the panic button and GPS tracking. There are group trips to ski, hike and listen to the symphony, and perhaps most importantly, Wurzburg gets daily, sometimes hourly help from his recovery coach. Kristoph Pydynkowski says he helps Wurzburg with everything.
KRISTOPH PYDYNKOWSKI: Like how to manage their emotions, how to go to meetings, how to fill out job applications, how to take care of themselves, how to go back to school - be a cheerleader - a beacon of hope, you know?
BEBINGER: Pydynkowski leans forward, ticking off the list of things he and Wurzburg do together - visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother - fishing and 6:15 a.m. trips to a coffee shop before Narcotics Anonymous meetings. It may sound like giving him so much attention would be very expensive, but the program is saving money because fewer participants are spending time in residential rehab. Every week Pydynkowski helps Wurzburg create and follow a recovery treatment plan. Pydynkowski argues that addiction must be managed for life like hypertension or diabetes.
PYDYNKOWSKI: Taking insulin, maybe watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill, making sure I'm taking care of myself - this is the same thing.
BEBINGER: New York and Tennessee pay for peer coaches to help treat addiction through Medicaid - something Massachusetts is taking a look at. Gosnold director Ray Tamasi says coaches are more effective in many cases than sending patients to an expensive rehab facility for weeks at a time.
RAY TAMASI: More beds is not an answer to addiction. You can't just keep people in beds all the time.
BEBINGER: To prove his point, Tamasi compared the records of 54 young adults in the pilot program one year before and one year after it began. There was an 83 percent reduction in emissions to rehabilitation facilities. Emergency room visits went from 16 to one. There were no new legal offenses. More than half of the participants are either working or back in college. Jeremy Wurzburg is in the framing department at an arts and crafts store and plans to resume classes towards a counseling degree.
WURZBURG: Just trying to keep doing a little better than I did yesterday.
BEBINGER: For NPR News, I'm Martha Bebinger in Boston.
RATH: That story is part of a reporting partnership between NPR, WBUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.