Sometimes for heroin treatment to work, it's the family that needs to change, not the addict.
Or so said some of the experts who spoke before the Madison County Heroin Task Force last week, primarily about family interventions as a method of getting an addict into treatment. An intervention takes place when family and friends meet with the addict to convince him that his disease is hurting himself and others, and he needs to seek help.
"Nothing works unless the addict wants it to work," said Rebecca Mowen, an addiction specialist with Recovery 360. "But we can shift the system, and we can make a difference. The intervention isn't always with the addict; sometimes it's with the family."
For example, Mowen said, convincing a mother that this time, she should not bail her son out of jail was very difficult. But by doing that, "the miracle happened" and he is now in recovery, Mowen said. "It wasn't by changing him, it was by changing her."
Mowen said the first thing is to set aside the reality TV show "Intervention," in which families allowed cameras to film their intervention efforts. It ran for 13 seasons and was canceled last year.
"An intervention is not a TV show," Mowen said. "It is not coercive; you cannot twist arms and make them do it."
Families considering an intervention have to set aside shame, anger and hurt; it cannot be about an ambush or declaring, "How dare you do this to us?" Mowen said.
Instead, she said, the intervention is about changing the system around the addict. It is about removing dependency and enabling behaviors that help keep the addict on the drug.
"You're just as much in the system as the addict is," Mowen said. "They're the eye of the tornado and they're anesthetized; they don't see the damage going on around them. If they start to feel, they use... You're going through the same thing the addict is going through, without the ability to anesthetize."
Instead, Mowen said, families need to follow specific steps in preparing for an intervention:
* Participants should be people who genuinely care about the addict. "We don't want someone who thinks it's just about willpower," Mowen said. "'All you have to do is stop' won't help. You don't want someone who's angry and can't set that anger aside ... It is a process founded on love and honesty."
* Each person writes a letter to the addict, which explains why you're there, shares love and concern and talks about good times as well as the bad things the addiction has created. The letter asks the addict to accept that love and concern, and take the chance being offered for treatment and help.
* The family and friends then rehearse the intervention, talking about what will be said and done. Each member will read his or her letter.
* Arrangements must be made in advance for treatment; the idea is to get the addict to go to treatment that same day. Families should anticipate all the reasons why an addict would refuse to go, and make arrangements for them: covering the rent, arranging child care and so on, Mowen said.
* Families should definitely consider hiring a professional, a social worker or addiction specialist or even a clergy member with training in addiction, Mowen said.
Everyone needs to know that addiction is a disease of the brain, medically substantiated and must be medically treated, Mowen said. And each family member needs to set a consequence for not entering treatment, one that they're willing to do.
In one case, Mowen said, a daughter informed her mother that while she loved her very much, if she did not seek treatment for her addiction, she would no longer be welcome at their home and would not have contact with her grandchild.
"If they decide not to go, it's not a failure," Mowen said. "You've changed the system; you've identified bottom lines."
Mowen said it's also important that the family continues to work on change while the addict is in treatment. Families need guidance, counseling and support groups to help them know how to deal with the addict before, during and after treatment. She said one 90-year-old woman had to go through her own therapy for codependency before she could stop enabling her 56-year-old son, who was by then incarcerated on drug charges.
But addicts also need to know that recovery is worth striving for, Mowen said. "We have to ... show them that the light at the end of the tunnel is not a train," she said.
Also speaking was Jared Opsal of the National Council on Alcoholism and Drug Abuse in St. Louis. His organization is part of the Not-Even-Once.com education program to raise awareness, particularly among parents and young people, of the dangers of heroin use and its increase. Overdose deaths in the St. Louis region numbered about 40 in 2001, but hit a high of 371 in 2011. In 2013, it had fallen slightly to 327 deaths.
More than half of heroin users were under age 30, and four out of five of them began by using prescription painkillers, Opsal said. Vicodin, a commonly-prescribed opiate painkiller, is "really just time-released heroin," he said.
"We've lost sight of the dangers that can be associated with that," said Opsal, who noted the legal painkillers came from a drugstore.
Opsal and Mowen said they have also worked on expanding education for doctors, many of whom base their prescription decisions on outdated information they may have learned in medical school. "Now we know the chance of addiction is much higher," Opsal said.
In 2011, a Belleville News-Democrat investigation found that drug overdoses were killing more metro-east residents than car crashes. About 70 percent of young overdose victims died of abusing opiods, which includes heroin and prescription painkillers.
In February 2014, three people died of heroin overdoses within six hours in Madison County. That was one of the factors that spurred Madison County State's Attorney Tom Gibbons and Sheriff Bob Hertz to form the task force, which has met several times to share information from health and recovery experts with law enforcement, education leaders, the medical community and the public.
"We keep hearing new things," Gibbons said. "We do want to distill it down at some point for real things we can do to make a real impact." He also took suggestions on future topics that would be of interest.
Opsal said since Not-Even-Once.com launched in 2011, there has been a small drop in overdose deaths. However, he said, it can't be solely attributed to their efforts. Treatment wait times are down and more paramedics are carrying anti-overdose medications, he said.