Capstone KFontaine 8.6.16F

Running head: OPIATE ADDICTION AND DRT’S 1
Opiate Addiction and Drug Replacement Therapies
Karen A. Fontaine
Cambridge College
BAM 490
Susan Brown, M.M.Ed.
August, 2016

OPIATE ADDICTION AND DRT’S 2
Table of Contents
Abstract……………………………………………………………………………………………3
Introduction………………………………………………………………………………………..4
Literature Review
Opiate addiction does not discriminate……………………………………………………6
Detox and a gap in next level of care………………………………………………...…....8
Housing issues for those on a drug replacement…………………………………………12
Stigmas associated with opiate addiction…………………………..……………………14
2012 Interviews – The voice of the opiate addict.…………………………………….…17
2016 Interviews - The voice of growth...………………………………………………...23
Conclusion……………………………………………………………………………………….29
References..……………………………………………………………………………….……...32

Abstract
Today’s doctors, addiction specialists and government agencies are providing opiate dependent
addicts with medication-assisted treatment and calling it Drug Rehabilitation or Pharmacologic
Therapy. They are luring countless addicts with no twelve-step recovery experience into a false
sense of assurance that they are clean and not under the influence of a substance that is affecting
their mind, body and spirit. This could not be farther from the truth. I intend to use a variety of
research sources, as well as the realism of personal interviews to investigate why this could not
be farther from the truth. The three interviewees share their adversities from opiate dependency
and discuss the complications of finding recovery housing due to the stigmas associated with
opiate addiction.

Introduction
It is shocking to hear that someone as young as 11 years old knows how to crush up pills
and snort the powder to get high, or to realize that this same youngster has watched an older
family member or advanced friend fix and inject heroin. Society’s dirty little secret is that heroin
addicts have been dying for years in the inner cities. Yet, society and the media only started to
take notice in 1999 when the numbers of prescription opioid deaths had quadrupled. That is the
same year when we began to hear about the 22 year old person who lived next door that died
after chewing a fentanyl patch.
When opiate addict shows up at detox, they are seeking immediate relief from active
addiction. They are displaying signs of being emotionally and physically exhausted and will
require both medical and clinical help to stop using opiates. During their initial assessment, a
determination will be made as to whether or not the facility will be able to meet their needs. If
they meet the criteria for admission, they will be able to start and complete their detox process.
Upon discharge, a gap in services is a common occurrence for the patient who just
finished a successful detox. A discharge plan was established before leaving the detox for the
patient who wants to be placed on the drug replacement therapy (DRT). The current detox
protocol is a five-day stay. Upon discharge, the patient who is leaving the facility is still most
likely experiencing post-acute withdrawal symptoms. Those symptoms include mood swings,
anxiety, irritability, sleep disturbances, tiredness, low enthusiasm, and poor concentration.
The undercurrent of experiencing this level of withdrawal, in turn, is often so miserable
that quite frequently the addict who wants to start a drug replacement therapy will not be
standing in line come morning at the methadone clinic to sign up for the program. The addict
will not make it to the scheduled appointment to receive instruction on what it will take to start

suboxone. That suffering addict is already on the way back to the street to obtain the drug of
choice in order to get relief from uncomfortable feelings. These choices will only enable the
progression of the disease.
Not all opiate addicts have a safe place to live once they leave detox. The cornerstone to
change is moving away from the people, places, and things that they have been associated with.
The stigmas associated with opiate addiction include not only the way society views the addicts,
but also the ways the addicts seeking recovery sees his or herself. A key element to the recovery
progress is self-empowering the addicts to rebuild their own dignity. Addiction is not a moral
failing. Rather addiction is a chronic illness. Working through 12-step program, along with the
healing benefits of one addict helping another helps save and rebuild lives.
In 2012 three recovering addicts gave their personal stories of what it was like to be an
opiate dependent addict and the choices provided to struggling addicts in association with a
DRT. Being homeless, destitute, and jobless only complicates the issues of finding stable, peer
based recovery housing after coming out of jail or detox, which is a common occurrence, and
also another gap in society’s understanding of what type of support an recovering opiate addict
needs. This is in addition to the stigmas associated with being afflicted with a disease society
sees as hopeless. In 2016 we catch up with the three original interviews to get a perspective of
the progress, if any they have made in the battle for a drug free existence.

Literature Review
Opiate addiction does not discriminate
Young, old and people of all ages are getting hooked on a highly addictive drug. It is
estimated over 1,000 people a day are being treated in emergency rooms (Reynolds, 2016). First
responders now have the ability to administer the opiate antidote, Narcan™ (Naloxone),
available in some states without a prescription. “A number of syringe exchange programs make
naloxone available to people who inject illicit drugs, which creates important linkages between
services that can help prevent both accidental overdose and the spread of HIV/AIDS, hepatitis
and other infectious diseases among people who use injection drugs. Expanding access to
naloxone: Reducing fatal overdose, saving lives” (“Expanding Access to Naloxone,” 2012, p. 4).
Thousands of opiate addicts’ lives have already been saved with the introduction and
administrative training of this antidote. Yet this “lifesaving medication is not a cure. After it has
done its job, overdose survivors are left with their cravings intact” (Schuppe, 2014, ¶ 2).
White (2009) stressed the importance of “understanding opioid addiction as a genetically
influenced chronic brain disease requiring prolonged, if not lifelong, medication support to
ameliorate the profound, persistent, recurring, and potentially permanent metabolic changes
resulting from addiction to heroin or other short-acting opioids” (p. 4). It is now understood that
opiate/heroin addiction is a metabolic disease; the occurrence of a chemical change has taken
place in the brain. “After prolonged opiate use, the nerve cells in the brain, which would
otherwise produce endogenous opiates (natural painkillers or endorphins), cease to function
normally. The body stops producing endorphins because it is receiving opiates instead. The
degeneration of these nerve cells causes physical dependency to external supply of opiates”
(Rackley, 2010, p. 15).

Because of the degeneration of these nerve cells, along with the physical dependency on
an outside supply of opiates, many opiate addicts who leave detox are electing to take a drug
replacement therapy (DRT) in order to control their physical dependency. Often they
underestimate repercussions of taking a substitute that has the potential to become just as
addictive, mood and mind altering as their drug of choice will, over time, develop into yet
another drug that they will need to detox from. There is growing evidence to suggest a
relationship between people who are prescribed pain medication and those who end up addicted
to opiates such as heroin after abusing prescription opiate analgesics. This “growing opiate
abuse epidemic has highlighted the need for effective treatment options... -long-term use of
opiates is defined as using the drug for at least several weeks or more on a regular basis which
produces changes in the brain” (‟FRN Research Report,” 2012, p. 1). The person who has
awakened the disease of addiction will find the ways and means to get more despite the fact that
it will make them …‟hostile, resentful, self-centered and self-concerned, cut off all outside
interests as their illness progresses” (Another Look, 1992, p. 1) despite the consequences that
await.
Dependence on pain medication can become very costly for the individual who does it by
obtaining illegal scripts. A growing number of people who once received prescriptions will end
up turning to the street drug heroin to support their habit because there is such a difference in
price. The issue with using an opiate such as heroin is the body will adjust itself to the amount
the addict is consuming. The quandary becomes not only is the person not getting relief from
any pain they were experiencing but also they are beginning to experience a euphoria that creates
a feeling of being high. This is when the disease of addiction becomes more of the problem as
the obsession and compulsion to feed the need to get high is the “result is dependence,

characterized by the need to continue to use the drug to avoid withdrawal symptoms” (“Drug
Facts: Heroin,” 2015, ¶ 7). That leaves the strung out addict with no options except to enter a
detox for help once they have run out of the means to get more, or have overdosed and are forced
into receiving help. In recovery that cycle is known as a God shot or when your God does for
you what you cannot do for yourself.
Detox and a gap in next level of care
Detox centers are a revolving door for opiate addicts in the United States. The struggle
and relapse rate of an opiate dependent individual measure those addicted to other substances.
An estimated 22.5 million Americans aged 12 or older were current (past month) illicit
drug users, meaning they had used an illicit drug during the month prior to the survey
interview. This estimate represents 8.7 percent of the population aged 12 or older. Illicit
drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens,
inhalants, or prescription-type psychotherapeutics (pain relievers, tranquilizers,
stimulants, and Sedatives) used nomadically. (“National Survey,” 2011, p. 1)
The number of opiate/heroin users has almost doubled in four years. “In 2011 (620,000)
individuals were addicted to opiates which is considerably higher than (373,000) in 2007”
(“National Survey,” 2011, p. 1). Today the numbers are staggering. Opiate dependent addicts continue
to grow “Of the 21.5 million Americans 12 or older that had a substance use disorder in 2014, 1.9 million
had a substance use disorder involving prescription pain relievers and 586,000 had a substance use
disorder involving heroin” (‟Opioid Addiction 2016,” 2016, ¶ 4).
More than ever before there is an urgent need for more effective treatment services. Programs
that service opiate dependent addicts must take the lead and fix the gap in the next level of care that
currently exists. “Drug overdose is the leading cause of accidental death in the US, with 47,055 lethal

drug overdoses in 2014. Opioid addiction is driving this epidemic, with 18,893 overdose deaths related to
prescription pain relievers, and 10,574 overdose deaths related to heroin in 2014” (¶ 6).
Upon arrival into detox, opiate users are given a few options for treatment. They are
asked if they want to detox using “Methadone, Buprenorphine or opt to go with comfort
medications such as Ativan” (C. Ely, personal communication, June 25, 2016). Within three
days, a discharge plan is discussed. The plan includes continuing on the DRT that was used
during their detox to withdraw from the original opiate. If the addicts choose a DRT as part of
their detox, they must have the understanding it is only being used to stabilize their withdrawal
symptoms and assist with a successful discharge in starting their recovery journey free from
using illegal opiates such as heroin.
But this is where the gap begins. They are being discharged after successfully
completing their detox but they are still in withdrawal. “In order for the addict to obtain a
referral to get the replacement therapy, they must wait for an intake appointment which can take
up to one or two weeks due to the demand. This is where the recidivism rate is increased
because the risk of relapse is great” (C. Ely, personal communication, June 25, 2016). Another
gap is the transition into safe, secure housing. “Programs such as Basic Needs are in place but
the addict must be enrolled in either an outpatient treatment or 1:1 counseling and they are
relapsing before they can even make their first intake appointments to get the help that is
available” (June 25, 2016).
“At one time, it was common to detox from opiates without much of a choice except
methadone and a benzodiazepine with a longer stay of seven to 10 days. This ensured a full
recovery from withdrawal symptoms” (C. Ely, personal communication, June 25, 2016). Today,
the common methods of detox only include “one replacement therapy drug without any comfort

medications except sleep aids given during evening med-pass. It is also common for the length
of stay to not exceed five days and more unless you are in alcohol withdrawal. Any patient who
needs more than what the detox is able to assist with during their withdrawal, is usually
discharged to the emergency room or patient will opt to discharge early against medical advice
(June 25, 2016).
If a patient has remained strong enough to follow through with their appointment for
aftercare, the DRT programs i.e. methadone and Suboxone clinics awkwardly will not start the
client on their first initial visit. “Consumers of DRT’s are typically required to attend two or
three appointments in a row, to show their motivation and dedication to their recovery process
and the replacement program. Frequently an addict looking to continue therapy will wait up to
seven days before seeing a medical doctor and/or psychiatrist, which is a requirement before a
prescription is dispensed” (C. Ely, personal communication, June 25, 2016).
Once they have been seen, then they can start their programs. Aftercare routinely
includes the disadvantage of daily trips to the methadone clinic and/or Suboxone clinic. Going
to the methadone clinics encompasses getting up as early as 5:00 a.m. and heading over to the
clinic where they most commonly stand in long lines in order to receive their daily dose of what
some call government juice. “In order to receive take-home bottles of methadone, the addict
must earn this usually by attending regular groups, clean urine screens over 90 days and active
participation in 1:1 counseling”. (C. Ely, personal communication, June 25, 2016).
Today, doctors have greater freedom to prescribe Suboxone. It is then easier for persons
on a prescription to take their daily dose at home and not have to deal with “a highly-regulated
federal program such as a methadone clinic” (Stukart, 2015, ¶ 5). Those on Suboxone are also
required to attend all appointments and groups prior to receiving their prescriptions for usage at

home, typically without any supervision. “It is much quicker to get prescription for usage at
home with Suboxone therapy vs. methadone” (C. Ely, personal communication, June 25,
2016). “Both these methods are considered as a Harm Reduction model of treatment” (C. Ely,
personal communication, June 25, 2016).
The advantage of taking a DRT is the obsession and compulsion called a craving has
somewhat subsided, which giving the opiate addicts the ability to maintain more of a normal
existence with in society. Rackley (2010), made an important point when he stated “These
people are not (drug addicts) in the stereotypical sense, but people with real medical conditions
who find themselves in the same situation as drug addicts” (p. 14). Rackley went on stating,
“opiate dependency was once viewed as a condition with no solution” (p. 14).
One drawback of using Methadone is that “Methadone causes dependence, but—because
of its steadier influence on the mu opioid receptors—it produces minimal tolerance and alleviates
craving and compulsive drug use” (Kosten & George, 2002, ¶ 25). “While Suboxone is used in
the treatment of addiction, the drug itself can lead to tolerance and dependence; suddenly
stopping use of Suboxone can elicit unpleasant withdrawal effects, and prove much more
difficult to quit than thought” (Patterson, 2013, ¶ 7). Ironically Suboxone was intended to assist
them in learning how to live a clean lifestyle that would eventually, hopefully lead them to
becoming substance free; yet many end up abusing even their medication which is intended to
help them.
Housing issues for those on a DRT
Recovery housing is exactly what it sounds like. “It’s a place people can go when they
first come out of rehab; somewhere to live, drug-and alcohol-free. Residents take drug test,

attend 12 step meetings and have curfews to keep them on the straight and narrow” (Gross, 2013,
¶1)
It was not uncommon in the 80’s, 90’s and early 2000, for someone on Methadone (the
primary replacement therapy), to be denied a bed in a recovery house as they were considered to
be on a mood or mind altering substance. During that period of time, a good deal of Connecticut
recovery housing stemmed from 12 step recovery group members who then and still today
believe it is a conflict with the 12 step program to be on DRT. You were not considered clean
from all mind and mood altering chemicals as their literature states.
The reasons why people open recovery housing or what they now call sober homes have
changed. There are still those who are community activists and who have a sincere interest in
helping the addict who still suffers and believe in other pathways to recovery. Then are those
who have come to realize that recovery housing and “sober homes have become a lucrative
business,” (Gross, 2013, ¶ 2). There is an endless supply of addicts looking for housing after
they have finished a rehab or detox.
Today it is not unusual to find addicts on a DRT who live in housing with addicts who
are substance free and have less than 30 days clean. This presents a predicament for those who
are clean from all mind and mood altering chemicals. But this is also a dilemma for those on the
DRT who are new to recovery and do not understand this form of treatment presents a problem
for those who are clean from all substances.
There is a stigma involved for those in recovery who are taking DRT. Their housemates
consider the drug replacement as a substance that is mood and mind altering and manifests as an
opiate. This becomes a no win situation for the new addict on replacement seeking recovery,

who is unaware of a peer’s state of mind which is often judgmental toward the person taking the
DRT.
It is common knowledge in the atmosphere of recovery that an addict trying to remain
substance free should change the people, places, and things they associate with and avoid anyone
on a mood or mind altering substance. It is not appropriate or responsible for a peer-based
recovery house to accept addicts who are dependent physically on a replacement therapy. The
limiting and debilitating stigmas attached to the addict who uses methadone and other
replacement therapy is “rooted in a larger anti-medication bias within the history of addiction
treatment” (White, 2009, p. 3).
Learning how to trust yourself and others in the process of getting clean and remaining
abstinent from active addiction behavior is part of the evolution of healing. It is known as being
in the process of recovery. In the setting of a recovery house, habitually individuals who are
substance free become suspicious of the person on a replacement therapy such as methadone as
“there are times when adjustments are made in the dosing; a weaning up or down can cause
symptoms like dozing during the day, pinned eyes, sweating and vomiting even hours after
treatment” (C. Ely, personal communication, June 25, 2016).
These side effects become a contradiction to the allusion of being clean and can turn out
to be detrimental to the relationship addicts are trying to build with others and to their own
recovery in the sense that they continuously feel like they have something to hide or prove. The
fact that most individuals do not experience euphoria when taking a replacement therapy is of
minor importance to a housemate who is substance free. “The body metabolically converted all
opiates to morphine” (Bedford, 1991, p. 2) and whether or not it is taken under the context of a
therapeutic live saving method the stigma, the addict is clearly taking a substance that was

chemically created to be a synthetic opiate and the body will respond with side-effects such as
withdraw.
Stigmas associated with opiate addiction
“For almost a century, the predominant view of opioid addiction has been that it is a self-
induced or self-inflicted condition resulting from a character disorder or moral failing and that
this condition is best handled as a criminal matter. Use of methadone and other therapeutic
medications has been viewed traditionally as substitute therapy” (“Medication Assisted
Treatment,” 2005, p. 8).
“There are many assumptions and belief’s associated with opiate addiction which
includes the controversial topic that, methadone and replacement drugs are a crutch, and by using
a replacement therapy a person is simply replacing one drug/addiction for another” (White, 2009,
p. 3). As mentioned, one of the core hindrances of an opiate addict trying to recover in recovery
housing involves a “processes of labeling, stereotyping, social rejection, exclusion, and extrusion
as well as the internalization of community attitudes in the form of shame by the person/family
being discredited” (White, 2009, p. 2).
There are three types of personal stigmas that an opiate dependent person experiences;
 Enacted stigma (direct experience of social ostracism and discrimination)
 Perceived stigma (perception of stigmatized attitudes held by others toward
oneself)
 Self-stigma (personal feelings of shame and self-loathing related to regret over
misdeeds and “lost time” in one’s life due to addiction). (White, 2009, p. 7)
It is clear these uninvited stigmas are something that not only hinders addicts in their efforts to
get clean but also takes away from their true positive recovery experience.

Homelessness is another “everyday prejudice which creates a host of obstacles for
recovering drug users” (Barasi, 2012, ¶ 5) in the atmosphere of an all-inclusive recovery house.
It is a well-known presumption that someone who has relapsed will often take someone clean
back into active addiction, as misery loves company. The relapsing addict can be one who is on
DRT or not. But the blame will often go on the DRT client living there who is presumed to have
caused an unhealthy atmosphere of recovery and to have been the possible trigger for the
addict(s) who relapsed.
Also an apolitical issue is when a personal item is missing within the house and presumed
stolen. Blame is often placed on the addict who is on DRT. Often “society's labeling and view
of opiate dependents as, (criminals), strips them of their human value; society is then forced to
protect itself from some of the same people who have indeed assumed the criminal status”
(Wright, 2010, p. 15).
Another area of reproach those on a DRT face, is in the atmosphere of a biopsychosocial
methodology. Often the addict will be referred by a facility to attend a 12-step fellowship as part
of follow up treatment in order to learn how to function without using a substance. The
worldwide 12-step fellowship of Narcotics Anonymous (NA) has guidelines regarding
replacement therapy. As stated in their Public Relations Handbook (2007), “Areas and groups
often enter into discussions about drug-replacement therapies and the Narcotics Anonymous
program. NA’s Third and Tenth Traditions are essential to these discussions. We need to
remember that we cannot assess anyone’s desire to get clean and that NA has no opinion on
drug-replacement therapies. However, the experience of NA members is that being clean means
complete abstinence from all mood- and mind-altering drugs, including those used in drug-
replacement therapies” (p. 72)

As the basic text stated,
Complete abstinence is the foundation for our new life. Raising awareness about our
Third Tradition—that the only requirement for membership in NA is a desire to stop
using drugs—can benefit discussions about drug replacement. Anyone is welcome at NA
meetings, even if they seem as though they don’t know if they want to stop using drugs.
A group must always maintain its primary purpose of carrying NA’s message of recovery
to addicts.
Although NA is a program of complete abstinence, nowhere does NA say a
person has to be clean to attend NA meetings. We need to be aware of this when
interacting with drug-replacement clients. Sometimes meeting formats ask those who
have used drugs not to speak—but it is not our job to judge or evaluate if someone is
clean or not. Our Third Tradition cautions us from judging another member’s desire and
encourages us to welcome any addict who comes into an NA meeting. In our public
relations service, we may choose to limit the participation of members on drug-
replacement medication. We do this because we do not want the NA program to be
misrepresented; we are a program of complete abstinence. Yet, we want to be inclusive,
so we treat these situations sensitively by taking members aside and sharing our own
experience with living drug-free. We can share that some members have tapered their
drug use to abstinence through replacement methods (World Services Bulletin, #29 can
be a useful resource). We can also share that drug replacement may seem to help today,
but our experience with recovery in NA means that we are able to live free from all drugs
without the need to substitute one drug for another. (Public Relations Handbook, 2007, p.
72)

Many addicts on replacement therapy could benefit from this lifesaving program. They
feel they cannot fully participate in this program and share that they feel stigmatized and judged
by the guidelines and other members of the NA fellowship. More often than not, they will hide
that they are on a DRT. It has been said addiction cannot be cured, but recovery is possible for
any addict including those who are addicted to opiates.
The use of behavior modification is often incorporated in various treatment modalities.
Behavior modification increases rewards for positive, pro-social behavior. Rewards may
include praise, attention, activities, and material items. For negative or antisocial
behavior, responses that are unpleasant or withhold rewards may help to extinguish the
unwanted behavior. Programs that gradually give participants increased freedom as they
show responsibility are using positive rewards. Some programs have levels, steps, or
phases that participants must earn through appropriate behavior; when advancements are
made, there are rewards of privileges, such as an increase in freedom, and decreased
supervision. (Treatment for Alcohol and Other Drug Abuse, 2012, p. 42)
The bottom line is that help is available for those who want recovery from active
addiction. It is evident there are many types of recovery houses with various levels of recovery
structure and not all addicts who come to live in them have the same understanding of what
living clean is. “The group is not the jury of desire” (Tradition 3, 1993, p. 108).
2012 Interviews – The voice of the opiate addict
It is important to get a personal perspective from the addicts themselves. In 2012, the
first interviewee went from having a good standing in the recovery community to being homeless
and labeled untrustworthy. JB was a 28-year old male who was clean for two months and living
in non- recovery type housing for five weeks. He was a father of three children that he knows of

as his behavior in active addiction may have created others. Genetically connected to addiction
by way of his father who was an opiate addict, JB has been an addict for 16 years and started
using heroin a few years ago. He has been homeless for four years, most recently for the past
two years. Within the past two years, he has been to six detoxes and has lived in four shelters
and three recovery houses. He stated, “I have never been on a replacement therapy as I feel it is
“just a crutch and excuse to use” (J. Botts, personal communication, November 12, 2012).
JB has overdosed twice and was brought back through CPR each time. JB in your words
can you share the stigmas that you feel are associated with being an opiate addict?
 Nobody likes a junky, there was this commercial that I remember growing up that use to
say nobody says I want to be a junkie when I grow up.
 People think "I’m a bad person and I’m not fit to take care of my kids.
 Society holds us back,” I can’t get a job I’m not trust worthy.
 I’m considered a thief whether or not I steal from them, because I shot heroin.
 People think we are dirty and we have diseases like Hep-C and AIDS.
 People are always thinking we are going to die” it’s hard.
 People don’t trust anything we say nor do, we have to prove in action before anyone will
believe our words (J. Botts, personal communication, November 12, 2012).
JB said the most self-defeating thing you tell yourself as an addict is "I’m not worth it -
people are better off without me and I’m not really hurting anyone but myself”. That’s how we
feel, and that’s how people feel about us.... that’s just normal” (J. Botts, personal
communication, November 12, 2012).
In the second interview, the stigma of being labeled mentally ill and opiate addicted is
often considered as one of those conditions with no solution. AM was a 25-year old dual

diagnosed female who had been clean for five months and was living in non-typical recovery
type housing for four and a half months. She stated, “I started using drugs at the age of six and
when I was giving beer by my step farther. I have not lived under my family’s roof since the age
of 12 with the exception of three months after my house burned down, when I was pregnant with
my second child.”
AM was a mother of two. She did not have custody or rights to her children at the time
of the interview. Her family history connected her genetically to addiction that was strongest on
her mother’s side. Her grandparents and great grandparents were all addicts. AM said her father
was also an addict. AM shared, “I have never been to detox or has used replacement therapy’s
because I have never been serious about getting clean” (A. Marino, personal communication,
November 12, 2012). AM stated I have basically been homeless for 13 years “I always get
kicked out of where I am living, my addiction always takes over and I end up selling drugs to
support my habit.”
AM never lived in a shelter and has been transient during her times of being homeless “I
know where all the tent cities and homeless camps are.” “I have lived in my cars and bathed at
friends’ homes to wash my ass.” She went on to say, “I was put in a state mandated recovery
house at age fifteen and was there for 15 months. I picked up six months later after losing my
virginity and sex was my new drug.” AM declared, “I have over-dosed 10 times and been
brought back 3 times by CPR.”
AM in your words can you share the stigmas that you feel are associated with being an
opiate addict?
 NO one believes me, I’m not trusted, and they will not let me in their homes
because I will steal there meds or rob their purses.

 When I have a cold people think I’m coming off opiates again.
 The state and my family think “I’m incapable of taking care of my kids because
I’m an addict.
 They are waiting for me to die because I am incurable (A. Marino, personal
communication, November 12, 2012)
AM shared the most self-defeating thing you I tell myself are, “I can never fix all the
things I have f**ked up and I’m just a f**k up - I was a mistake never supposed to be here...
(Here) refers to life. (A. Marino, personal communication, November 12, 2012)
“Stigma affects patients in various ways. It discourages them from entering treatment and
prompts them to leave treatment early. It creates a barrier for those trying to access other parts
of the healthcare system. A striking example is the failure of medical practitioners to adequately
medicate pain in this group” (“Medication Assisted Treatment,” 2008, p. 17).
In the third interview the female was denied adequate medical attention due to her
addiction to opiates. AK was a 40-year old female who had been an opiate addict for 19 years.
She first injected heroin in 1993 and has been in the fight of her life ever since. She was a mother
of four. Her youngest was thirteen, and was living with her parents.
AK had not raised or had custody of her children in over nine years. She was linked to
addiction by her biological father, also an addict. Her longest amount of clean time was from
1999 to 2004. This was a time when she was raising her children.
AK reported her first detox was in 1994. Her best guess was that she had been to at least
15, and had stayed in two inpatient programs that lasted at least 30 days and had been enrolled in
five methadone programs. She explained why she did not take methadone any anymore. “My
bone mass is about half of what it should be from being on methadone” (A. Huntley-Kettle,

personal communication, November 12, 2012). AK also had at least three legal scripts of
Suboxone and often maintained on Suboxone by getting it illegally off the street” (November 12,
2012). Often in order to get her life together, typically after an arrest, she used a substitute off
the street when she did not have or could not afford insurance. AK had been homeless. “I lived
in my car for three months and I always find a place to squat” (November 12, 2012). She
appeared proud when she said, “I am a transient functioning addict and have only stayed in a
shelter 4 times” (November 12, 2012).
AK in your words can you share the stigmas that you feel are associated with being an
opiate addict?
 I was misdiagnosed when I had a broken hip and suffered a lot of pain because the doctor
at the hospital said I was pill seeking.
 Even when I had a clean hair and urine test, I was told by a judge that my kids were being
given to my mother-in-law because I was an opiate addict.
 I had a DCF worker tell me she has never seen a mother who loves her kids more than I
do, but because of my extensive history with heroin, I basically was unfit to raise my
children.
 I know I did better when I had my kids; after they took them away - it was all downhill
from there (A. Huntley-Kettle, personal communication, November 12, 2012).
AK said the most self-defeating thing you tell yourself is “I am 40 years old and I have
nothing to show for my life. I am always abusing myself, "what’s the point of living? I can’t get
my kids back there grown now”, “I’m always battling myself and I don’t have any peace.” Even
when I have clean time; like 5 years clean, “It’s like I can’t trust myself”... “I get so discouraged
because even if I have some clean time – I don’t have faith in myself, as at any time I could get

hurt and have to take pain meds and then it would start all over again”. “I get mad at myself, and
think am I really this week? It’s like I have no control over myself. “I feel like I’m alienated
form society because I have shot drugs for so many years, and as soon as any one finds out, it’s
like you have to prove you’re not using; for even a bruise on my body.” I know it’s up to me,
but when I’m on meds - I feel like I’m being set up to fail; as at some point my insurance is
going to run out and then I relapse” (A. Huntley-Kettle, personal communication, November 12,
2012).
On 11/14/12, AK was able to get into an efficiency apartment of her own but as she
moved out she admitted to relapsing a week earlier while living at the non-typical recovery
house. She stated when she was not able to get the Vivitrol shot to help with the cravings she
was having and because her insurance had run out, her disappointment took over. She gave into
the anxiety/obsession and compulsion of her disease and started chipping, chipping means
snorting small amounts of heroin intermittently as to hopefully not get strung out. Her boyfriend
was getting out of jail within a month. They have a long history of using together despite the
insanity for the relationship and the codependency of drug abuse. The disease of addiction takes
lives and may one day take her.
JB was able to get a job in construction 40 hours a week. He borrowed a vehicle to get
back and forth to work with. Unfortunately a few days later on 11/22/12 he was asked to leave
his non-typical recovery house after not being able to give a clean urine sample and admitting to
relapsing. He had been giving a reprieve after coming up with a dirty urine sample the week
before and was told to go seek out some professional help of counseling/support. He chose not to
and started hanging out with an old using buddy. His behavior had changed just before he was
asked to leave and it was noted he had started to take things that did not belong to him. As he

packed up to move out of the recovery house, he took a small laptop without asking. JB did
return the laptop when confronted by phone within one hour. In hindsight, this may be an insight
to his post on Facebook. The post stated he was still headed in the right direction. Something
must have changed for JB not to sell the laptop in order get high. Perhaps the stay at the non-
typical recovery house helped nurture the seed of recovery for his future.
As of 11/22/12, AM passed her last urine test and is still clean. She continued to live in
the non-typical recovery housing she was in for 6 months. AM is proud of the relationship she
has developed with her sponsor and the women in recovery. AM utilized the tools she learned in
the 12 step program of NA and was able to get through some difficult times/feelings in regard to
witnessing her sister ordeal about being diagnosed with breast cancer and having a double
mastectomy. AM continued to look for work and admits to struggling with her disappointed
about not having a job yet. She decided to return to school and completed her Pell grant on
11/28/12 and was scheduled to start an online college in January of 2013. AM was excited about
school and the positive path of recovery. Her future has endless possibilities if she remains drug
free.
2016 Interviews - the voice of growth
Four years have passed since the first interviews. The information these three addicts
revealed gives another glimpse into the nature of the disease of addiction and the struggles of
opiate addict’s journeys to find safe housing and do what is necessary to persevere and maintain
their recovery. The first interview was with JB who had much better standing in his community
of recovering addicts. He is in the process of rebuilding trust with the people he cares about
today. JB have you been able to maintain your recovery since the last time we spoke? JB shared

that he relapsed numerous times in the past four years. “I overdosed one time seriously and died;
brought back after four times with the paddles, the air bag and three doses of Narcaine”.
He currently has “six months clean… has been to detox seven times, four programs and
back to jail three times” (J. Botts, personal communication, June 26, 2016). He went on to share
that he is currently living in a sober house for the relationships between addicts; “it’s the
therapeutic value and camaraderie” (June 26, 2016). JB explained that, “My biggest issue was
getting and keeping work while having a habit, also housing was always an issue - especially
right after getting out of jail; I was often homeless, I had no money to pay” (June 26, 2016). JB
affirmed that he would go back to his drug of choice “after constant disappointment” (June 26,
2016). He appeared to have great insight in to his shortcomings when he shared that his
disappointment is “Always an excuse to use… that I wasn’t ready to live in more than four sober
environments. All was useless until I made the true decision inside myself to stop” (June 26,
2016).
JB do you still identify with the stigmas associated with opiate addiction? He shared that
“I always will. The difference is when people who aren’t addicts find out that I am. Most
people’s perspective is negative and not understanding and depending on their experience
determines the way they look at me usually” (J. Botts, personal communication, June 26, 2016).
JB why is it hard to get clean as an opiate addict in a 12 step program? “Our minds either
convince we are better, it’s different, were different, or we just don’t care or fit in” ((J. Botts,
personal communication, June 26, 2016). JB has your view of your own self-worth improved
over the past four years? “I view myself worthy - highly. I am more fortunate because of my
previous experience in NA and the work I have done on myself; it’s more about how I am

internally than any other sort of progress. It’s the way I live and treat others that define me… my
shortcomings I understand, accept and try to improve (June 26, 2016).
JB do you feel that society has changed in the way they view opiate addicts today vs. for
years ago? “As for society, there is much more awareness now. It’s an epidemic that will not
cease! Their solution is jails, revolving doors at rehabs and substitute drugs”. “I don’t exactly
disagree yet I don’t agree”…“We can’t help those who don’t want help” (J. Botts, personal
communication, June 26, 2016).
Subject number two was AC she got married 3 months now goes by AB. The interview
began with asking AB if she has been able to maintain recovery since the last time we spoke.
AB shared that “I have relapsed more times than I can count before September 26, 2014 when I
was arrested for the sale of narcotics and went to jail” (A. Burke/Huntley-Kettle, personal
communication, June 27, 2016). She added “When I was arrested for the sale of narcotics, I did
a month and a half before I was given a JRI bed at a program called Fresh Start” (June 27, 2016).
In the state of Connecticut, a JRI bed is a platform called the Justice Resource Institute which
works with government agencies and family’s to “Addressing the most confounding challenges
of both the human services and educational systems…in order to “pursue the social justice
inherent in opening doors to opportunity and independence” (Krpata, 2014, p. 3).
Essentially because AB had such an extensive history of drug addiction and times spent
in institutions she was granted a program that had access to local and government moneys. The
primary purpose of the program was to help break down the chain in the cycle of her going back
to jail time and time again for the behaviors of an active addict. AB explained, “I was mandated
to a six month program after struggling and definitely falling through cracks; I didn't have
enough inner stability to stay clean” (A. Burke/Huntley-Kettle, personal communication, June

27, 2016). “I learned a lot about myself in that six months and I did leave with the belief that I
could stay clean; but I had nowhere to go” AB went on to share that “I relapsed shortly after the
Fresh Start Program for about 3 months; and finally had enough due to the fact that I had had
that six months clean and a lot of therapy while there. Because I had relapsed, I had minimal
faith that I could stay clean so I got on the suboxone program again in Sept of 2015” (June 27,
2016).
AB stated “I have been clean again since October 9th”. She said that “I have never fully
given any program a chance before now and I am doing everything they say, but still have had
no real therapy. The state therapists have such long lists that you never get in i.e. I was in a
trauma group for woman, from September to March and on the list the whole time to see a
therapist and never did and now they're closing that fresh start program that helped me so much
due to lack of funding” ... (A. Burke/Huntley-Kettle, personal communication, June 27, 2016).
AM had a third child since we last met and begun the interview by proclaiming “I am an
addict and by the grace of God I now have four years clean. Fortunately even with all the moving
around I have done, I have not had to relapse because I stay close to my God and my recovery”
(A. Marino, personal communication, June 18, 2016). AM went on to say “I have weathered
many storms in the last four years, I am grateful I have not had to use. AM explained that “I
have been back to live in the shelter twice in the past four years and the first time I was homeless
was when my child was a new born” (June 18, 2016). AM acknowledged that “housing stability
has been an issue my whole life and currently it feels like my biggest shortcoming; as I am
working on my step six” (A. Marino, personal communication, June 18, 2016). AM had no
difficulty sharing that “Right now I am working with a therapist at CHR and I have agreed to
introduce housing stability to my recovery plan” (June 18, 2016). AC disclosed that “due to my

choices, I’ve move from place to place repeatedly. I have been homeless several times. The
destruction of my past has continued to affect my current life. It’s nearly impossible to find a
place to live with bad credit. I’ve have move 9 times in 4 years” (June 18, 2016). AM what was
passionate when she shared “I truly believe having a safe stable place to live would make my
recovery a lot more stable, but like I’ve been told if an addict wants it enough they could stay
clean living in a crack house” (June 18, 2016). The question about opiate replacement came up
and AM said “In the past four years I have not been on an opiate replacement therapy and I
would never go on one because I know as an opiate addict; I would abuse the crap out of it”
(June 18, 2016).
Do you still feel stigmatized by the status of an opiate addict? “Yes, live with the stigmas
of being an opiate addict. I have to constantly refuse pain medication; as my Doctors are more
than willing to prescribe it, even after I admit to being an addict. They tell me if I take it as
prescribed I’ll be fine. I know for this addict any opiate I put in my body, I will abuse and
fortunately because of that fear, I have not had to experience another over dose” (A. Marino,
What has changed for you in the past four years? “I attend therapy for trauma and abuse
and actively work the 12 steps. I have gained self-worth. I don’t allow certain things to happen
such as boundaries being crossed. I allow myself to be respected and complimented. I do self-
care now – “The stigma for addicts has not improved. Society still believes it’s a choice and it’s
not. We weren’t raised in hopes of becoming an addict and causing all the harm and destruction
that comes with addiction. This heroin epidemic has been going on for 10 years but now that
suburbia is affected they want to take a look at it. We are still crucified because of the stigma.
Personally when people find out I’m an addict in recovery I get treated like crap. They judge

me, they assume a lot. If I’m having a bad day they assume I’m getting high. So I don’t react to
the treatment I receive from others because of their misguided assumptions. I respond
differently today. Because today there is hope for addicts and we do recover” (A. Marino,

Conclusion
It is with great passion I say all addicts on a replacement therapy deserve the same
dignity and respect as any addict looking for a safe place to live as they begin their journey of
recovery. It is my thought that specific housing should be developed in order to support the
addict that is not yet substance free. The magnitude of housing newly clean addicts with people
who are not just suffering from the disease of addiction, but also from a somatic disease of the
mind; only sets up the addict that is already clean as well as the one on the DRT.
The struggle is real. People of all ages, races, and genders are dying from opiate
addiction as the disease of addiction does not discriminate. Whether it is pills, patches, or the
street drug, heroin, with any prolonged use of an opiate changes will take place within the brain
causing a physical dependency to an outside source. Those who find themselves caught up in
this depravity of active opiate addiction will reach bottoms that will rob them of their family,
friends, and even their passions for life, affect their spirit. The obsession of an opiate habit never
ends well. Eventually the compulsion to continue to use the drug without an intervention will
lead to situations such as, stealing to support the habit, not being trusted by family and friends, a
loss of a good job, jail time, institutions and perhaps even an untimely death.
This thesis has exposed several gaps in services for the opiate addict who has completed
a successful detox and is in pursuit of continuing on a DRT. Too many addicts are being lost
back to the streets because the detoxes are not keeping addicts long enough to finish dealing with
the symptoms of withdrawal. Those who want to continue receiving the replacement, which was
used during their detox, could find it is not immediately available once they leave the front door
of the detox center. It is these types of gaps in services that significantly contribute to the high

recidivism rate among opiate addicts who are returning to detox and missing out on the
opportunity to find recovery.
The issues for those on a drug replacement being housed with those who are clean of all
substances typically have to do with the side effects of the drug replacement itself. These addicts
noticeably look the same as someone who is abusing/using opiates such as heroin. In early
recovery the newcomers do not have the awareness or resources not to judge and compare
themselves to their peers. The housemate who is considered clean and not on any mood or mind
altering medications can become judgmental toward the person on a replacement. They are, in
all reality, taking a substance despite the fact that it is a medication that is manifesting as a mood
and mind altering substance.
The stigmas associated with opiate use and replacement therapy exclude and ostracize the
individual who is already afflicted with a disease that is said to have no known cure. Society’s
view of opiate addiction keeps them from being supportive which is a tragedy for the individual
whose process of recovery is hindered. Stigmas are limiting and affect everything from housing
to the lifesaving therapeutic relationships of one addict helping another.
There is no website, journal article, or document that can provide the voice of an opiate
dependent addict’s adversities and the stigmas they live with better than the addict themselves.
The snap shot position of the three interviews in 2012 reveals that each one of them has had
many experiences with the stigmas that come with the using of illegal substances such as heroin,
Their comments showed how each of them have faced homelessness because of their drug of
choice and how they have earned the status of being too untrustworthy even to raise their own
children.

In 2016 we see the decline and progression that has taken place for those three over the
past four years. The one thing they all have in common is each of them has continued to combat
the disease of addiction to opiates. Although each of them has continued to meet up with the
stigmas and adversities of being considered opiate dependent, all three have made strides to work
toward not using a substance that has stolen so much from them in regards to their overall
wellbeing. Yet, they are improving how they view themselves today and how they deal with
society’s vision of opiate addiction.

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