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About-Face: Hazelden Offers Maintenance Treatment

The influential rehab's policy change will roil the abstinence-based recovery movement.

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Maintenance treatment: now available at
Hazelden

By Maia Szalavitz

11/05/12

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In a move sure to send shockwaves through the recovery community, Hazelden has announced that it will offer buprenorphine (Suboxone) maintenance for patients addicted to heroin and prescription painkillers. That’s right: the pioneer of abstinence-based treatment, which put the "Minnesota" in the Minnesota Model of treatment used by most private programs nationwide, will now offer medication-assisted care—in some cases, indefinitely. The change, as reported today in Time, comes as a result of the epidemic in opiate-based prescription drug abuse, which over the past decade has flooded the renowned rehab with a new breed of patients with new needs (in 2001, only 19% of its adult patients, and 15% of adolescents and young adults, were addicted to heroin or prescription pain relievers; by 2011, the numbers had increased to 30% and 41%, respectively):

“This is a huge shift for our culture and organization,” said Dr. Marvin Seppala, Hazelden’s chief medical officer, who pushed for the new practice. As the program’s first adolescent patient, and someone who has been in recovery from multiple drug addictions for 37 years, Seppala is keenly aware of how dramatic this decision is for the organization, which once debated whether or not coffee was acceptable in recovery. “We believe it’s the responsible thing to do,” he says.

Driving the need for change is the sobering reality of how patients addicted to prescription pain relievers fare once they leave the Hazelden program.…Within days of leaving a residential treatment facility, most were relapsing—and at least half a dozen have died from overdoses in recent years. It was time, Seppala argued, for a radical change.

Although the World Health Organization, the Institute on Medicine, the National Institute on Drug Abuse, and the nation's "drug czar" have all determined that maintenance medications like methadone and Suboxone are the best hope for people addicted to opioids, Minnesota Model programs like Hazelden and Betty Ford have limited their use to short-term detox. Meanwhile, on the Minnesota model-based Celebrity Rehab, Dr. Drew has popularized an extremely negative—and completely unscientific—view of these treatments, claiming that methadone “takes your soul away”; one of his counselors called Suboxone “the root of all evil.” At least two of the patients that Celeb Rehab put through its harsh, nearly cold-turkey withdrawal have since died opioid-related deaths, including Alice in Chains bassist Mike Starr and actor Jeff Conaway. Research shows that such grim outcomes are often preventable: maintenance cuts mortality in people addicted to opioids by at least 50%. That’s why every scientific group that has examined the data has come down in favor of it.

Hazelden’s embrace of maintenance is likely to spur soul-searching in the recovery movement. Hard questions, which have mostly been ignored by the abstinence-only establishment, will now demand answers. Can maintenance really be integrated into a 12-step-based program? Will people on Suboxone or methadone—which, after all, can cause a high in people who aren't tolerant to the drugs—genuinely be seen as “recovering,” just like people who are drug-free? What will such people do in community-based 12-step groups that have traditionally viewed maintenance as being just “substituting one drug for another?” And will Hazelden “lose its soul” by making this change?

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