When Cody Goodwin, of Independence, Missouri, was 24, he had already been hooked on opioids, including heroin, for years. His sister decided jail was the only way he could be cut off from drugs, so she reported him to the police.
“I was mad at my sister at first, boy, you know, she got me locked up. I was upset. But now I look back and it saved my life,” Goodwin says.
When he got out, he found a methadone clinic where he could get medication-assisted treatment, but there was a catch that made him leery. If he wanted methadone, he’d have to do talk therapy as well.
Federal treatment guidelines say that drugs to treat opioid use disorder should be used in conjunction with drug counseling. But many people seeking treatment have to wait to get it because of a shortage of counselors to meet the demand.
Over the past few years, there’s been growing agreement that medication-assisted treatment is the best way to kick opioids. But Marsha Page White, clinical director of substance use disorder services at ReDiscover, a nonprofit community mental health center in Kansas City, says medications like methadone and buprenorphine only treat the physical side of addition.
That’s because therapy is needed to address the changes in thinking that occur when someone goes through addiction.
“You start to give yourself permission to do a lot of things,” White says. “Where a person may have never shoplifted in the past, now they need to get some money to support their addiction, so now they’re giving themselves permission to shoplift.”
And there may be underlying mental health issues as well. People often use opioids to self-medicate, for example, or to help deal with trauma.
White says that drug counseling is an especially difficult line of work because of the peculiar challenges posed by addiction.
“You have to try to outsmart the addiction, so you have to do a lot of confrontation of folks,” White says. “If someone looks like they are using, you have to say, ‘Are you using?’ and they say no, but you know they are.”
White says ReDiscover has had counselor positions open for months, and that’s affected its ability to help people. It currently has a list of around 55 people waiting to get into treatment.
Although substance abuse programs have suffered from public funding cuts for years, David Patterson Silver Wolf, an associate professor at Washington University’s Brown School of Social Work in St. Louis, says the system has reached a breaking point.
“With this opioid use disorder, things are occurring that have never happened before in the treatment industry. People are actually OD’ing in the waiting room. Patients are OD’ing in the bathroom,” Patterson Silver Wolf says.
Combine wages that average around $40,000 a year nationally with the difficulty of the work and little professional support, and drug treatment counseling is not a job many people want to go into or stick with.
Lots of federal and state dollars have poured into opioid treatment in recent years, but Patterson Silver Wolf says temporary budget increases or big one-time grants aren’t enough for the long-term transformation that’s needed.
“There needs to be some stability. Just like any business. It’s hard to think way out. Can we really invest? Are these monies going to be around in a year or two?” Patterson Silver Wolf says.
Cody Goodwin continues to meet with his counselor, Mary Bitterman, on a regular basis, but his recovery has shifted from fighting constant cravings and withdrawal to bigger-picture rethinking of his life and future.
Goodwin marks his second year free of drug this week, and he says that, despite his initial skepticism about it, talk therapy has made all the difference.
“You don’t want to tell a stranger about your deepest, darkest, most embarrassing stuff,” Goodwin says. “But in order to be able to move forward and able to move forward without shame or guilt, you have to.”
Alex Smith is a health reporter for KCUR. You can reach him on Twitter @AlexSmithKCUR