Over the last couple weeks, ideastream has been looking at many facets of addiction as part of our health series, Be Well.
In our next story, reporter Anne Glausser helps answer the question, "Can a pill be a cure for addiction?"
(Zingale and bird making back and forth chicken noises)
That's not a chicken but a cockatoo imitating one. She’s named Opie and belongs to Tony Zingale, from Euclid Ohio.
Opie also says "I love you," laughs like Zingale's wife, whines like their kids, but hasn't picked up on some of his choice phrases.
ZINGALE: No, there's no swearing at all, no, we made sure of that (laughs). That's all I needed, you know.
Zingale just got a job as a card dealer at the new Cleveland casino.
He’s the father of triplets.
And he’s a drug addict.
It started with a softball injury.
A guy slid into him--broke his leg in two places--and they gave him some Percocet.
His reaction was immediate.
ZINGALE: That's, that, that's what I like. That's the feeling I like.
He continued with the pills long after his leg healed, for many years.
For the last 3 years though, he’s been free of drug abuse.
But his memory of days spent searching for a fix remain fresh and vivid.
ZINGALE: Your day revolves around are you going to have enough for tomorrow, are you gonna have enough for the weekend, what pharmacy's open, what doctor can you go to, which one have you not seen in a month, which one is giving you hassles…I mean, it was a job.
He was taking nearly 200 narcotic pills a month.
ZINGALE: If not more. If I could find 'em.
Prompted in part by the birth of his triplets--he decided he wanted to end this cycle for good.
He checked himself into rehab at the Cleveland Clinic.
Their program includes intensive counseling, 12 step programs like Alcoholics Anonymous and Narcotics Anonymous, as well as the option to use a medication.
Not all addictions can be helped by medication.
But for opiate-based drugs, like pain pills and heroin, there's been what some call a revolution in medical help.
COLLINS: I been in the addiction business for 40 years so I cut my teeth on drug-free treatment. So kind of originally the AA model or Narcotics Anonymous model, so be drug-free and go to a lot of meetings and all will be well.
Dr. Gregory Collins is an addiction psychiatrist and directs the Clinic's treatment program.
He says medications for addiction were once just a dream, but now they're here, and they're underutilized.
When paired with therapy and group meetings, Collins says the meds have achieved
COLLINS: Dramatic improvements in our positive outcomes for these people.
Tony Zingale is one of them.
He started on a medication called Suboxone, which is a weak opiate that prevents cravings and withdrawal.
COLLINS: It doesn’t produce that kind of drug euphoria. What it does do is calm the nervous system down and satisfy the disturbed architecture of the brain that chronic abuse of opiates has produced.
Zingale describes it like this:
ZINGALE: When you're detoxing, you're sweaty, you're nervous, you're sick--it takes that all away.
Suboxone not only makes withdrawal much easier, it reduces cravings once sober.
It was FDA approved in 2002.
Patients don’t have to go to a special clinic every day to get it.
This is different from methadone, which is another treatment option that helps when used appropriately but its abuse creates euphoria and can also kill you.
Suboxone is harder to abuse because of the way it’s formulated, though there’s concern with the diversion and illegal sale of it because new users can experience a high from the drug.
Collins says Suboxone does its job and nothing more.
He puts it this way: if two people addicted to painkillers came in for treatment, and went through the same behavioral therapy, same group meetings required of all people in the Clinic program, and one took Suboxone and one didn't – which one will stay clean?
COLLINS: I would certainly put my money on the guy on Suboxone, because his outcome, his chances are going to be at least double the other guy's, without the medication.
That kind of boost in batting average is huge in addiction, a medically classified disease where relapse is a clear and present danger.
But clinicians and addicts stress that it’s not an “either, or” thing.
Tony Zingale credits his stable recovery to, number one, his family, number two, the Clinic's rehab program, and
ZINGALE: Then AA, then Suboxone, you know, in that order.
The pill is important and he takes it religiously, but it's just part of the package.
It’s not a cure.
Research shows that combining medication with behavioral therapy is the best way to ensure success for most patients.
But some people, and treatment centers, resist using Suboxone because they don’t want to be on any drug.
There are differing opinions in the medical community about whether a long-time addict should stay on Suboxone for life or whether it should only be used for the short-term.
It's a pricey drug--costs about $500 dollars a month out of pocket--but many insurers cover it, including Ohio Medicaid.