Recovery coaches save lives

Lorie Simmons is in the middle of recounting how drugs ravaged her life when her phone rings.

“Excuse me, it’ll just take a minute,” she says in a low gravely voice. She answers her cell. “Sure … OK … I understand,” she says in a volley of conversation. “If you need anything, you can still call me. I’m here for you.”

The woman on the other end of the line overdosed the day before. Lorie is briefly disappointed that she won’t be entering treatment at Oaklawn – where Lorie was once a client and now works – but she will be getting treatment, and that’s the important thing.

“Where were we? Oh, yeah. My relapse.”

Lorie continues to tell her story. She doesn’t share every detail; in spite of that, or maybe because of it, it’s obvious that she has hard-earned wisdom to share. It’s called “lived experience” – and it makes a difference in addiction treatment.

ER partnership

Lorie is a certified recovery specialist, trained in helping others on their journey to recovery. She’s part of a new team at Oaklawn operating in partnership with Beacon Health System.

Michelle Pyburn is team leader for the small-but-growing group of CRSes who work on-call. “A patient comes into the Memorial ER department, typically in an opioid overdose,” Pyburn says. “Once they’re stable, the doctor talks to the patient to see if they’re interested in treatment. If they are, they call a recovery coach who goes into the emergency department to assess the patient’s stage of change and motivation. If they’re motivated, that first week is pretty intense.”

Some patients may be given their first dose of prescription medication to treat addiction before they even leave the hospital. Their recovery coach goes to work right away scheduling a follow-up with a physician, an assessment with an Oaklawn therapist and helping them arrange for any other immediate and long-term needs like housing or employment.

Medication-Assisted Treatment

Prescription medications combined with traditional talk or group therapy are key components of the program. The approach is called Medication-Assisted Treatment, or MAT, and is proven to be the most effective intervention in opioid addiction, according to the Pew Charitable Trusts.

Locally, Beacon Health Physician Brandon Zabukovic is a champion of MAT and a leading provider of prescription medications to combat addiction. He, along with Oaklawn Addictions Director John Horsley and Notre Dame Professor Todd Whitmore, all members of the South Bend Area Opioid Task Force, are the architects of the new program.

Zabukovic began prescribing buprenorphine about five years ago at the request of NICU physicians. They thought babies born to mothers on buprenorphine did better than babies born to mothers on methadone. Once he started treating pregnant mothers, he also began to treat their partners in the hopes of boosting their success.

“The reason I prescribe it and I’m an advocate is I see that it works,” Zabukovic said. “People with treatment get better. Just telling people to stop using opioids doesn’t work well. Trying to access the system and then [having to] wait a month or two doesn’t work very well, either.”

Prescription medications are effective in treating addiction because they address the biological changes in the brain that occur during active addiction. When people use opiates repeatedly, they increase the number of opiate receptors in the brain, Zabukovic said.

“That’s kind of the basis of why people need greater and greater doses to get the same effect over time,” he said. “If people are not using an opioid, but they have these receptors, the brain will experience withdrawal because of a lack of the opioid. The reason the medication works is that it can fill that void. It replaces it with something that lasts longer, doesn’t cause euphoria and doesn’t have the risk of overdose.”

But medication alone isn’t as effective as medication plus behavioral intervention and support, which is where recovery coaches play an important role.

Recovery coaches

Recovery coaching isn’t a new idea – but it is a growing one, especially as providers across the country grapple with how to address the opioid epidemic.

Anchor Recovery in Rhode Island is a national model for peer recovery services, and the new local program is loosely based on it, Horsley said.

“They have 83 percent of their contacts entered into meaningful treatment,” Horsley said. “And all their recovery coaches are in recovery themselves. The guys who leads their outreach was in detox 39 times before he got clean and sober.”

That lived experience makes a difference, says Zabukovic.

“[Recovery coaches] have a credibility that I don’t have – that been-there-done-that,” he said. “I think they can recognize dysfunctional thought patterns and maladaptive behavior people have in the beginning of treatment and they can call them on that in a way that I can’t.”

While peer services are proven to improve treatment outcomes, training CRSes is time- and cost-prohibitive, Horsley said, and many struggle to pass background checks, even with some concessions by employers.

To create sustainability for the program, a 21st Century CURES grant paid to train 50 local people as Certified Recovery Specialists, broadening the pool of candidates. It also paid to train three local people as CRS trainers, so they can offer trainings as needed going forward.

Treatment, Expansion, Challenges

The partnership between Oaklawn and Memorial officially started in August. Since then, recovery coaches have been called to see 32 patients, with 27 entered into treatment with Oaklawn or another provider.

Memorial’s ER doctors see three to four overdose cases per shift, Pyburn said. She wasn’t surprised by the number, “but it did break my heart.”

Other local hospitals and organizations have already contacted Oaklawn about bringing recovery coaches in. A partnership with the South Bend Fire Department is being discussed, with the intent to reach overdose victims who are revived but refuse transport to the hospital.

Growing the program will require hiring more CRSes and possibly even increasing the number of local physicians who are licensed and willing to prescribe buprenorphine and other addiction-fighting medication.

“I can see this growing rapidly,” Pyburn said. “It’s just a matter of getting people hired.”