The first time Jeremy Wurzburg left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. But one week later, the skinny, pale young man was hanging out with a guy who was also in early recovery, experiencing what Wurzburg, now 21, has come to realize is a typical turning point for recovering addicts: two guys sitting casually in a car, poised to use drugs again.
"We're not sure whether we're going to use or not," he says, "and someone makes like a half joke – 'We could just go out and drink right now,' or something. And the other one is like, 'Yeah let's do that. Sounds good.' "
From that first drink, Wurzburg was quickly back to heroin, his drug of choice. Most recovery programs don't — and maybe can't — prepare freshly discharged patients to fight that urge on their own, he says.
High Relapse Rate In First Year Of Recovery
"Once I got out of treatment into the real world, it was a big shock," Wurzburg says.
Of patients addicted to heroin who are able to quit their habit, 40 to 60 percent relapse within the first year — often within the first weeks of finishing a treatment program, studies show.
Wurzburg is now in a new program aimed at young adults. It's a one-year pilot project run by Gosnold, a network of addiction treatment services on Cape Cod.
As part of the program, Wurzburg agreed to live in a household that doesn't allow the use of drugs or alcohol. He agreed to attend daily 12-step group meetings and to get individual counseling. Perhaps most importantly, Wurzburg now has help daily — sometimes hourly — from a recovery coach.
Coaches in the Gosnold program get much more involved in the lives of the people they're mentoring than the typical sponsor in a Narcotics Anonymous program would.
The recovery coaches show patients "how to manage their emotions," says Wurzburg's coach, Kristoph Pydynkowski — "how to fill out job applications, how to go to meetings, how to take care of themselves, how to go back to school." Pydynkowski, who also calls himself a "cheerleader, a beacon of hope," quit using heroin seven years ago.
Much More Than A Sponsor
Pydynkowski ticks off the list of things he and Wurzburg now do together: visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother, fishing and 6:15 a.m. trips to a coffee shop before attending NA meetings. Pydynkowski helps each of the 10 patients he manages create and follow a weekly recovery treatment plan.
Ray Tamasi, the director at Gosnold, says this aggressively supportive approach is paying off. His evidence? A comparison of medical records collected during the year before the program's inception to records collected in the year after its start. The comparison is striking. Fifty-four young adults (ages 18 to 28) who participated in the coaching program saw an 83 percent reduction in admissions to rehabilitation facilities during their year of intensive coaching. Emergency room admissions also dropped — from 16 in the year before the program, down to one during the year of coaching.
Coaching Costs Save States Money
Because fewer people had to be readmitted to rehab centers, Tamasi says, the program saved the state an estimated 37 percent in total outlay.
"Think about the cost/benefit," he says, "if at 19, you're cycling in and out of treatment, but there's an alternative — going back to school and living life."
The program makes sense economically, he says, "and it makes sense simply from the value we place on the human life."
And it may make more sense to state legislators than simply increasing the number of beds in recovery facilities, he says, "because you can't just keep people in beds all the time. They have to come out at some point."
Gov. Deval Patrick's administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. A task force report recommended more peer support and home-based counseling. Health insurers and state Medicaid leaders have said they will look into funding for recovery coaches, but there is right now no plan in place.
New York and Tennessee pay for peer coaches to help treat addiction through Medicaid — something Massachusetts is taking a look at. The use of coaches is built on the idea that addiction is a disease that patients will deal for life, a disease that will be treated by primary doctors in a general medical setting, not just in rehabilitation facilities.
Pydynkowski is teaching his patients to treat addiction as they would hypertension or diabetes.
It's just like taking insulin, he says, "watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill — making sure I'm taking care of myself."
This story is part of a reporting partnership among NPR, WBUR and Kaiser Health News.