JENNIE: Treating Opioid and Other Addictions with Aversion Therapy


You hear about the opioid crisis in our country all the time on the news. So, today we’ll take a look at some numbers and an amazing 10-day treatment that is getting attention from medical professionals around the country.

First, let’s understand the problem: drug overdose deaths in this country are staggering and opioids, you know those pain killers, both prescription and illicit, are the main drivers of the trend. Opioids were involved in 42,249 deaths in 2016. From 1999 – 2016 more than 350,000 people died from an overdose involving any opioid, prescription or illegal. According to the CDC, six out of 10 drug overdose deaths does involve opioids.

In Georgia the Attorney General has declared opioid abuse not just a statewide issue, but a national emergency. A new Peach State Task Force has been created to fight the opioid crisis, composed of public, private, and nonprofit leaders.

Even Walmart is taking a swing at the opioid epidemic, launching a new disposal product called Dispose RX. When added to a pill bottle with warm water, it separates the medication into a biodegradable gel.

This gentleman beside me might look quite familiar now, you’ve just seen his picture in that ad for Schick Shadel Hospital. This is Dr. Richard Montgomery and, yes, we are related. Richard is my brother and I’m so pleased that he is visiting Augusta right now. Richard lives in Boise, Idaho and in Seattle, Washington, where Schick Shadel Hospital is. Richard’s practice in Boise is North End Psychiatry.

Richard, the whole opioid epidemic is something that we can’t ignore and in your field, of course, you all don’t ignore it but I want you to tell us about what you’re doing with aversion therapy.

“Aversion therapy was something I, you receive some basic information about when you’re in residency training but it’s something that’s not implemented widely in psychiatry and there are a number of different reasons for that but I was approached by a good friend of mine, who’s the CEO of Schick Shadel, about a year ago, as he thought I’d be a good fit for the staff there and wanted me to look at the hospital. He thought I’d really enjoy the work and I went to look at it and I became aware of really the only implementation of aversion therapy that’s going on in the United States right now.”

JENNIE:  And before you went, you were skeptical about aversion therapy.

“Very, very. I think like some other therapies in psychiatry, aversion therapy has some misinformation that goes around about it that’s not entirely undeserved. Aversion therapy is really a principle of behavioral treatment that can, like anything else, be misused. Schick Shadel, however, has been implementing this version of aversion therapy for close to 85 years and there are few other alcohol or drug treatment centers in the country that can say that they’ve been around anywhere near that long.”

JENNIE:  Basically, we’re talking like Ipecac.

“We are talking about using a natural pathway that all mammals have evolved over eons to deal with toxins in their environment and animals, cave people, if they ate a toxic plant or a toxic animal, two things would happen; They would either die or they would become very sick and if they lived, if they survived it, they had a really, really crisp recognition of what it was that made them sick so they wouldn’t go near it again.

“And what I tell people when they come into the hospital is they need to think of it like this, how many times have you had food poisoning from a restaurant? Okay, I’ve had my share. How many people ever go back to that restaurant they’ve had food poisoning from?   Almost nobody raises their hand. The reason for that is when the brain’s in the state of nausea or dire sickness, it will reach out to look at anything that it ingested that it can attribute that illness to. It’s a mechanism that we’ve evolved over eons to keep us safe that still functions today. All we are doing is co-opting that and putting alcohol in the place of a toxin so the body recognizes alcohol as a toxin. Now, we also do this for opioids of different forms and certain other medications. We can’t do it for every medication because we have to be able to duplicate not only the mode in which the drug or the liquid is used but we also have to replicate as best we can the taste and in some instances the function of it. But we block the effects of it. We block the effect of an opioid when we give somebody that to be used in the aversion training process. So it’s done very safely. Our processes have been refined over 85 years.”

JENNIE: I read something with you, Richard. I read an interview someone else had done and one of the things that came out was that the core principle for you all is this isn’t a morality thing, addiction isn’t about morality. Addiction is a sickness we’re gonna treat and in speaking with Richard, one of the things that you said was quote, “I believe my role as a psychiatrist “is to join my patients on their life journey for a time, “relieving their symptoms when possible, “reflecting their own truth when evident, “and empowering them to make changes “that are often the only pathway “to complete healing and growth.” I think that is lovely.

“Psychiatry and substance addiction are very squishy fields, they’re not anything, in most cases, you can do an MRI for, you can’t do a blood test for most of it, much of it relies on the experience and the skill of the provider to draw from that and find a treatment plan for everybody that works and it is true, the best outcomes result from developing a real relationship and collaborating with the patient to find what works for them and the one further thing I’ll say, many of the changes that people need to make that result in long term health, they’re the more difficult ones and that includes not medication, but changes in environment, changes in spouse, changes in career, difficult life changes often stand in the way of people having true recovery.”

The nation’s chief doctor says he’s committed to increasing access to the opioid overdose antidote, Naloxone.

US Surgeon General, Dr. Jerome Adams, is calling on more people to carry the antidote, which is available over the counter. Adams says 95% of all insured Americans are covered to purchase the drug, which can cost around $80/dose. He also wants more federal funds dedicated to increasing Naloxone access.

Dr. Richard Montgomery is a psychiatry specialist in Boise, Idaho and has been practicing for 19 years. He also works in Seattle at a special treatment hospital called Schick Shadel and he is involved in treating the opioid epidemic, treating some addicted patients with aversion therapy and, you know, I think that we’ve known sort of about aversion therapy with alcohol.

“What we do when we place an aversion therapy with somebody, we are actually removing the craving. We are taking someone, who is craving opioids or alcohol, and we immediately are able to remove the craving.

Now, the degree of aversion that somebody leaves with at the end of 10 days, is variable. We shoot for someone to have an indifference to whatever the substance it, opioid or alcohol, or in some cases methamphetamine that we can treat, and sometimes the aversion is so strong that people can’t walk down an alcohol aisle in a grocery store because they will literally become nauseous.”

JENNIE:  “And it’s not punishment on your part.”

“Exactly, people enter this program willingly. It is not punishment, it is a very super smart way to treat addiction, I wouldn’t be doing this job if this treatment did not exist because the existing modalities of alcohol and drug treatment, I know that I would not be a good fit for This is very, very good treatment.”

“We are losing 115 people a day to overdoses from Opioids. This is the definition of a public health crisis.”

 The National Safety Council says one in four Americans has been directly impacted by the opioid crisis but 40% still don’t consider it to be a threat to their family.

There are people who may really, really be at a point where they’re willing to try something different. Seattle’s far away from Georgia but we do have the number for Schick Shadel and there are people who may want that number and so I hope that you’ll consider passing that information along or sharing this segment of the Jennie show with them.

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