Erasing stigma toward medication-assisted treatment

When Walter Ginter started, as a person in recovery, to learn about and understand addiction and how methadone treatment works, he became angry. He concluded that treatment providers had failed to educate him properly, and he could not fathom why he was still taking methadone. Like many individuals receiving methadone treatment, Ginter felt stigmatized, as if he were merely taking a substitute for heroin and nothing else.

Ginter's anger spurred him to start a certified methadone advocate training program. Over the course of five years, primarily at American Association for the Treatment of Opioid Dependence (AATOD) conferences, he trained more than 500 people. Ginter says he knew that advocacy needed to come from peers. As a person in recovery, he knew the level of mistrust that exists between providers and methadone patients.

“If, early in my treatment, a treatment provider had told me, ‘You have a brain disorder and quite possibly might be on medication for the rest of your life like a diabetic,’ I would have said they were just trying to squeeze every last dime out of me,” says Ginter, Project Director of the Medication Assisted Recovery Services (MARS) project in the Bronx borough of New York City. “I wouldn't have accepted it, and most patients don't.”

When Ginter learned of the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Recovery Community Services Program (RCSP), which funds peer-to-peer support groups, he saw an opportunity to take his advocacy to the next level. That involved locating a peer support group in the same building as a major methadone treatment provider—in this case, the Albert Einstein College of Medicine.

“We believe that people who are on medication who understand what addiction is as a disease scientifically, and who understand how their medication works—specifically methadone or Suboxone—and who understand recovery will do better than someone who does not,” Ginter says. “It sounds like a no-brainer, but there wasn't any data to show that.”

A culture of recovery

MARS does not exist as part of a methadone or Suboxone project, but is located near such a program to offer recovery support services for people whose recovery is assisted by medication. MARS applied for the SAMHSA grant and began to receive funding in 2006.

“We're a little bit less than two years old, and we're doing great,” says Ginter. “Our results are better than we had any right to anticipate.”

One of the key reasons MARS helps its members do better in treatment and in life involves its fostering of a culture of recovery. “We can give people a place to go where they can do productive things,” says Ginter.

Unlike most mainstream recovery communities, where people can attend meetings, make friends, and develop a support network in order to move away from a culture of addiction, people recovering on medication usually lack that community support. “People on medication are stuck with one foot in each world,” Ginter says. “They have to go get their medication, and they could be standing in line next to someone who's not in recovery, or who's been in recovery for an hour, or someone off the street talking about where they can get some great crack. It's difficult for someone early in recovery to have that around them.”

He continues, “We give them a choice when they leave that program—they can go out and take a left turn out into the street and the world of addiction, or they can make a right turn and come to our project.”

Peer-driven pursuits

MARS, with two full-time and four part-time staff as well as a host of volunteers, provides a core training on what addiction is and how methadone works. It then offers a host of other programs, many of them peer-driven. MARS, which has 60 “regulars” and about 120 weekly participants, teaches clients about HIV and the hepatitis C virus, and at the request of peer members expanded that offering to teach general anatomy.

The project offers off-campus social events, advocacy for members trying to negotiate the social service system, one-on-one mentoring, housing referrals, and some career counseling. Peers are trained to become peer leaders, who in turn drive many of the MARS initiatives.

SAMHSA is funding MARS through 2010. While there are rumblings that the RCSP program will end, Ginter, who says he has been substance-free for more than 15 years and in recovery for 10, vows to keep the program running, even if it means knocking on every door in Albany for support.