Inside Rehab

Practical information about addiction treatment and recovery

What Farewells to Monteith Don't Say About Addiction Rehab

It’s time for consumers to question what goes on in addiction treatment

Last week, TV show “Glee” characters and fans said their final farewells to the fictional Finn Hudson, but they were also saying good-bye to Cory Monteith, the real-life actor who played him. I thought the show’s tribute did a tasteful job of saying good-bye without any explanation of how Finn (or Cory) had died. People Magazine put it nicely with, “This turned out to be a succinctly dignified approach: Not specifying the cause or events in effect acknowledged them without denying them. The emotions, like the musical selections that are the heart of the show, were allowed to cut through the accumulated media clutter around and about Monteith.”

However, I always have a terrible time laying to rest my feelings of despair when someone – especially a young person – dies because of an addiction. Others’ feelings run the gamut from uninformed comments, like, “He was a drug addict and has only himself to blame” to extreme sadness to those of Glee’s fictional high school principal, played by Jane Lynch, who said, “It’s just so pointless; all that potential.”

I always want to get to the bottom of things, to understand, “What went wrong? What possibly could have led to this person’s failure to get well, and, in the end, to his demise?” As the final Glee episode’s only allusion to the cause of Cory’s death stated in a public service announcement after the show, “Our friend,

We have treatments that lower death rates by as much as 50%
SBukley/Dreamstime.com
Cory, didn’t look or act like an addict. He was happy, successful, and seemingly had it all.”

But it’s likely that something or multiple things did go wrong along – the way they often do in the course of the lives of individuals who misuse drugs and alcohol. It’s been reported that as a kid, Cory had social difficulties at school and was using alcohol and marijuana as early as age 13, when his school truancy began. The 16 schools he attended included “alternative” programs for troubled teens, which according to Maia Szalavitz, author of Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids,  would have been places where “tough love reined” during the time when Cory attended (1995-1998.) She noted that tactics at such schools were aimed at "breaking" youth through physical and emotional abuse – everything from solitary confinement and punitive restraint to sleep and food deprivation and public humiliation.

At age 16, he dropped out of school and turned to petty crimes to fund his drug and alcohol use until at 19, his mother and some friends staged an intervention that landed Cory in rehab. There, he’s reported to have done his time and then, in his own words, “went back to exactly what I left off doing.” We know that traditional “interventions” like the ones you see on TV are not the most effective in helping people with addictions to change their behaviors or to motivate them toward treatment. Numerous research studies have shown the non-confrontational CRAFT approach to be far more effective.

Perhaps most concerning given Monteith’s recent history is that he returned to residential addiction treatment at a prominent facility as recently as March of this year. Apparently he stayed just shy of a month, when recommendations from experts and leading organizations such as the National Institute on Drug Abuse (NIDA) say that treatment should be at least 90 days. Such treatment need not be residential, but should be on-going in some capacity. We really don’t know what Cory’s continuing care situation was, if there was any, or if he heeded recommendations. However, in writing Inside Rehab, I found that many addiction treatment programs don’t follow through adequately when the first phase of treatment ends.

Perhaps the greatest travesty – given that Cory died with an empty hypodermic needle by his side and with morphine, codeine and a heroin metabolite in his system (all drugs in the opioid family) – is that the rehab he went to earlier this year (like the one he went to when he was younger) doesn’t support the on-going use of some the most effective tools we have in the arsenal for helping people recover from addictions: the medications, methadone and buprenorphine (most commonly available as “Suboxone.”) Now, we don’t know for sure why Cory went to rehab, but given that he died with numerous opioids in his system, it seems obvious that these were among his drugs of choice. Sometimes rehabs use medications like Suboxone short-term, just to ease the misery of withdrawal as patients go through “detox." But once withdrawal symptoms have passed, cravings for opioids can last for months or even years.  

Methadone and buprenorphine are substitute drugs that block cravings for illegal and unauthorized opioids. They’re legal and do not produce a high or impair functioning when properly medically prescribed, allowing people to live normal lives. If a person treated with these medications takes an opioid such as heroin, the euphoric effects are usually dampened or suppressed. Research suggests that most people addicted to opioids should be discharged on “maintenance” doses of such medications or they are very likely to relapse. To achieve stable recovery, some people need to stay on these medications for long periods of time, sometimes for life. 

In 2009, the United Nations’ World Health Organization (WHO) published guidelines for treating opioid addiction based on an international consensus that concluded maintenance therapy with either methadone or buprenorphine produced far better outcomes than withdrawal and detoxification alone and that “opioid withdrawal (rather than maintenance treatment) results in poor outcomes in the long term.” The report found maintenance treatment, combined with psychosocial assistance, to be the most effective of all treatments examined. Not only that, but a number of studies show that such treatment markedly lowers the death rate in people addicted to opiods—by as much as 50 percent. According to NIDA, “Scientific research has established that medication-assisted treatment of opioid addiction increases patient retention and decreases drug use, infectious disease transmission, and criminal activity.”

Why then, in the vulnerable months following rehab discharge, wouldn’t ALL rehabs offer clients the very medications that we know are life-saving – or at the very least, provide balanced, science-based information about them?

Anne M. Fletcher, M.S., R.D., is the author of Inside Rehab: The Surprising Truth about Addiction Treatment – And How to Get Help That Works.

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