Through podcast, Madison treatment center hopes to inspire better addiction care
Madison — In a shocking move, Tesla three years ago announced it would make the technology that runs its vehicles publicly available, free for companies acting in good faith to duplicate as they wish.
In making that decision, CEO Elon Musk made a statement: He wasn’t trying to get rich off electric cars — he was trying to fill the world with them.
It’s with a similar mindset that Dr. Marc Bono, clinical director of the Center for Compassionate Recovery, hosts his podcast, Open Source Recovery Radio.
Over the past several months, he has used the show to disperse information about the types of opioid addiction treatment that are returning the best outcomes. Sometimes he features local grass-roots groups that are taking unique approaches. Other times he talks about his own center’s methods.
“My partners originally were concerned I was going to give all our secrets away,” Bono said. “I just want the care to get better.”
Operational for about two years, the Center for Compassionate Recovery offers an integrated approach.
Clients who call the center are seen within 24 to 48 hours, Bono said. When they walk into the historical building at 17 Wall St., the space that greets them looks more like a living room than a doctor’s office. The staffers exude compassion and respect.
“There’s a high value put on providing a dignified environment,” Bono said. “That’s a culture that permeates all of our policies and procedures.”
On arrival, clients meet with a physician for a medical assessment for Suboxone, a blend of buprenorphine and naloxone that reduces the symptoms of withdrawal. A therapist then begins a psychological assessment to determine what’s going on with the person — a process that in some cases requires multiple sessions.
“So the physician and therapist work 20 feet apart and are in constant collaboration on all of our clients,” Bono said. “That’s the first thing that should happen everywhere and it almost happens nowhere.”
Bono, a nationally recognized addiction psychologist, said screening for and treating mental health issues is a must when it comes to recovery from substance abuse. A mental health disorder left undiagnosed and untreated “means treatment outcomes are going to be poor,” he said.
About half of his center’s 80 clients have been diagnosed with some kind of mental health issue, he said. And that’s where the individualized psychotherapy comes in.
Some clients receive therapy in a group setting. Others come as individuals. All are seen weekly.
“Opiate addiction is really hard to overcome,” Bono said. “You don’t just come get a script and come back a month later and everything goes great. It doesn’t work that way.”
Bono said many residential and outpatient programs skip the therapy aspect in favor of simply teaching clients about addiction. Many practices also kick participants out if they miss a couple meetings or have opioids show up in their drug screens.
“If one of our clients has a setback, we’ll just add more therapy ... to revise the plan and figure out what went wrong,” Bono said. “It’s a very non-punitive approach. That’s something the clients often had not had before. It keeps them engaged in treatment.”
In the end, the goal is to wean the clients off the Suboxone, but only after 18 to 24 months have passed and clients have developed necessary coping skills.
Bono said he wishes more groups would follow the Center for Compassionate Recovery’s model. Instead, he sees money going toward methadone clinics and detoxification — two practices with which he takes issue.
Methadone, he said, is a “1970s medicine” that is less safe and less effective than Suboxone. To obtain it, people often have to venture into a "toxic environment" — one where drug dealers sometimes wait outside, hoping to lure in those who are in recovery. In the whole process, no therapy is involved.
“You’d have to be Superman to succeed,” Bono said.
As for detoxification, Bono said it typically isn’t detoxification at all. Anyone with state insurance can get into detox, he said, where they’ll get a few days of methadone or Suboxone and then a tapering-off protocol “not based on science.”
“All that does is put you into withdrawal two or three days later,” he said.
Bono’s center accepts all types of insurance. In a recent snapshot of those who had been with the center for at least three months, less than 3 percent were found with opioids in their system.
“We get all this great feedback from other providers who say our outcomes are tremendous,” he said. “But what we’re doing is the standard of care. It’s very sad that our practice stands out so much because we’re doing the standard of care.”
Bono’s weekly podcast is on hiatus for the moment as he seeks out a new recording studio. Still, he has issued a call for guests willing to speak about their experience with the opioid crisis — they’ll be featured once the podcast starts back up again.
Anyone who has a story to share is asked to email firstname.lastname@example.org or call (203) 421-6071.
“Nobody really talks about the most important thing, which is quality of treatment,” Bono said. “They talk about changing prescription practices and having Narcan available. There’s a little bit of talk about access to treatment. But they don’t talk about quality of care.”
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