Walter Ginter, CMA, has been one of the country’s leading advocates of medication-assisted treatment (MAT) for opioid addiction over the past decade. He has been in recovery for more than 30 years. In September we talked with him about the success of his pilot project on peer recovery support in the Bronx, New York.
If Walter were to post a credo on his office wall, it might read something like this:
- Opioid addiction is a brain disorder
- Opioid addiction is a chronic disease
- Some people will be prescribed methadone maintenance for an indefinite time
The medical community wasn’t convinced of these facts 30 years ago, when Walter began methadone treatment. At several intervals over the next 20 years, his counselors and family told him it was time to quit MAT—despite his successful therapy. Each time he tried to quit, he relapsed to illicit opioids.
It wasn’t until the late 1990s, when Walter met advocates from the National Alliance for Medication-Assisted Recovery (NAMA), that he was introduced to the science of addiction and methadone.
His initial response was anger. „Why did I have to go through 20 years of feeling miserable about myself because I couldn’t get off of methadone?
„After I got over my anger, I didn’t want others to go through what I did. That’s when I became a patient advocate supporting recovery.“
The MARS Project
In short, what happened to Walter many years ago led to his becoming the founder and director of the Medication Assisted Recovery Services (MARS) Project, a peer-initiated and peer-based recovery support project sponsored by NAMA. Funded in the fall of 2006 through the Recovery Community Support Program (RCSP) under the Substance Abuse and Mental Health Services Administration (SAMHSA)/Center for Substance Abuse Treatment (CSAT), MARS is the first project funded for MAT patients, and the first recovery support project created and carried out by MAT patients themselves. According to Walter, „the learning curve of grant writing is steep, and the project didn’t succeed until its third submission round.“
MARS is a collaboration between NAMA and Albert Einstein College of Medicine (AECOM), Division of Substance Abuse (DoSA), in the Bronx, New York. „AECOM provided our space. It’s not actually inside the OTP, but it’s right next door and gives us convenient access. We provide peer recovery support services; Einstein provides treatment, from primary care to medication-free services, links to vocational rehab, and mental health services. MARS offers a place for all patients who want to take part to meet and share experiences, strengths, and resources, and to support each other.
MAT patients are welcome to participate in MARS as regular attendees or on a drop-in drop-out basis. The depth of participation is their choice; there are no „stages“ or „phases“ to pass through.
Core Training on Addiction and Methadone
„The most important thing we do is our core training,“ Walter explains. „We realized patients were missing exactly what I missed during those early years: an understanding of what opioid addiction is, how it affects your brain, its chronic nature, and how methadone works. The MARS project differs from other programs in that we teach about medications, including stabilization during induction, the half-life of methadone, and the importance of coming to the clinic every day to receive medication. And why some patients may need methadone for the rest of their lives, like me; how each patient is an individual.
„For a long time, the medical community had two views about methadone. The ‚magic bullet‘ view, ‚Just take the methadone, that’s all you need.‘ On the other side was, ‚You don’t need methadone, just go to groups and control your behavior.‘
„Now we know that opioid addiction has two components. Many patients need medication, and methadone works. But opioid addiction has behavioral components as well; managing them may require peer recovery support services that traditionally have been available only in the medication-free or drug-free recovery community.“
Group Sessions and Advocacy
„We’ve registered about 450 peers in MARS. About 50 are at our recovery project on a given day. MARS has 12 peer leaders who come from the community of patients at Einstein.
„We established a MARS council, where peers decide weekly what the project is going to do, what groups they want, what events they want to hold, and what their plans are for the future. We plan for recovery month events each September. The peers make decisions regarding recovery and project issues.
„Each week there is one peer-leader training session and 18 group sessions. We also provide two types of advocacy for patients: one with treatment providers, such as Albert Einstein; the other with social services. Some peers are intimidated when they try to enroll in Medicaid, so they walk out without getting a card. We go back with them and help them obtain Medicaid and other entitlements.
„Except for core training, our groups are peer initiated and peer led. Many groups are about health and wellness. Peers choose the topics; they know what they need—such as information about hepatitis C. We also have groups on HIV, trauma, and other health and mental health issues.
„Every Friday, MARS conducts a relapse-prevention course that addresses the upcoming weekend, and is designed to help peers maintain their recovery focus through to Monday morning. That was something the peers wanted. MARS also holds off-campus events funded from the grant. We visit museums, often go bowling, and have picnics. We don’t go to movies. Instead, we focus on places where our peers are able to communicate with one another. Many peers don’t know how to socialize without a glass of wine or some cocaine or marijuana. Just learning to socialize, to talk with people, is so important.
„When patients come into an OTP, they view being on medication as the low point of their life. ‚I’m now in the methadone program.‘ Many will say, ‚I’m just going to be here for three months, until I get my act together, then I’m going to detox, and then I’ll be off.‘ If they want to try to taper, we support their choice. I tell them, ‚I’m not selling medication, I’m selling an informed decision.‘ I want them to have all of the answers I didn’t have.“
Are They Patients . . . or Peers?
„When we first became part of the RCSP community, we were encouraged to use the term ‚peers‘ instead of ‚patients.‘ It took a long time for our people to refer to themselves as ‚patients‘ instead of ‚clients,‘ and it wasn’t something I was prepared to abandon. But those in MARS made the decision for me. They decided that when they’re at the OTP, they’re patients, but when they’re in the MARS recovery project, they’re peers—and peers in the purest form: equals. That was one of my happiest days, because I knew that they had taken ownership of the MARS project, as well as their own recoveries.“
Recovery Is . . . and Isn’t . . .
Recovery is a key component of the MARS project, and something few people understand. „Some patients come in believing that recovery is something that happens after you leave treatment,“ Walter says. „At some 12-step meetings, methadone patients are often forbidden to speak. They’re viewed as using a mind-altering drug [methadone] and as still getting high.‘ That’s not true, of course.
„So, many come away with the attitude, ‚I’m less worthy than somebody who’s medication-free‘ — the same way I felt years ago. ‚What’s the matter with me?‘ Well, it’s just the nature of the disease of opioid addiction.
„Our core training helps patients understand that if they stop using alcohol and illicit drugs, they’re in recovery. If they start using less, they’re on the road to recovery.
„Recovery has nothing to do with giving up or not giving up medication. Those who stop using are in recovery, whether they’re taking medication as part of treatment or not.“
The Future of MARS
The MARS project is now up for renewal. Walter notes: „During our four-year pilot project we’ve proved our premise: There are certain things patients—peers—can do better than treatment providers can.“
Peer recovery support provides someone to share experiences with, someone to learn from, „and,“ Walter notes, „more important, someone to teach the lessons I didn’t learn during those first 20 years.
„The MARS pilot project is a huge responsibility for our peers. They realize this project is unique. People go out of their way to help one another, because we all want MARS to be successful and to continue beyond the initial funding.“
As Walter notes, the current success of MARS is especially remarkable because the clinic is located in the south Bronx, a poverty epicenter in our nation, with the highest rates of addiction and HIV infection in New York City. „We’re located next door to the OTP. Patients leaving the OTP have a conscious decision to make—a right turn into the elevator, then out to the street, where heroin and crack cocaine are easily available, or a left turn into our MARS project, and an investment in recovery.“
The fact that so many patients choose that left turn into MARS describes much better than words the success of the MARS project.
In addition to his work at MARS, where he is a project director and director of training and recovery services, Walter Ginter represents NAMA as a planning partner for National Alcohol and Drug Addiction Recovery Months. Walter served as a board member of Faces and Voices of Recovery, and remains an active member of that group. He is often called upon by SAMHSA/CSAT to represent medication-assisted recovery on panels and workgroups, and delivers presentations at major conferences throughout the nation on this topic.
Walter received the Richard Lane Advocacy Award at the April 2009 conference of the American Association for the Treatment of Opioid Dependence (AATOD).
As AT Forum went to press, Walter received word that the MARS project will be funded for four more years.