Comprehensive Opioid Addiction Treatment (COAT) Here at Chestnut Ridge Center, we believe that healing from the disease of addiction includes abstinence from alcohol and all other drugs of abuse. Recovery also requires an active recovery program that includes behavioral and cognitive changes. Before a person can be accepted into the Comprehensive Opioid Addiction Treatment (COAT) program, he or she must complete an intake evaluation. During the evaluation, individual history and needs are considered. If the person is recommended for medication-assisted treatment, he or she will review and sign a program agreement and be given an appointment time. Participants attend two meetings during each visit: medical management therapy sessions In addition, participants are required to attend 4 Narcotics Anonymous and/or Alcoholics Anonymous meetings per week. Random urine screens may be conducted during any clinic visit. These screens may also be observed by appropriate clinic staff. Medication Assisted Treatment One medication approved for the treatment of opioid dependence is Suboxone®. At the right dose, Suboxone® suppresses cravings for opioids and eliminates withdrawal symptoms. The medication is a combination of two drugs that eliminates the high from opioids and has two mechanisms that protect against abuse of the medication. Buprenorphine, the active ingredient in Suboxone®, works by strongly binding to opioid receptors in the brain. Buprenorphine attaches to the opioid receptors, activating them partially, enough to suppress withdrawal and cravings, but not enough to cause extreme euphoria. Even when all available receptors are occupied with buprenorphine, the total opioid effect is relatively low. Therefore, even if the patient decides to misuse opioid drugs after taking buprenorphine, the effects can be blocked, depending on the dosage. The ceiling effect and the blocking ability give buprenorphine a favorable safety profile and help lower the risk of overdose and misuse. Group Information All meetings take place at Chestnut Ridge Center Outpatient Services. Basic/Beginners Group: All participants entering the COAT Program start in the Basic/Beginners Group. Participants meet in this group once per week until they have 90 consecutive days without relapsing on any prohibited substance and/or alcohol. The participant must also have an active, functional sponsor from either NA or AA in order to graduate to the Intermediate Group. Intermediate Group: All participants in this group meet twice per month. Participants meet in this group until they have 365 consecutive days of no relapsing on any prohibited substance and/or alcohol. During this year, participants work actively on their recovery program. Consideration of medication need is part of each person’s recovery plan, which is developed during an individual evaluation at 6 months. Advanced Group: All participants in this group meet once a month. While participating in this group, the doctor, patient, and therapist work closely together on a tapering method, if appropriate. Relapse Prevention Group: All participants in this group meet on a weekly basis focusing mainly on relapse prevention. Participants who relapse consistently remain in this group until otherwise recommended. Makeup Clinic: A makeup clinic is offered to participants for missed (excused) clinic appointments. Basic Groups are permitted to use this clinic once every 6 weeks, the Intermediate Group once every 3 months, and the Advanced Group once every 6 months. As Suboxone® Therapy Begins A person may safely begin to use Suboxone® when they are in mild to moderate withdrawal. Buprenorphine (one part of Suboxone®) attaches to the same receptors as other opioids leave the person’s system. Withdrawal symptoms decrease within minutes of the administration of Suboxone®, because it attaches to the same receptors. At this time, cravings begin to reduce. Buprenorphine firmly attaches to the receptors and blocks other opioids from attaching. With an adequate dose, buprenorphine has a long action duration and doesn’t wear off quickly. COAT Program Rules The long-term goal of treatment is to remain drug and alcohol free. Participants must keep and be on time for all scheduled appointments. Cancelled appointments without seeing the physician may result in not receiving medication. Fees and co-pays will be collected during each visit. Medication will be taken as directed by the physician. Replacement prescriptions for lost or stolen medication are not provided. Mixing Suboxone® with other medications, especially benzodiazepines, can be dangerous and is forbidden. Filling any controlled substance prescription, without approval, will result in an immediate discharge. Participants must behave in a courteous manner and not deal, steal, or conduct illegal or disruptive activities in the clinic or pharmacy property. Participants will provide their own urine for random drug screens as requested. Tampering with, buying, selling, or otherwise procuring urine will result in an immediate discharge. Participants understand treatment is strictly confidential and violation of other participants’ confidentiality may result in an immediate discharge.