Dependency & Addiction

A thin but visible line.
As a society we know that medications are a necessity. Antibiotics fight infections; specialized medicines treat unique conditions; chemotherapy medication destroys malignant cancer cells; pain medications block acute and/or chronic pain. Of this list, pain medications are unique in that they carry a level of social stigma that is uncommon when compared to medications used to treat other health issues.

The fact is pain is one of the most powerful forces in human physiology. It can lead to depression, a loss of mobility, decreased cognitive function, and in some cases, thoughts of suicide. For many, this reality leads to a dependency on pain medications, which is often the only viable solution for the “pursuit of happiness”. It can however lead to health risks and even dangerous behaviors like addiction. This evolution of dependency and addiction is preventable with open and honest communication with your prescribing doctor.

Acknowledging the difference between dependence and addiction is an important component of this communication. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) views substance use disorder as a spectrum disorder in which there is a thin, yet visible, line between dependency and addiction; one that is easily misplaced in the absence of mindful consumption. Someone who is dependent on pain medication may actively follow dosing prescriptions, be more likely to have a moderate or low tolerance for the drug, and even seek to lower or stop dosing all together. Someone who is addicted to pain medication will exhibit compulsory behaviors, tendencies to hide consumption behaviors, a change in personality, and an especially high tolerance for the drug coupled with a desire for a higher dose. The DSM-5 also clarifies the point that to be addicted to something you must experience dependence. Dependence is, in fact, a symptom of addiction. Conversely, dependence does not equal addiction, which is a fundamental concept easily missed in our social discussions related to drug use and abuse.

This distinction is relevant because the transformation from dependency to addiction is preventable, and, most importantly, observable. We know that medications are useful, but they can also be dangerous when consumed outside of the parameters of a prescription. Whether you are the person prescribed the highly addictive medication for your now injured leg, the unfortunate product of an accident, or you are a witness to such, it is important to note that changes in behavior may be a distinct indicator of addiction and should be investigated. While it is the responsibility of the person prescribed the medication to monitor their own consumption, it is imperative that we, as a society, are aware that the evolution from dependency to addiction is not one that happens overnight, nor is it one that knocks at the door. As keepers of ourselves, our bodies, and that of our brothers and sisters we should all keep a watchful eye, with patience and vigilance, so as to prevent the unnecessary suffering of addiction.

If you believe that you, or a loved one, have transitioned from dependence to addiction there are resources available to you. WIN Recovery, formally known as Western Indiana Recovery Services, is an opioid treatment program (OTP) in West Central Indiana. The program is the first of its kind in the area and offers medication assisted treatment, in the form of methadone, to treat the disease process of opioid use disorder by offering daily medication, group and individual counseling, and case management services. For more information about services visit To set up an assessment, call 1-812-231-8484 or stop by the facility at 88 Wabash Court in Terre Haute, IN. Walk-ins are welcome.

Hamilton Center, Inc. also offers behavioral health services including addictions counseling and case management. For more information on services call 1-800-742-0787 or visit

Knox & Hendricks Selected for OTP’s

State Awards Licenses to Hamilton Center, Inc.

On Wednesday January 23rd, at Hamilton Center, Inc. in Terre Haute, IN, CEO Melvin L Burks was joined by Kevin Moore, Director of the Department of Mental Health and Addictions (DMHA), to announce the State of Indiana has awarded Hamilton Center two additional licenses to open opioid treatment programs (OTP) in both Hendricks and Knox Counties. These programs are the first of their kind in their areas, and will offer medical and behavioral interventions to those with opioid use disorder (OUD). Community members and local media from Hendricks, Knox, and Vigo Counties attended the event. The new clinics will be modeled after Western Indiana Recovery Services, an opioid treatment program of Hamilton Center that opened in May of 2018, located in Vigo County.

Hamilton Center applied for both licenses in August of 2018 and was notified in November of 2018 of their selection by the state. These clinics will open on or before December 31st of 2019 offering medication assisted treatment (MAT) in the form of methadone, group and individual therapy, and case management services. Locations have not yet been identified, however referring organizations have been contacted for feedback and recommendations. Once a site has been selected, Hamilton Center will begin the rigorous process of achieving certification through various state and federal agencies including the State of Indiana, the Drug Enforcement Administration (DEA), The Substance Abuse and Mental Health Services Administration (SAMHSA), and The Joint Commission (TJC).

Hamilton Center partnered with Sagamore Medical Recovery Services to open Western Indiana Recovery Services in 2018, the first OTP of its kind in Vigo County. The program delivers daily medical and behavioral interventions to those with opioid use disorder. Sagamore physicians and medical staff deliver medical services which include medication assisted treatment in the form of methadone, while Hamilton Center delivers behavioral interventions, including group and individual therapy, and case management. Medication assisted treatment is associated with a decrease in the spread of HIV/AIDS and Hepatitis C, a decrease in criminality, and an increase in employability and overall functioning.

Opioids are a class of drugs that work to block pain receptors giving the user a feeling of calmness and happiness. Use of prescribed and illegal forms of opioids can lead to opioid dependency and opioid use disorder (OUD) after just a few days of regular use. Consequently opioid overdoses are a growing trend in the United States. The National Institute on Drug Abuse (NIDA) found that more than 130 people die every day from an opioid overdose, while the National Safety Council found opioid overdose deaths to be more common than deaths involving motor vehicles. Furthermore, the cost of prescription opioid abuse alone is over $78.5 billion in the US annually, which has led to increased health care costs across the country.

Indiana has had its own unique struggle with opioids. With roughly 1,138 opioid related overdose deaths in 2017 alone, as reported by the Indiana State Department of Health (ISDOH), Indiana Business Review reports an estimated cost of economic damages related to the opioid epidemic to be $43.3 billion dollars from 2003 through 2017.

Hamilton Center, Inc. is a regional behavioral health system in Central and West Central Indiana. Services are provided to children, adolescents and adults, with specialized programs for expectant mothers, infants, and people with drug and alcohol problems. Counseling services are provided for people who may be struggling with stress, life changes, or relationship issues as well as more serious problems such as depression, anxiety disorders, and serious mental illnesses.

Sagamore Medical Recovery Services, LLC, was formed in 2016 by Christian Shaw, MD, PhD, and his partners. Dr. Shaw is a leader in the field and has worked to develop the most successful, innovative and respected methadone based opioid treatment program in New Mexico.

OTPs, Mental Health, and the Opioid Crisis

By: Jessica Nevill, LMHC, Clinical Director, Western Indiana Recovery Services

Opioid use has been the focus of a great deal of national attention recently, with good reason. According to the National Behavioral Council, Americans consume 80% of the opioid prescriptions given worldwide. On average 44 people die per day in the United States from overdoses on pain killers according to the Centers for Disease Control and Prevention. As a result,  America is now in an opioid crisis. There is a growing numbers of individuals dying daily from overdose as well as increased criminal activity and increased HIV/AIDS rates.

Opioids have been prescribed in the United States to help individuals who are experiencing pain. These medications are effective at blocking the pain and providing relief. This is done by impacting the “reward pathway” which allows the person using the opioid to experience pleasure and an overall state of well-being. When used repeatedly over large periods of time, however, the person can build a tolerance to the medication which does not allow them to experience the same levels of well-being that they experienced before. This results in individuals taking more and more of the medication to get the same desired results.

So how does this result in an opioid crisis? When individuals need more and more medication to reach desired amounts of relief, they will use medication faster than prescribed. This can result in individuals seeking alternatives ways of getting pain medicine as their bodies have become dependent. The Substance Abuse and Mental Health Services Administration (SAMHSA) reported that over half of individuals who abused pain killers received them for free or from a relative. Once these individuals are no longer willing or able to provide this medication individuals often turn to other methods for achieving the same effects such as buying medication illegally or beginning the use of heroin which is also an opioid. Once individuals begin using illegal methods to maintain an opioid dependence they are then at higher risks for HIV and AIDS as well as incarceration, separation from family, and loss of employment.

Opioid Treatment Programs (OTPs) are working to tackle the opioid crisis. Opioid treatment programs provide individuals with medication such as methadone, buprenorphine, and naltrexone to help them discontinue the use of illicit substances. Methadone activates the same parts of the brain other opioids do. Buprenorphine activates the same parts of the brain but without the rewarding effects. Naltrexone blocks the part of the brain that opioids activate and removes rewarding effects. Research shows that methadone and buprenorphine, when prescribed by a physician and closely monitored, are the most effective treatment methods for opioid use disorder. Methadone is considered the “gold standard” of treatment especially for pregnant woman who are addicted to opioids. This along with behavioral health services such as individual and group counseling help individuals gain the skills needed to maintain success in their lives. Western Indiana Recovery Services is privileged to bring these services to Vigo County with the integrated approach to recovery to help individuals reach their potential. Through medication assisted treatment and behavioral health services we are working to help individuals able to maintain success within the program and for many, regain life – job, family, school, etc. Recovery is possible and appropriate treatment works.

Western Indiana Recovery Services, Vigo County’s first certified opioid treatment program, is located at 88 Wabash Court, Terre Haute, IN. The Clinic provides comprehensive opioid treatment including medication (methadone) coupled with individual and group therapy and other behavioral health services as needed.   The clinic is open now from 6:00 a.m. – 12:30 p.m. Monday through Friday and 7:00 a.m. – 10:00 a.m. weekends and holidays. Patients can make an appointment by calling (812) 231-8484 or (833) 232-0215. Beginning May 28, walk-ins will be welcome. Patients will be assessed for specific admission criteria to the program. This program is one of several addiction programs of Hamilton Center Inc.