For an individual addicted to heroin or prescription pain medications, achieving and maintaining abstinence is probably the greatest challenge he or she will ever face. Most people with opioid addiction tell themselves over and over again, "I need to stop. This is the last time," but they find themselves living out the "one last time" illusion day after day, month after month, year after year while the rest of their lives — relationships, employment, self-esteem, health and financial and legal status — are destroyed by the disease of addiction.

The heroin epidemic in this area disproportionately affects young people. From 1992 to 2008, the percentage of patients in treatment for opioid addiction under age 30 increased from 19 percent to 53 percent.

Young people who use heroin cross an invisible line that results in social ostracism. They often feel trapped among their "new friends" — fellow heroin users and dealers. Parents are baffled at this social transformation and even more baffled when their child's behavior spirals into lying, cheating and stealing. Parents are shocked to find out that their child is using heroin. Sometimes, a young person using heroin will confess to using "prescription pain pills," as if that were less serious. Prescription opioids are involved in twice as many fatal overdoses each year than heroin and cocaine combined.

Untreated opioid addiction is highly lethal. Currently, more than 200 people die from opioid overdose in the St. Louis region every year. Many more receive emergency naloxone treatment that reverses the effects of opioid overdose and brings individuals back from the brink of death. Heroin forums held at public schools throughout the region are overflowing with parents terrified for their children. Tragic stories of parents losing their children to overdose have become common. These stories often portray treatment as pointless and ineffective, breeding a sense of hopelessness and despair among individuals and families affected by heroin addiction.

Heroin and prescription opioid dependence is a chronic disease requiring long-term treatment. People with heroin addiction have an allergic reaction to the very idea of using heroin — when they perceive the possibility of getting high. The allergenic idea penetrates the individual's mind and causes such a violent malfunctioning of the motivational system, such an uncontrollable attraction to the drug, that every good intention to stay clean and sober is overridden by the drive to use.

Although conventional psychosocial and mutual support programs are important resources in a comprehensive recovery program, there is no good evidence that they are sufficient to treat people addicted to heroin or prescription opioids. In the person's natural environment, triggers are too plentiful and the drive state too powerful to arrest using psychosocial or mutual support alone. This insight comes from the U.S. heroin epidemic of the 1960s and 70s. At that time, failed attempts to treat heroin dependence with psychosocial and mutual support interventions led President Richard M. Nixon and Congress to fund large-scale methadone treatment. Today, more than 200,000 Americans are receiving methadone treatment for opioid dependence.

Since the 1970s, medical treatment for heroin dependence has advanced beyond methadone. Now, there are three U.S. Food and Drug Administration-approved medications available for the treatment of heroin and prescription opioid dependence: methadone (an opioid agonist), buprenorphine (a partial opioid agonist) and naltrexone (an opioid antagonist). All three are paid for by private insurance and, more important, through state-funded programs in Missouri. These medications combined with robust psychosocial intervention gives patients the very best chance to achieve long-term recovery.

In addition to providing a full range of medication assisted treatment options to persons with opioid dependence, effective treatment must be ongoing. The idea that 30-, 60- or 90-day treatment programs adequately prepare individuals with opioid dependence to re-enter their natural environment and successfully manage the risk of relapse flies in the face of all available evidence.

Arbitrary limitations on the length of treatment have made treatment for opioid dependence a revolving door: One in four people who enter treatment for heroin dependence has already been to treatment five or more times. The rational response to a disease that requires multiple, costly and acute treatment episodes is to stop providing short-term treatment episodes and to adopt a model of continuous care.

Political, economic and moralistic agendas have perpetuated an antiquated model of treatment for opioid dependence in which clients have poor access to approved medical interventions and almost no access to ongoing care on a timely basis.

Addiction must be treated like any other chronic illness — with collaborative and ongoing assessment, treatment planning and multidisciplinary clinical care. The combination of medication and continuous care can help stem the tide of tragedy that is washing over the St. Louis community and give people with heroin and prescription opioid dependence hope in the possibility of recovery.

Ned Presnall, MSW and LCSW, is the clinical director for the Assisted Recovery Centers of America.