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ARUN RATH, HOST:

You are listening to ALL THINGS CONSIDERED from NPR West. I'm Arun Rath. 40 to 60 percent of heroin addicts who stop using relapse within the first year. Many within weeks of finishing a rehab program. A treatment center on Cape Cod in Massachusetts says it is breaking the cycle by treating heroin addiction as a chronic disease that can be managed but not cured. From member station WBUR, Martha Bebinger reports.

MARTHA BEBINGER, BYLINE: The first time Jeremy Wurzburg, now 21, left a heroin treatment program, he planned to begin Narcotics Anonymous and do all the right things to stay off drugs. One week later, he was hanging out with another person in early recovery, in what he came to realize is a typical turning point.

JEREMY WURZBURG: You know, this happens a lot. There's the two of us sitting together - like in my car after a meeting or something. And we're both kind of - we're not sure whether we're going to use or not, and someone makes like, a half-joke, you know what I mean? Like, oh you know, we could just go out and drink right now or something. And the other ones like yeah, let's do that - sounds good. And then it's off.

BEBINGER: From that drink, Wurzburg, a skinny, pale young man was quickly back to his drug of choice - heroin. Most rehab programs he says don't, and maybe can't prepare patients for that moment in the car.

WURZBURG: Once I got out of treatment it's the real world. It was a big shock because you know, it was really easy not to use when you're in rehab - it's not put in front of you or anything - but once I got out into the real world it's like, I had the knowledge of what to do but I didn't have that - those skills yet or the tools to say no.

BEBINGER: The next time Wurzburg came out of treatment, he graduated into the Young Adult Recovery Program - a one-year pilot project run by a network of addiction treatment services called Gosnold on Cape Cod. Wurzburg agreed to live in a sober house, attend a daily 12-step group meeting and get individual counseling. There's a smartphone app with the panic button and GPS tracking. There are group trips to ski, hike and listen to the symphony, and perhaps most importantly, Wurzburg gets daily, sometimes hourly help from his recovery coach. Kristoph Pydynkowski says he helps Wurzburg with everything.

KRISTOPH PYDYNKOWSKI: Like how to manage their emotions, how to go to meetings, how to fill out job applications, how to take care of themselves, how to go back to school - be a cheerleader - a beacon of hope, you know?

BEBINGER: Pydynkowski leans forward, ticking off the list of things he and Wurzburg do together - visits with Wurzburg's parents, a reunion in Los Angeles with Wurzburg's twin brother - fishing and 6:15 a.m. trips to a coffee shop before Narcotics Anonymous meetings. It may sound like giving him so much attention would be very expensive, but the program is saving money because fewer participants are spending time in residential rehab. Every week Pydynkowski helps Wurzburg create and follow a recovery treatment plan. Pydynkowski argues that addiction must be managed for life like hypertension or diabetes.

PYDYNKOWSKI: Taking insulin, maybe watching my diet, getting my blood work drawn, going to different appointments, walking on the treadmill, making sure I'm taking care of myself - this is the same thing.

BEBINGER: New York and Tennessee pay for peer coaches to help treat addiction through Medicaid - something Massachusetts is taking a look at. Gosnold director Ray Tamasi says coaches are more effective in many cases than sending patients to an expensive rehab facility for weeks at a time.

RAY TAMASI: More beds is not an answer to addiction. You can't just keep people in beds all the time.

BEBINGER: To prove his point, Tamasi compared the records of 54 young adults in the pilot program one year before and one year after it began. There was an 83 percent reduction in emissions to rehabilitation facilities. Emergency room visits went from 16 to one. There were no new legal offenses. More than half of the participants are either working or back in college. Jeremy Wurzburg is in the framing department at an arts and crafts store and plans to resume classes towards a counseling degree.

WURZBURG: Just trying to keep doing a little better than I did yesterday.

BEBINGER: For NPR News, I'm Martha Bebinger in Boston.

RATH: That story is part of a reporting partnership between NPR, WBUR and Kaiser Health News.

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