What medications are people using these days in order to treat addiction?
Is it possible that the world of addiction treatment is about to change based on a new breakthrough drug?
I have paid close attention to these ideas as I have gone through the last 12+ years of my recovery. At one point I worked in a rehab center that often put people on certain medications that were supposed to help with their addictions. My conclusions are mostly based on my own personal observations, so they are very limited in scope and are certainly not very scientific. But I still believe that I observed enough to note that the trends and the major pitfalls of using medication to fight against addiction.
The number one “pitfall” in my opinion is this:
* The struggling addict or alcoholic who is most likely to elect to take medication that helps with their addiction is already of the wrong mindset to overcome their addiction at that time. They are generally not at the point of “full surrender,” which I believe is critical for their long term sobriety.
In other words, if you go to a drug rehab or an alcohol detox center and offer a bunch of people medications to help them overcome their addiction, the ones who are most eager to try those “anti-addiction” drugs are the ones who are not yet in a state of full surrender, and they are not the prime candidates for staying sober in the long run, with or without the medication.
This is based on my own personal observations while working in a drug and alcohol detox center. It is not scientific data.
Specifically, a number of opiate and heroin addicts have come through the detox center where I worked, and several of them elected to take a medication that was intended to help with opiate cravings. Another group of opiate addicts elected to not use this medication.
This was not a controlled study, this is just my own subjective observations. But what I noticed was that nearly every single person who elected to use the medication ended up coming back to detox at a later date for more treatment. Not just a large majority, but nearly every single example that I remember dealing with. Really, it was just that astounding for me.
Now this is very limited in size and scope, and it is definitely not scientific. It was just what I noticed. But it was enough for me to realize that there are probably some flaws in the whole idea of using medication to treat addiction.
The fatal flaw is this, and it is a two part flaw:
1) The people who most want a “magic pill” for recovery are those who are the least willing to put in the hard work that real sobriety requires, and
2) There is no magic pill (as of yet) that makes you WANT to stop using drugs or alcohol.
That second point is very important. I think that some people are secretly hoping for science and medicine to come up with a cure in the form of a pill that can cause addicts and alcoholics to actually WANT to be sober.
I think at some point you have to stop and ask yourself: Do you think such a pill really exists?
And as a corollary to that idea:
Do you think that the struggling addicts and alcoholics who are really at a point of full surrender actually need medicine to help them? (For example, I did not need medicine to recover once I fully surrendered, and I have seen the same in others, but of course I cannot speak for everyone). Yet is a good question to explore. not only in terms of what medicine can do for you, but in terms of what “full surrender” can as well.
Is there a breakthrough drug on the horizon for addiction and alcoholism treatment?
There are a couple of reasons that I personally do not believe that a cure for addiction is coming in the form of a pill (or a patch, or an injection, etc.):
1) Size of the industry severely limits new research (more on this below).
2) Success in recovery seems to have much more to do with surrender, willingness, hitting bottom, etc.
3) Existing medications don’t seem to have much positive data backing it up in studies (the word you here most is “hopeful,” but they never seem to say “if only we could get all addicts to take this medicine, the world would be healed!”). In other words, existing medications show weak data. They “sort of help” in some cases.
So what would the future bring? Of course no one knows for sure. Researchers may discover a miracle cure tomorrow, or isolate a part of the brain which is easily controlled with a simple drug combination, brain implant, or what have you. I am not ruling out the possibility of a total cure in the future. But I would not bet big money on it real soon, and I certainly would not bet on it if I was a currently struggling alcoholic or drug addict. The disease is progressive, it moves quickly, and you can become sober without a “magic pill” if you are willing to work hard for it (ultimately my belief is that there are no real shortcuts in recovery. It takes work to change your life).
The old joke: “But wouldn’t you just get addicted to the cure?”
There is an old joke among old timers in AA about medications to help treat addiction. The joke is essentially “but wouldn’t you just get addicted to the cure?”
It’s funny because it has more than a hint of truth to it. If you study the outcomes of Methadone programs in treating heroin addiction you can get a good idea of what the logic behind that joke is really indicating. Having worked in a detox unit for over 5 years, I watched many people suffer through methadone withdrawal. It is not a pretty picture.
I do not want you to assume that all medications to treat addiction are, themselves, addictive. Because in truth most of them are not addictive (just a few of them are, but are supposedly less harmful for you).
My issue is not that the cure is worse than the disease in this case, but simply that the “cure” does not really work, and can steer people away from the real solution. If you jump on the idea that a medication can fix all of your problems, then this can divert you from the real work that might save your life (or even just make for a happier existence).
What we can learn from Antabuse trials
Many years ago there was a large study done with a medication called Antabuse. Basically, Antabuse makes you feel really sick if you drink alcohol while you are taking the medication.
The conclusion of that study is widely known: There was no long term difference between the two groups in terms of sobriety. That said, it does seem to help people who are already highly motivated to stop drinking on their own (but then again, perhaps they don’t really need the medication anyway, and are fooling themselves?).
Most people who relapse while taking this medicine simply stop taking the pill in order to be able to drink a few days later. It is a deterrent but apparently not a very effective one. From a personal perspective, I tried this medicine myself and it did not cause me to “want” to stop drinking. I simply decided that I wanted to drink again and I waited a few days for the medicine to wear off so that I would not get sick. It really is all about willingness and commitment, no?
Size of the market dictates potential drug research
Sad as it may be, the drug companies that create new medications are at least partially motivated by money and profits. They are not going spend millions of dollars to develop a new medication if it cannot recoup their costs and then allow them to make a profit.
I was shocked when I saw how small the potential market was for drug addiction and alcoholism medications when compared to some other markets. For example, most of the medications that you see advertised on television commercials represent a potential market that is at least 100 times larger than the addiction and recovery market. So you really have to think about that sort of thing when you are crossing your fingers and hoping for the magic cure for addiction. It is easy for the general public to say “shoot, if they came up with a cure for addiction they would make a fortune!” The reality is that this is a very naive statement, considering that the market for depression, heart disease, or obesity all represent vastly bigger markets by several orders of magnitude.
I hate to put it all in terms of dollars and cents but this is simply a fact of economics. Drug companies want to put their research dollars where there are lots of customers. Of course it can still happen but I would not bet the farm on it (simply because it is such a complex problem and they are not putting tons of money into it).
Why you should focus on recovery strategy instead of a miracle cure that may or may not exist some day
The fact is that while medication can help a lot of people in this world with a variety of different problems (anxiety, depression, physical pain, etc.), there is no magic pill yet that can cure addiction or cause a person to want to change their life.
Addiction and alcoholism are lifestyle diseases. In order to overcome the problem you have to do more than just take a pill. You have to change your whole world, your whole lifestyle. That is why people in AA say “you have to change everything.” Because after you have lived through six months of early sobriety you can look back at the whirlwind of your journey and realize that you really have changed just about everything.
The first part of this is in making internal changes. Every addict and alcoholic who tries to get clean and sober has what we might call “inner demons” to contend with. These might be in the form of shame, guilt, anger, resentment, self pity, and so on. It’s the stuff that goes on inside of your head each day. It’s the stuff that takes up your mental cycles when you could be enjoying yourself or at total peace, but instead your mind is working overtime because there is something in your world (or your mind) that is just not right.
For me, it was self pity. I loved to feel sorry for myself. This is the “internal drama” that would fuel my desire to self medicate and drink more alcohol and use more drugs.
When I first became clean and sober, this mind pattern did not just go away. It remained. I was in alcohol treatment, feeling sorry for myself, and I realized that this was how my brain was wired to behave now. This was “normal” for me. My brain was running this cycle of self pity and it expected me to medicate it with drugs and alcohol in order to make it feel better.
Why was it doing this?
The “why” does not matter. It had become my pattern in life. It was what fueled my disease.
I have since learned that other people in addiction and recovery will have other patterns that run in their minds. Most of the time it is a pattern of resentment. They resent others, they relive the anger in their minds, and they drink or use drugs because of it. Their anger fuels their addiction. This is extremely common, I have found.
So when you think about it, expecting a medication or a pill to “fix” this sort of problem is a pretty big stretch. We are talking about a pattern of your thinking that may have been established for years or even decades. In the end, the thinking pattern does not even change when you are using your drug of choice. It just sort of dulls your anger (or your self pity). As tolerance builds your drug of choice will become less and less effective for you. It will no longer do what you want it to do (kill the emotions in your mind so that you don’t have to feel them).
Most of addiction is about running away from ourselves. It is about avoiding our emotions. The real stuff, the stuff that we feel in our hearts, the stuff that we are afraid to share with the world. That is what many people are medicating when they become addicted to alcohol or drugs. It is a tall order to expect for a new medication (that is not addictive) to be able to gloss over our emotional problems so easily.
If you are looking for medication to help you in recovery, I would not necessarily discourage. But if that is your only strategy and you are secretly hoping that it can make your journey a whole lot easier than it would otherwise be, I think you are in for a rude awakening. The fact is, there are no magic pills out there that can make recovery easy or painless. It takes work, it takes effort, and any medication that you might take to supplement recovery is only going to have a tiny effect on your overall progress. There just isn’t an easy way to reverse a lifetime of drug or alcohol abuse and turn it into a happy and joyous life without a whole lot of effort on your part.
Does this mean you should give up on recovery? Because someone is telling you that there is no magic cure, or that “recovery medication” doesn’t really help all that much?
Of course not! You should still embrace recovery and give it everything you have got. The fact is, many people recover from addiction and alcoholism and go on to live a fulfilling life. Most of them do it without any medication to help them, but this is largely beside the point. The point is that it takes willingness, it takes commitment, and it takes surrender. Whether you take something like Campral or not (for alcohol cravings) or Suboxone (for opiate addiction) or any of the other newer medications that may be coming on the market to treat addiction is almost irrelevant. The medications are not a problem. The problem is the struggling addict who relies on the medication to fix their addiction. That has not happened yet and it is not likely to happen in the foreseeable future. Addiction has proven to be a very tough problem to “fix” or to “cure.” It has not happened so far and it will likely not happen anytime soon.
My belief is that if you go into recovery with the idea that you need to take some sort of pill or medication in order to remain clean and sober, you are probably not going to do so well. I hate to be negative like that but this has been my experience and my observations thus far. Anyone who is seeking the medication to help with their addiction problem is already in the wrong frame of mind, they have likely not surrendered fully to their disease yet, they are still trying to control things and manipulate the situation. This is my opinion, based on what I have seen in the past.
I can even site myself. When I was still drinking and using drugs, the idea of using medication to help control my addiction was actually somewhat appealing. I liked the idea. I thought it was a great idea. I even experimented with Antabuse even though I was not yet ready to surrender or quit drinking yet at the time.
Later on in my journey I reached a point of full surrender. At that time I was truly ready to make a change in my life. I was completely done. At my bottom. And the thought of taking a pill to help me with cravings never even entered my mind. If it had been a few years later perhaps it would have been suggested to me, but back then it was not yet a mainstream idea in the rehab centers. So I went blissfully unaware through my early recovery and had to rely on taking positive action in order to learn how to fend off cravings.
And I think this is at the heart of the idea here. Not that medications are bad, but that they can become an excuse. If you are seeking them as your solution then you are probably not seeing the real solution, the thing that you most need to do in early recovery, and that is to take positive action every day by establishing new healthy habits in life. Taking medication might be one of those habits, but if it is the only thing you are focusing on (and secretly hoping that it will be your saving grace) then you are setting yourself up for a relapse (in my opinion anyway).
I have watched it happen enough while working in rehab for 5+ years that I feel that I can warn people about the concept anyway. There are no magic pills, and you need to take a whole lot of positive action in early recovery in order to remain clean and sober. It takes hard work, and no pill is likely to every change that (I hope I am wrong some day, but the medical science has not “arrived” at that point yet).