Is a Medical Approach to Addiction Treatment Going to Show an Improvement?

Patrick
  • By Patrick
  • The world is starting to shift towards a more medical based approach to treating addiction. This is evidenced by the fact that government agencies such as the NIDA are starting to push for more medical treatment to be accepted as standard practice in treating addiction. For one thing, new drugs are constantly being developed that seek to reduce cravings, or implement existing medications in new ways. For example, there is a drug that opiate addicts can use to help control their cravings for heroin or other opiate medications (called Suboxone) and now this is possibly going to be implemented as an actual implant (very convenient!).

    But in spite of all of the recent efforts to create drugs to help “cure” addiction, how much progress has really been made? Can we count on the idea that modern medicine may one day cure addiction and alcoholism altogether?

    Drugs for alcoholism

    There are a few medications that are used to treat alcoholism, and from what I have heard there are more in the pipeline. One is known as Antabuse, a deterrent drug that makes the alcoholic sick if they drink while taking the medicine. This has been around for years now and I have not seen any studies to suggest that this is any kind of miracle cure. Most people simply won’t take it. Maybe some day they will create an implant form of the drug? This would be much more interesting because then it makes the condition much more permanent (when I was taking Antabuse myself, I simply stopped taking it three days before I wanted to drink. So I planned out my next relapse. Not very effective, in my opinion!).

    There are some other medications for alcoholism such as Campral, which have been shown in studies to help reduce alcohol cravings. But again, the kind of numbers that these studies have produced are not enough for people to shout in joy from the rooftops of rehabs or anything. This stuff may be helpful to a very small percentage of people but it is far from being a miracle cure.

    Lots of progress but not any wonder drugs or solutions

    The big pharma companies seem to be in a race to produce drugs that can help to curb or cure addictions, and they are targeting all sorts of different substances. There are several medications to help with alcoholism, and now there are at least a handful to treat opiate and painkiller addiction as well (such as methadone, suboxone, naltrexone, etc.).

    I have been told (by an addictionologist) that there are more drugs in the pipeline that are said to help reduce cravings for meth, and for cocaine.

    So the drug companies are definitely working on the problem to try to create new products to fight addiction, but as of yet little progress has been made.

    Key idea: Don’t base your recovery on a breakthrough medication!

    This brings us to a key idea:

    Do not base your recovery on medication!

    This is just my opinion, but it is backed up by about 5 years of working a detox and short term rehab facility, and watching thousands of people go through the treatment process.

    After working for those 5 years and observing all of these people try to recover, I can firmly say that addiction medications–in their current state–do more harm than good. This is simply based on my own opinion but I would like to remind you that I paid very close attention for those five years and watched thousands of cases. This is not based on raw data but only on my own anecdotal evidence. This is just my opinion, but I would like to think that I was in a good position to have a well-informed opinion.

    Anecdotal evidence from working in a detox unit for 5 years

    So I worked in detox unit for 5 years and I had the chance to see a number of things. One thing that I witnessed were a certain amount of recovering addicts and alcoholics who elected to take medications in order to help them fight their addiction.

    There were basically two such possibilities at the rehab center that I was working at (at the time). One is that an alcoholic could elect to take Campral to help with alcohol cravings. The other possibility was that an opiate addict (either prescription painkillers or heroin) could elect to get on a medication called Suboxone. So while I was working in this detox for 5 years, I saw a number of people from both of these groups (alcoholism and opiate addicts) who elected to take the medications and then go follow up with their own doctors and get a full prescription for the new medication. In other words, they started on the medication in the treatment center and then after leaving rehab they went to their own doctor to get a full supply via prescription.

    So a certain percentage of people elected to do this in order to help their chances at recovery.

    Now the data that I collected from this is not official in any way. My only “data” is in watching who came back to treatment (after having relapsed) over the years.

    This may sound a bit weak, but you have to realize that the amount of people who come back to treatment is insanely high. A large amount of people (much higher percentage than what you might think) end up coming back to rehab after having relapsed.

    And here is the thing:

    I had thought that the people who took these “anti addiction medications” would have a much better chance at success than everyone else. I would have thought that I would see less of these people returning down the road for more treatment, because they had the medication to help them out and give them that extra edge. I would have thought that the people who elected to have the medication in order to help them would have had a tendency to succeed, at least more so than the others who did not have the help of the medication.

    But I was wrong.

    I was shocked, in fact, at how every single person who elected to use these medications ended up coming back to rehab at a later date for more help. This is strictly anecdotal, mind you–I did not actually collect any data or measure anything. But I was truly shocked to see that every single person who went on Suboxone or Campral ended up coming back to rehab after a relapse. I have no way to know if it was truly every single person, but it sure seemed like it.

    And out of the all the success stories that I found in that treatment center, none of them were from people who had used these medications.

    Now I know that this is purely anecdotal evidence, and I know that there are studies that prove these medications have at least SOME effectiveness, but under the real world conditions of seeing it get put to use in a rehab setting, I am far from convinced.

    And I think I understand the problem much better now. This is also something that a double-blind, placebo controlled study cannot account for.

    The effect of the drug seeking bias on the results that I witnessed

    The biggest problem I can see now (looking back on everything especially) is that the people who elected to try these medications are the people who were destined to relapse anyway.

    Think about this drug seeking effect for a moment.

    You get a bunch of addicts and alcoholics who all end up in rehab. Some of them are truly at the point of surrender and have totally hit bottom. They are sick and tired and they are willing to do just about anything to stop the pain and misery of their addiction.

    The others are wishing that their addiction was gone, but they are not necessarily willing to take massive action just yet. They may not have fully hit bottom. They have had some consequences and they wish that they were not an addict, but they are not yet fully surrendered.

    This second group is not fully at the point of surrender and therefore they are not truly done using drugs and alcohol yet. If we could see into the future we would see that all of these people from the second group are destined to relapse at some point. They have not “had enough” of their addiction. They are not finished with it all yet.

    Now, realize that the people in rehab who elect to try these “anti-addiction medications” are almost always people from the second group. Those who are in the first group are only likely to take the meds if their counselor or therapist is pushing it on them.

    But the “drug seeking” crowd is actively looking for an easy way out.

    And this is the biggest problem with any sort of “anti-addiction” medications. The people who hear about the “wonder drug” are the ones who really want to try it out, because they believe that this will be the easy way out for them. “Just give me a pill to treat my addiction.” If only it were so easy.

    This also goes back to the tendency for every addict to:

    1) Overestimate how easily they can conquer their addiction.
    2) Falsely believe themselves to be much better equipped than the average person at overcoming an addiction. They believe that their willpower is stronger than average, etc.

    So based on those false beliefs, the addict will hear about a medication that can “help control cravings” and they believe that this is the answer for them. They are combining this idea of a helpful medication with the false belief that “If they really try to overcome their addiction and put a solid effort into it that it will be pretty easy.” Most people have this secret belief that once they really try hard to beat their addiction that it will be pretty simple. Hearing about a pill that can help control their cravings is enough to give them the false confidence that it takes to really screw up their recovery.

    Instead, it might be more beneficial for most struggling addicts to be told the opposite: that there is no medication on this earth that can help beat their addiction, that none of the medications for treating addiction are helpful at all (even if this is a lie), and that the only way that they are going to get clean and sober is if they put 100 percent of their effort into making it happen–without taking any shortcuts whatsoever. What I am suggesting here is that even though this is not necessarily true (some of the medications might actually help some addicts with cravings via clinical trials, and we are telling them that they do not help at all), at least this would set the addict on a course of 100 percent personal responsibility. At least then they know that there are no easy shortcuts, and that their recovery is all up to them. They have to commit to taking action in order to overcome their addiction.

    I really believe that this would be more beneficial for most addicts and alcoholics, because then it forces them to stop looking for the easy way out. If they are told that there are absolutely no shortcuts (including via medications) then they will be forced to accept that their situation is going to require lots of dedication and hard work, rather than using a pill or a shortcut to make things easier for them.

    Really that is all one of these medications is promising, isn’t it? To make recovery easier. That is the whole point of a medication designed to help overcome addiction. The drug must somehow make the struggle easier, right? If the medication does not help to prevent relapse or make it easier to avoid drugs or alcohol then it would not be put on the market as such.

    But is taking a pill in order to overcome an addiction really the easy way out? Doesn’t doing this prevent us from taking a long hard look at our life, making the tough decisions, and getting serious enough to take the positive actions that we need to take every day in order to build a new life in recovery?

    Isn’t taking a pill to beat your addiction cheating yourself out of the rewards of recovery? Isn’t it just really switching from one drug to another, in some ways?

    There is a good counter-argument to the idea of medically “curing” addiction that is often toted in 12 step programs:

    If you cure addiction with medication, then it robs people of the benefits of growing in the 12 step program.

    I have to agree with the idea behind this statement (even though I do not necessarily believe that a 12 step program is necessary for growth in recovery).

    Basically what they are arguing is true, in my opinion: that if a miracle cure were to come along in the form of a daily pill that you could take to cure addiction, doing so would be cheating yourself out of the real benefits of recovery.

    In other words, before I got clean and sober AND before I ever picked up a drink or a drug, there was something wrong with me and with my life. I had an unease about me that I eventually started to self medicate over. Call it anxiety. Call it a social awkwardness. Call it whatever you want, but that was a deeper and more fundamental problem with my life than what my addiction was. I believe that whatever was “wrong” with me was just a giant trap laid out that would eventually lead me into drug addiction and alcoholism. The first time I got drunk I had never felt so “right” in my life. I said “this is what I was meant to do with my life! To drink!” I had discovered my calling, because there was some deeper problem within me that needed fixing, and alcohol (at least in the short run) did a wonderful job of fixing it.

    In the long run, of course, drugs and alcohol could not keep filling in that hole, they could not keep correcting the problem and medicating me as I wished. They could not do this indefinitely due to tolerance and addiction. There are limits to how many days in a row you can stay drunk for. At some point, being completely wasted becomes the new “normal,” and whatever pain you were feeling before starts to show through again. You can never drink enough or take enough drugs to completely fill in this void.

    Some people argue that this is a “spiritual void” that needs filling, and the only way to fill it is to get sober and find God. I would agree that this is at least partially true, but the definition of “finding God” is so much more broad than what everyone has in their minds. For example, the distance runners who work a program called “Racing for Recovery” have essentially beat their addiction and “found God” even though they may never pray or meditate directly while thinking of a traditional higher power. Their exercise and the discipline that it created and the open road and the running in nature are all part of this spiritual experience for them, and they may never even label it as “spiritual.” Yet this is the sort of transformation that has led many people out of addiction (yes, there is an entire program dedicated to overcoming alcoholism and addiction through regular exercise).

    Is taking a pill to fight addiction the easy way out?

    If such a miracle cure were to come along, I would be grateful that I “fought the hard way to get clean and sober” before having the option to take such a miracle drug. This way, I get all of the benefits of “real” recovery without being cheated by a pill that does all of the work for me (and thus does nothing to really improve my life situation).

    My life got a whole lot better in recovery not just because I stopped using drugs and alcohol, but because I was forced to make a real effort at personal growth. After the first year or two I decided to walk away from traditional support groups (AA and NA) and thus I had to kick my personal growth into even higher gear in order to stay clean and sober. In other words, since I was leaving AA, I knew that I had better work extra hard at making positive growth so that I did not end up relapsing. Now I am at over eleven years of continuous sobriety and I could not be happier with my life.

    I cannot imagine what my life would be like today if there was some miracle cure for addiction back when I sobered up. If someone had just told me to take a pill, I may not have gone back to college to finish up that degree. I may not have built a business that eventually set me free. I may not have started running and getting into shape and completing 3 marathons. I may not have worked hard to improve my relationships or learn to communicate better with others. And many of these positive goals that I achieved (as a result of my “hard” recovery) also had second and third order positive effects. In other words, because I became a runner I also quit smoking cigarettes. Then I also started trying to eat healthier. And so on. All of those additional goals may have been forgone if I had just been handed a magic pill to cure addiction.

    What this all means for you

    In my opinion it may be best for most addicts and alcoholics to just forget about the possibility of “anti-addiction medications.” They may do more harm than good, and they may also rob you of some amazing benefits.

     

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