Doctors against medicalization

“If the only tool you have is a hammer, you tend to see every problem as a nail.” — Abraham Maslow

An addiction physician says:

Over the past two years, I’ve witnessed a worrisome trend: the medicalization of addictions. Some of this makes no sense to me. Let me explain.

He describes the emerging norm of discharging patients with up to 7 medications, often including drugs that have potential for misuse, and finishes with this thought:

Message to substance providers: We have a problem. Although addiction experts may justify these “treatments” because education and solace is provided to the patients, I believe that this mocks the purpose of (the very important and necessary) addiction treatment. There is little, if any, harm reduction, because the clients are prescribed the same or other addictive compounds during and after rehab. The clients are also prescribed new drugs, particular in the latter case of the alcoholic woman, whose potential for drug-drug interactions and future adverse events cannot be accurately predicted.

The clients are receiving expensive inpatient care [$40,000+ per month] for services and treatment that could easily be managed in cheaper and less-acute-care outpatient settings, like intensive outpatient or partial hospital programs. And, most importantly, the clients are continuing to rely heavily on pills to combat their anxieties, mood changes and addiction.

Problem? Relying on pills got them to rehab in the first place. So what’s the point of attending and paying for — or charging a commercial insurance carrier, Medicare or Medicaid, or any other third-party payer — for an expensive retreat that leaves you in virtually the same mental place, or worse, than you started? Not that much.

I’m even more worried about what health care reform will mean for this. I fear primary care physicians are going to be the front lines, armed only with a prescription pad.

7 Comments

Filed under Controversies, Policy, Treatment

7 responses to “Doctors against medicalization

  1. And not just in the United States. I’m astounded at the number of drugs people can end up on when medics get involved in addiction treatment. The medicalisation of ‘normal’ human experiences and emotional states is already alarming.

    Unhappiness at times is normal. As is anxiety. They are very normal in active addiction and early recovery. Muffling them with chemicals may interfere with healthy healing (I’m not talking about treating major mental illness).

    Of course we must strive to relieve suffering, but we can’t usefully anaesthetise it or obliterate it out of experience. There are other ways to support and help people.

    I often wonder if health care professionals intervene with the prescription pad so readily because they themselves can’t bear to see suffering and immediate solutions trump what might actually be in the longer term best interests of the patient.

    • We routinely see people on combinations of 4 to 8 meds. All prescribed while they are using or in the first days of abstinence. The combinations are often like signatures. You ask a client for their current medications and then say, “So you saw doctor so-and-so?”, and clients are shocked that you know.

      A big problem right now is people seeking detox from suboxone.

  2. What is implied but unsaid in the article is that long residential stays were once justifiable if patients were really getting clean and sober. The transition to the clean life has never been easy, so a protected stay in a residential setting made a lot of sense. But if doctors are now focusing on pharmacological treatments, what’s the point?
    Like Dr. Kruszewski, I’m all for making detox safe and mitigating the discomfort, but habit-forming drugs must be avoided or their use curtailed to the period of inpatient detox and stabilization. Otherwise, the supposed treatment will only make the patient sicker.

  3. I was saddened by this article. I’m glad my rehab didn’t give me anything – I think they suggested anti-depressants and I didn’t want them (?) … it’s actually kind of hazy, now LOL. But I do remember that one of my rehab roommates, who had an infant son born dependent on opiates, was having a terrible detox off of benzo’s and heroin. After about a week the doc referred her to a methadone program and she never finished the group therapy. I was so mad! I thought that doctor didn’t give her a chance. Obviously I don’t know what her chart said, and maybe they made the right decision, but I still remember my sense of indignation…

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