“real addiction treatment”

pills galore by Boots McKenzie

I’ve previously expressed concern about the medicalization of addiction treatment as health care reform takes effect. Here’s an ASAM member’s complaint that addiction medicine physicians have not sufficiently medicalized their treatment services:

I also respect those individuals who have suffered from the disease of addiction and have found help with 12-Step based programs. I understand their desire to recommend the treatment that worked for them to others, but enough is enough. Peer support groups and the 12-Step philosophy are fine, but they are not medical treatments and they are not counseling.

If ASAM wants to move forward as a professional organization, and become the voice of real addiction treatment, we must move past this never-ending discussion about, and homage to, 12-Step programs. Evidence-based treatment is medically managed withdrawal (not “detox”), and, if available, medication-based stabilization for as long as necessary. This needs to be combined with appropriate, evidence-based psychosocial interventions such as cognitive-behavioral therapy and motivational enhancement techniques that can be brief, mostly carried out on an outpatient basis, and focused on relapse prevention.

Notice the exclusion of twelve step facilitation in the list of evidence-based practices. (In spite of the fact that it has been found to be just as effective as CBT and MET, and more effective than either with the heaviest drinkers.)

7 thoughts on ““real addiction treatment”

  1. I read the hard line approach in many articles. In this particular field, people believe what worked for them, will work for everyone. That is not the case with other diseases, where patient treatment is individually based after assessing all mental and physical factors.

    I had a discussion with another blogger about the idea of “relapse is part of recovery.” Most young addicts today go to treatment before they are exposed to anything else. There they are told relapse is part of recovery, so when they relapse, everyone accepts it as the normal path to sobriety. My friend has many years sober (almost 30) and she was told when she first came to AA “relapse is not an option.” She lamented one doesn’t hear that anymore.

  2. I have no interest in eliminating options. I just want everyone to have the opportunity to get the kind of treatment doctors get.

    I appreciate the intention of people who say “relapse is part of recovery”–that it doesn’t mean the person is doomed and that it can offer helpful lessons. What I don’t like is the suggestion that relapse is an expectation.

  3. I love that the author runs a recovery center in Bel Air…. Maryland. Ha ha – I wonder how many patients delivered there are seriously disappointed (before they even get to whatever his version of evidence based treatment is).

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