Thursday, February 7, 2013

The Need for Something New in Addiction Treatment

It will come as no surprise to regular readers of this blog that there is a need for new approaches to treating addictions. In particular, people with substance use disorders (SUDs) and their families need access to current, scientifically based practice and greater consumer choice of treatment modalities. Today, I've been receiving a resounding validation of this fact from the response to Jane Brody's column for the New York Times three days ago. In the last two days, I've received almost 30 calls from all parts of the US from people who are interested, if not desperate, for something new, either for themselves or for a relative who is suffering from this disease. One person called me from China!

The main focus of Jane's column was a terrific new book by Anne Fletcher titled Inside Rehab. It's already #1 on the Amazon best-seller list for alcoholism recovery books, and it's been receiving widespread coverage that is overwhelmingly positive. And this is before it's actually available to the public! (Full disclosure: I was one of many experts in the field whom Anne used as resources for her book, and since she also lives in MN, we have become friends.) Jane, with whom I had previously talked with when I was at NIH, called to talk about the book and the state of the treatment field today, and this conversation figured fairly prominently in the column.

Of course, I'm grateful for the coverage of my efforts to change the treatment system and of Alltyr, but I'm saddened by the similarity of the stories I hear time and again. Mostly, it's about going through rehab over and over, almost all of them 12-step oriented, cookie-cutter programs that show films, give lectures, send clients to 12-step groups and use low-quality group  counseling. Clients of these programs are told that the program always works if they accept it, that they must not be motivated or willing, or that they are in denial, and so forth. Families often report nearly bankrupting themselves paying for expensive residential rehab programs that don't work. In too many cases, 12-step abstinence based treatment is used for opioid addiction even though all the evidence shows it doesn't work. Almost always, these are stories about repeated episodes of time-limited low quality treatment without continuity over time, attention to co-existing psychiatric and medical disorders, or meaningful family involvement. There is very little consumer choice or even information about the various options that have been shown to work. Little has changed from when I was at NIH, and frequently gave talks and interviews that were covered in the media. I would always receive calls and emails there asking how to find evidence-based treatment.

At the same time, I am heartened by this latest demonstration of how pressing the need is, how many people are desperately wanting something new. And it inspires me anew to keep pressing forward on a mission that at times feels overwhelming, where there are so many barriers and where progress is often difficult to see. The palpable pain and suffering I hear remind me why I'm doing this. And I know I am not alone, and as more people join the effort the momentum will continue to build.



  1. I'm glad to hear you mention the families of those afflicted with SUD(s). I have been thinking about families a lot lately, and wondering why there is no continuing care for them. We know COD(s) are high in the population that ends up in treatment, and we know of the rates of heritability of mental health disorders so the question is why only offer family programs while the loved one is in treatment with no professional continuing care. The idea of co-dependency may have some credibility, but in my mind we are more likely seeing the high stress and mental health issues not being addressed. The usual referral to Alanon is rather lacking with the above thoughts in mind. Why are we not taking care of loved ones?

  2. Hi Mark,
    I cannot agree with you more, and I happen to have ordered Anne's book as well - I have been following it in the press. I recently wrote this criticism of faith-based rehabs which are prolific in my local setting: Faith based rehabs: What, in God's name, is going on? and I am about to write a piece about what rehab should include.

    I also find a problem with referring parties insisting that a patient go into in-patient settings without a proper assessment or trying the out-patient option. I have found medium term out-patient (3-4months) combined with long-term individual counselling and therapy to be effective in most cases.

    I only refer to in-patient in a few circumstances, and usually I consider that more of a detox and we continue with long-term therapies afterwards. There are, of course, a few individuals who benefit from longer term inpatient and/or therapeutic communities, but these too need to offer more than what you describe above.

    I look forward to a time when treatment actually matches the evidence! Keep up the good fight!

  3. Dr. Willenbring -- hope it's OK to ask a question that's been bothering me. What's the current data on the chances of success for a younger addict going on bupe OMT for several years and then successfully leaving and remaining drug-free from that point? I'm particularly interested in research findings. I have a fairly good notion of what it is for MM clients but haven't been able to locate any research for Suboxone. I confess I'm a bit concerned at the remarkably rapid expansion of bupe OMT in our area -- are we looking at something similar to MM down the road, where clients remain on the medication on a de factor permanent basis?

    Thanks much for any info you can provide.

  4. Well, I could have written this article. In fact, I think I had done some thing very similar. At least my complain after complain that what we call substance use treatment today is based on religion and is not supported by quantitative empirical scientific research (we do not know every thing, but it is a great start and we could do a lot better).

    I at least know one thing, I know the difference between scientific treatment and religion. To many patients except at face value what their "professional" staff tells them. Specially if they have 27 years of experience and have not read a Scientific Journal of their profession since they left graduate school.

    Thank you for bringing attention to my pet peeve, some times I feel extremely along. You have no idea how much I appreciate this blog.


Comments are welcome.