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This week’s discussion and debate has a fair bit of controversy around it.
Medication Assisted Treatment.
When I first entered recovery Antabuse was being used. I was never on it but I knew many who were. Methadone, and more recently buprenorphine, has been quite accepted to assist opiate dependency. Naltrexone is now being administered for alcohol dependency.
Now I know there are strong opinions on both sides of the question. So let’s have a healthy debate. Should we assist those suffering from addictions with medications? Why or Why Not? When is it appropriate? When is it not?
Simply click on Comments, read the submissions, type yours and submit.
I look forward to your opinions and experiences.
Jeff
April 27, 2009 at 4:39 pm |
Clearly, medication can be used successfully as an adjunct to any comprehensive treatment program. Specifically, as an addiction therapist in a medical clinic, which primarily administers methadone maintenance to treat opiate dependency, the benefits have been clearly shown. Several individuals have progressed through the continuum of harm reduction; many now maintain a substance free lifestyle, often for the first time in many years. Of course, medication alone may be beneficial. However, a more comprehensive therapeutic regime, including counseling and aftercare components, should also be considered. The rapid proliferation of individuals utilizing this type of program, speaks both to the obvious need, as well as perhaps the practice of opiate prescribing and utilization.
April 28, 2009 at 1:05 am |
I agree with Blair that medication can be a useful addition in treatment planning, however, it should not be used as a replacement for building therapeutic relationships with clients. Medication only works when clients are compliant with a medication regimen.
April 28, 2009 at 12:28 pm |
I agree that addicts seeking recovery may require some of these drugs to ease the severe discomfort and certainly the considerable medical risks associated with the discontinuation of opiate drug dependence. In my experience this can be done in a proper setting (i.e. supervised staged treatment centers) However, when left to doctors who are un- educated in the addiction process and who routinely send addicts to the “methadone program” i have seen the window of willingness for the addict close and the instinctive manipulation process kick in. Frequently I hear stories of methadone being increased instead of decreased and the merry go round is in full operation with the addict at the controls.
I do not believe that medication is required for most alcohol withdrawal symptoms. The ones who would benefit from that are the pharmaceutical companies. There is no substitute for abstinence. It is not this pie in the sky impossibility that some professionals seem to think it is. It is a reality for MILLIONS of seemingly hopeless people. What is required however, is an honest desire to be helped and to follow the path that others who have successfully achieved this goal and much much more. Harm reduction is an automatic result of abstinence
April 28, 2009 at 12:58 pm |
I am surprised the question is being asked, in 2009. I have never question the need for medications in a persons recovery…especially for withdrawal purposes. Society doesn’t let those who are suffering physical discomfort for other illness….why addictions? The only concern I have had over the years is the mismanagement by those who prescribe the medications….lack of counselling to augment the script, larger then required quantities of the script, lack of accountability when client returns “too early” for a repeat of script. All of these are the responsibility of the person prescribing. There is not enough trained addiction medicine specialist and there is not enough physicians who will take the time to be accountable for medications. Physicans need to accept that ‘drug seeking’ is core to some patients behaviours who are addicted…not all….so they need to be trained to manage the drug seeking in a therapeutic fashion.
April 28, 2009 at 2:33 pm |
Your central point is a good one Michael. Perhaps we could get a couple of physcians to comment. Jeff
April 28, 2009 at 1:23 pm |
I agree with Carla’s comment that medication only works when clients are compliant with a medication regimen, and in my opinion, medication should only be used for those who are committed to recovery. Of course individuals should not have to suffer unnecessarily as they attempt to manage their cravings, but I do not believe in prescribing it for those who are just looking for an “easy” way out, or who are not serious about engaging in treatment in general.
April 28, 2009 at 5:49 pm |
I agree with Michael. The question is not whether we medicate or not, I believe it is necessary without question and on so many levels. I think the discussion and training needs to happen with physicians. Too many people are medicated without the supervision this is needed. If physicians had the skill to work with the addicted population I believe we would go far in helping the addicted person who required medication.
April 28, 2009 at 6:03 pm |
I believe that medication is medically necessary in some cases especially when dealing with people who are experiencing significant withdrawl symptoms or have the likelihood of these, but that’s where it should end.
Barring any medical concerns, part of the ‘recovery’ journey should be uncomfortable..whether it’s physically, emotionaly and/or mentally. When an individual is uncomfortable, the desire to end that uncomfortablness surfaces and with that usually comes the contemplation of change (doing something differently).
April 28, 2009 at 6:15 pm |
Michael, I couldn’t agree more. As you know, at times certain prescribed medications are invaluable in withdrawal management. For example, diazepam at a relatively low dosage can help prevent seizures and ease the more severe symptoms of alcohol withdrawal. Having said that, it seems to me that far too frequently much larger quantities are prescribed than necessary, raising fears of substitution of one substance for another.
April 28, 2009 at 6:55 pm |
I believe that we have to further our education and understanding of addiction particularly in connection with mental health. Given that recent research suggests that nearly half of the persons suffering from addictions are also suffering from other mental disorders; I think that meds are a must. Not just the standard ones mentioned above. More and more SSRI’s are being used to treat addiction problems and other disorders that are believed to have precipitated the addictive behavior.
I have taken psychopharmacology but I am still a neophyte in the area. I also am aware that medical doctors are not well informed (still) about addictions. Just had a client and the doctor decided to put her a trycyclic which from my understanding is bad news as they are as habit forming and a person can develop a dependency on them. It was to treat the depression. The depression can be the result of her cocaine addiction but I am also detecting many attributes of bi polar 11.
I have sent her to the psychiatric clinic now that she has been clean for five months. She is not out of the woods re cocaine addiction and I most certainly don’t want her addicted to prescription drugs. I sent her to a doctor that I believe is well informed on addictions. Just wish I knew more about the different drugs and mental illness.
April 28, 2009 at 8:30 pm |
As others have already said, there are many meds out there that are helpful to clients in early recovery and throughout their recovery if they have co-occuring disorders. I couldn’t agree more with Michael though…there are too many docs out there who are quick to prescribe but who do not responsibly follow up with clients and who do not consider the dynamic of “drug seeking”. We work with women over the long term and there’s nothing more frustrating than to have journeyed a long road with a client only to find within weeks of their having left our program that they’ve presented at the doctor complaining of anxiety and being prescribed some addictive medication, no questions asked. The anxiety is within normal limits and not life threatening but a symptom of the trauma work the client is doing and that doc is spending what, 10 minutes with her? In that regard, I feel we are fighting a losing battle unless as addiction and mental health professionals we’re willing to take these physicians on!!
April 29, 2009 at 11:36 am |
Any suggestions on how we can start making an impact with the medical profession?
April 29, 2009 at 1:59 am |
I don’t know to many addicts that have come through the front door of recovery. Most seem to come through the basement or the back door using whatever it takes to get there. Medication may or may not work but anything is worth a try if your struggling. Most have to go back to the drawing board a number of times before abstinence is achieved. If the client believes medication will help then it most likely will. We have to think out of the box when it comes to recovery.
April 29, 2009 at 4:23 am |
I have been working in the field for about 37 years (longer than Jeff) and this question has been around for longer.
Initially, I was totally opposed. I was a “abstinence only” guy. Over the years my position did not change a lot until…..
Two years ago, I was offered the opportunity to work with a group of wonderful individuals on the Prince Albert Methadone Assisted Recovery Program. While the Methadone clinic provided the medical management and the pharmacists provided the methadone, we provided social skills and bridging to employment training. The results have been astounding!!! Many did not only change their lifestyles and personal lives dramatically, but they were also able to become ordinary, law abiding citizens working in good jobs without any apparent problems.
We are carefully documenting all the results which are available upon request. They are very promising. And the program is getting a lot of attention within the media. Funding agencies have recognized that there is something to what we have been offering and are now prepared to finance the program for the third time in a row.
Even at my age, it has made me a changed man!!!
April 29, 2009 at 12:29 pm |
The only way to have an impact on physicians is to start a healthy dialogue with them. I, for one, have forwarded this blog address on to someone involved with the American Society for Addiction Medicine (ASAM). He also used to be a Medical Officer of Health in this region.
April 30, 2009 at 6:27 pm |
In Tulsa, Oklahoma in 1985 I set up a Native American co-ed redidential treatment facility on 1135 and 1137 South Peoria. I begin the operation with 34 clients. 17 women and 17 men. I had no funds. Myself and three men and two women painted the complex for two months rent FREE. I helped the residents find jobs based on their skills and education. I charged $60 dollars a week for room and board. The residents attended local AA and NA meetings by riding the city bus. After convincing the state and county officials I meant business about recovery; the county provided me small financial assistance and food stamps. Then I begin to branch out and came up with a plan to shelter battered women. The bottom line most of the hard core American Indian street people stayed sober. Certain individuals became emotional stable and social productive citizens again. I thought every knew this. The problem needs more recovered alcoholics and drug addicts to be making the major decisions. The recovery world now is filled with people with degrees and they don’t know what to do to help because they never had the problem. This recovery process has turned into a big business. There is no simple passion anymore; it’s all dollars and sense and degrees. One of the first questions someone should ask a person applying for a substance abuse job is; HOW MANY PEOPLE HAVE YOU SOBERED UP. For the record I have been instrumental in helping over 500 people achieve sobriety and it wasn’t me. I just showed the way and they recovered on their own. The passionate and damn good counselors are a dying breed and I’m one of them. So long!
May 2, 2009 at 3:47 am |
“. . Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous brain damage
Or to take arms against a sea of difficulties in the recovery”
First of all, thank you for this chance to talk about this subject.
In my opinion, medicine for the treatment should not be mandatory. It is important that we examinate the patient and what it is beyond what we see. At the same time we find patient with many nutritional deficiencies (such as luck of B12 complex, Folates, and so on) so the toxic itself and the nutritional deficiencies and the circadian cycle almost missed may lead us to choose to offer to our patients at least the chance to balance this in order to help the whole cognitive area, the stimuli reception, etc. Then we should consider any other morbility such as eschizophrenia, personality disorders, etc. Once we know that our patient has other morbility and (in case it requires medicine) treat this. It could be a great mistake not to see what is beyond the drug abuse.
Thank once more! It s bee very interesting to read the comments in your post.
Regards,
Gabriel Gonzalez
May 4, 2009 at 3:22 pm |
I believe that addressing the issue of substance abuse with therapy as well as medicating to a point to help ease the withdrawl is very important. I lean more towards the therpeutic side, addressing the issues that make someone go to their drug of choice, abuse it and then making it their lifestyle if of the utmost importance. Jailing them is redundant and is a sign of our times that our government does not want to address any issue that they themselves may cross over
May 9, 2009 at 1:00 pm |
The main disease of addiction centers in the mind not the body. The addict should be medically detoxed by trained professionals for the prescribed period of time, and after that no!!
We keep treating the body of the addict or alcoholic, but that is not where the main problem centers. Why keep pumping meds into people when they are of no use.
What the addict needs is a complete physic change, a rearrangement of thoughts, which works best from a twelve step program
May 11, 2009 at 9:03 pm |
Medication is an interesting question. Methadone has been successful in many cases, however, there is all too often the lifers. This medication was never intended to be a life long approach to sobriety. It was to help the person slowly wean off while learning coping skills. The Antabuse drugs are very dangerous if not followed to the letter and under the watchful eye of a trained addictions physician.
It is proven that taking Vitamin C D E B1 and B12 Magnesium, Zinc, Amino Acids are effective in fighting cravings and symptoms associated with withdrawals.
For those who need medical detox, the necessary hospital based programs or residential programs are a must. We know that valium is used a great deal in helping those with severe alcohol addiction to prevent seizures.
To sum up my thoughts on this subject: Some medications are required some of the time, but must be under the watchful, knowledgable professional. Let’s not forget about fighting addiction from a nutrient level as well.
May 14, 2009 at 2:15 pm |
Hi Rosemary
I would love to know if you could source any research mentioning the benefits of taking vitamins and supplements to reduce cravings? I’m sooooo… interested in this topic, and I’m always eager to learn more. I believe this is where we should be looking to help stabalize any chemical imbalances in the brain!
If you have any info, thanks I would really appreciate it!
May 12, 2009 at 4:47 pm |
Everything that our body does, including thinking and feeling, is physiologically based. Medication’s design is to assist with the functions of said physiology. If medication can be prescribed to assist with withdrawal, and to assist in the prevention of relapse, or to ease the pain associated with trauma, depression or whatever ails us, of course it should be prescribed – and taken! What would it look like if we worked with our doctors? Held seminars at hospitals for attending physicians and nurses to offer some enlightenment to the detoxification process? Offered information instead of resigning to the fact that they do not understand?
Further, addicts have suffered enough, many from childhood – why must the processes associated with recovery also be painful? What exactly does it mean to “fight addiction”? Addiction requires treatment. Constant and vigilant. Addicts are seeking a reprieve from pain in everything they do – substance and behaviour related.
So yes, medicate as required.