Promising new medical treatment options for drug addiction!!!

Researchers are attacking the issue of drug addiction from multiple angles, and the results seem to be more and more ways to help. Some promising new developments in pharmacological (as in medication) therapies include a new cocaine-vaccine, as well as expanded use of Buprenorphine, for the treatment of opiate (heroin, morphine) addiction.

  • These medications are best used along with behavioral treatment in order to increase to probability of treatment success.
  • By reducing cravings, as well as reducing the effects of the drugs themselves, these medications can increase the length of time that patients will stay in treatment, which is the most reliable way of producing better treatment outcomes.

What else is new aside from medications?

There are also some exciting developments in the behavioral treatment, including Contingency Management (CM), a treatment method that tries to reteach addicts positive, drug-free behaviors by reinforcing those over the use of drugs. While some people still have problems with programs that use CM because of the notion of rewarding drug addicts for not using drugs, I say use whatever works!

Lastly, as early as 2003, researchers have noted that proper drug treatment may take longer than the 14-30 day programs that are currently being offered (1). In fact, while the article I’m referring too speaks specifically about methamphetamine addiction, we now know that the long use of many drugs, including cocaine, leads to long lasting brain changes that can take up to a year to show significant recovery.

I personally think that proper drug treatment for long time addicts (anyone with more than a year or so of heavy use) should take on the order of 6 months to a year, and should be supplemented by some outpatient post-care for an extended period of time (I’m far from the only one calling for this, see article 2). It’s the only sensible thing to do given the long term changes that such drug use creates in the brain…

I think it’s about time that insurance companies step up the plate and recognize that the huge cost of drug problems for our society (estimated at more than $100 billion annually) can be vastly reduced by providing sound, scientifically based, medical treatment options for those who need it.

citations:
(1) Margaret Cretzmeyer M.S.W, Mary Vaughan Sarrazin Ph.D., Diane L. Huber Ph.D., R.N., FAAN, CNAAc, Robert I. Block Ph.D. & James A. Hall Ph.D., LISW( 2003) Treatment of methamphetamine abuse: research findings and clinical directions. Journal of Substance Abuse Treatment Volume 24.
(2)
A. Thomas McLellan, PhD; David C. Lewis, MD; Charles P. O’Brien, MD, PhD; Herbert D. Kleber, MD (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. Journal of the American Medical Association, Volume 284, pp. 1689-1695.

Question of the day:
Do you know anyone who’s been through residential drug treatment?
How long were they in for?
How many times?
Did it help?

How it doesn’t work – the dogma of the 12 steps

Imagine being diagnosed with cancer, going through a regimen of chemotherapy only to have the cancer return within months, and being told by your doctor that there must be something wrong with you and that he can’t treat you unless you let the chemo do its work.

Absurd right?

12-Step dogma

Everyone wants to know if they can become addicted

Unfortunately, if you replace the cancer above with addiction, the chemotherapy with the 12-steps, and the doctor with 12-step dogma, you have what we know as the ________ Anonymous model (fill in your favorite blank). It’s even written in what 12-steppers call The Big Book (officially called “Alcoholics Anonymous”) and often read as part of the “How it Works” section.

“Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves… They are naturally incapable of grasping and developing a manner of living which demands rigorous honesty.”

Well, as far as I’m concerned, this is where the 12 steps lose credibility with me. In any other field, if one treatment doesn’t work, another one is tried, and another. Different people with different conditions may need slightly different approaches. If no known treatment works, experimental ones are attempted. This is how medical science advances. Still, the notion of a physician blaming the patient for a treatment not working is ridiculous. There’s an entire field built around intervention research and I’m pretty sure that simply dismissing the patient as constitutionally dishonest isn’t a common technique.

Treating chronic conditions

In diabetes, like in addiction, there is a rate of compliance with prescribed treatment. And just like among addicts, that rate is relatively low, averaging around 30% or less. Relapse is also pretty common in other chronic conditions like diabetes, asthma, and hypertension, and rests around 50%-60%, not far from estimates for addiction.

Some patients are better at following one regimen while others do better with a different schedule, different doses, or different treatment methods altogether. Similarly, while some addicts respond beautifully to CBT, it seems to help some very little. The same is true for the 12-steps, religion, and a host of other practices. As far as I’m concerned, this means that when an addict seeks treatment, their provider should take a good assessment of the issues, prescribe the treatment that seems to fit best, but if that one doesn’t work, try another method, not throw them out because the favorite approach didn’t cut it.

12-step Dogma Vs. Progress

And therein lies the problem with the 12-steps, whether supporters acknowledge the religious nature of the program or not is tangential, the important thing is that they cling to a book written decades ago much like believers hold onto a bible. Both are collections of stories and messages passed on that no one is willing to re-examine and, if needed, change. Medical texts, and indeed any textbook seeking to stay relevant, stay current by issuing new editions that incorporate new knowledge, but the 12-steps haven’t been touched since 1939, or since the beginning of world war II!!!

Advancement requires flexibility

1939 was an important year, with the 3rd Reich beginning its exploits, Steinbecks’s “Grapes of Wrath” seeing its first publication (another book without major edits since), the first stocking ever sold, and the emerging use of penicillin. I think many of us would agree that there have been some serious advances since that time.

When it comes to addiction, those advances include our vastly improved understanding of the neuroscience, genetics, and general brain function involved. Additionally, the development of very effective treatment modalities, like Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and Contingency Management (CM), has given providers a much more complete toolbox with which to deal with addiction problems. Unfortunately, many within the 12-step community have never heard of any of these methods, or of the use of medications (like Bupropion) to help with cravings. Personally, I think that’s just sad.

How it works. Really.

It’s time to dust off the covers, and incorporate the 12-steps into the bigger picture of addiction treatment. When 12-steppers wonder why people can’t just see the value of the program, I automatically think of the preacher who sat in on of my addiction class and kept yelling that if only addicts accepted Jesus into their lives, they would be saved. Laugh all you want, but not only did the 12-steppers dismiss him, they missed an opportunity. He had a point- those who accept Jesus into their lives fully may succeed in recovering from addiction on that basis alone – but those who fail to do so should be given every other treatment tool available so that they may also.

This is supposed to be the age of inclusion, a time for Change with a capital “C.” Let’s make ourselves proud and help those suffering by making sure that we’re offering every treatment option possible.

More from AHSR – Addiction research to increase treatment success

Okay, there was almost too much to cover in a single post today. Actually, hold the almost. I want to cover a few of the basic things we talked about today, but many of the rest will have to be incorporated into future posts.

Yesterday, I wrote about talks having to do with new ideas about necessary steps to improve treatment. Today, the main speaker hit on one of the factors discussed yesterday:

How can we improve the length of time that patients stay in drug treatment?

We know from research that one of the best predictors of success in treatment is longer retention. Some of today’s ideas were revolutionary and some not, but here’s a partial list –

  • Plan treatment lengths that are longer – This is especially true for outpatient treatment. If patients think of longer treatment from the outset, even if they don’t hit the intended mark, they’re likely to stay longer than if no end goal was set (this is called anchoring in psychology).
  • Send out appointment reminders and make phone calls – it works for dentists and doctors!
  • Start treating to patient strengths instead of just trying to fix their weaknesses – If you’ve never heard of motivational interviewing, you should read up, it’s all there.
  • Allow patient choice in treatment – The notion that patients shouldn’t have any say in their own treatment should be seriously questioned.
  • Provide small incentives (one way this is done is known as contingency management).
  • Create contracts and provide social reinforcement (like plaques and certificates).

That’s probably a good enough list for now. If we could put all these things to use, we’d already see a significant increase in client retention AND satisfaction.

I had a great day, more tomorrow!!!