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Please Post Research on the Success Rates of Various Forms of Treatment

I actually have a very good understanding of both addiction, and opioids in particular. I also dare to argue that the issue is dependancy. Stating that dependency is not the issue is like saying obesity cannot be solved with less food. In some extreme cases.....it cannot; however, most of the time the root cause of it all is self control. Now with that being said, I do believe addiction is a disease and should be treated as such, but dependency is the issue. Not to get too off topic but alcohol withdrawal is actually a lot more fatal, yet the best treatment for that is non controlled substances, and therapy and people push through it. Anything in life that is worth having such as freedom of a substance is going to require a life or death fight. The truth is...there is no magic pill or substance.
 
Comparing gabaergic use disorder to opioid use disorder demonstrates you don't quite understand the difference! Clearly dependency is an issue as far as having to take a medication every day and experience withdrawal upon cessation. However, comparing opioid use disorder to obesity is also disingenuous.

If you want a condition to compare it to, diabetes is a pretty good one. Diabetics are dependent on insulin, but it doesn't tend to interfere with their lives (such as the consequences of not taking the medication as prescribed). Likewise, when used property, maintenance regiments of ORT don't interfere with ones life either (with stigma and discrimination being the possible exceptions).

Some of the great folks of history used opioids their entire lives while accomplishing great things (by the same token of course, people with opioid use disorder have also done some horrible things - so the point is really about HOW it is used).

What non-controlled medication are you talking about for alcohol withdrawal or use disorder? Benzodiazepines and barbiturates are the first line of defense for alcohol related withdrawal, and those tend to be tightly controlled.

You're clearly prioritizing abstinence as the means to the good life. I'm not interested in that. I'm interested in meeting people wherever they are to gain the tools for them to achieve that for themselves. Telling someone, "here is what you'll need to be happy, healthy and successful" is too cultish for my broad minded tastes, not to mention itself disingenuous. I'm more interested in supporting and promoting individuals own efforts at self determination, regardless of what those might be.

And to be even clearer, dependency is really only a problem for folks who prioritize abstinence over present moment quality of life. Abstinence may or may not be the goal for folks, that depends on their own needs and wants. Dependency vis a vis ORT is also a type of abstience for those who make it such, so they're not at all mutually exclusive approaches either, though most people misunderstand them as such.
 
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Diabetes in most cases can be prevented, as well as completely cured with the proper diet. I am not saying that complete abstinence will work for everyone, but I definitely encourage it, and do not co-sign people not exploring natural options (under professional supervision) of course. Yes, you are correct controlled substances are used for about a week when tapering a high-seizure risk alcoholic. With that being said though, after that they have a choice to make. The medications I am referring to are SSRI's, Gabapentin, Hydroxyzine, Seroquel, and a lot of others that do not provide the euphoria of wanting to continue your substance of choice. I am not telling anyone to directly do anything, rather I am providing facts that I have gathered so they can make an educated decision. It would be easy for me to advise them to continue standing outside of a clinic waiting for a drug they feel they are going to die without for the rest of their life.
 
Interesting conversation, K88 and TPD.

For what it's worth, the article you (K88 ) mentioned by McKeganey et al won't help us draw much of a conclusion about the relative merits of suboxone vs. methadone--the methodology of the study (it's a "naturalistic study")--seriously impinges on its ability to support conclusions of any kind.

A better, though older, article is described here: https://www.ncbi.nlm.nih.gov/pubmed/12804429 . This article is a meta-analysis of randomized clinical trials, which makes it about as credible as we're likely to get.

The authors' conclusion is pretty succinct: "Buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate dosages."

It's amazing to me how little high-quality research has been published on issues like this. One thing that is clear, though, is that the choice of medications for treating opioid use disorder is a very individual question, relying on many idiosyncrasies of each patient's situation. I do, however, think it's fundamentally wrong to argue that suboxone is categorically superior to methadone for this purpose.
 
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Very succinctly and well put simco. I had been looking forward to your thoughts on this and as usual you don't disappoint :)

I'm excited to having new life breathed into this thread. I'm going to make collecting some of the research on this a priority during the fall semester.

Any contributions and discuss is most welcome and appreciated!
 
I really learned a lot from you guys! Thank you for helping me to look at other avenues as well. I will be doing much more research on this.
 
And thank you for giving me a lot of food for thought when it comes to discussing this stuff! I too really benefit from the exchange :)

If you ever run across any research on substance use disorder or it's treatment, please share them with us here.
 
It's a shame there is such a limited amount of unbiased research regarding ORT. The unbiased methadone studies tend to be ancient relating back to when methadone was first approved for use in opiate maintenance. And the suboxone research seems to be highly skewed by drug companies looking for approval of there drug. Hints how naltrexone ended up in suboxone. Truth is we need more options in ORT not less.
 
I could not agree more. The more I began to dive into it, the more I discovered that there was not really a ton of research backing any of it. It was a solid lesson for me, and I will be looking into things I may have "thought" versus the actual facts.
 
Always playing the devil's advocate here I go again. My background is in statistical analysis and I would be happy to provide access to some of my research although it is outside the bounds of the scope of this forum. If I were to design a perfect study I would want a situation that nearly mimics the methadone clinic. It is virtually a forced compliance situation. The best studies require a high probability of continued interaction with the sample set for data collection purposes. There may not be a study environment that guarantees rigorous data collection that is superior to a methadone clinic. With that being said, there is one serious problem. It is called selection bias. This is one of the least random sample situations that comes to my mind in the history of research studies. If they were giving heroin at the methadone clinic and the measure of success was that the people receiving heroin kept using heroin then we would likely have a 100% success rate. That is not a research study. People who use a highly dependence inducing substance to get off a highly dependence inducing substance to stay on a highly dependence inducing substance will probably continue to use the highly dependence inducing substance. Now the studies that actually would be valuable are the ones that have more troublesome and difficult to collect data. Mark Twain really said it best...
 
Seriously, sometimes I feel like Mark Twain said everything best! =D Have you ever visited the Mark Twain house in Hartford, CT? SOOOOO cool! I know you'd love it, so much amazing stuff.

Actually your comment about heroin assisted treatment (a form of ORT) is not really accurate, about what you mention regarding ORT success rates. Treatment retention is a valid and important data set for ANY form of treatment and lends itself to one of the easier areas to quantify when it comes to treatment efficacy (treatment efficacy to be sure isn't limited to retention rates, far from it, but it's an important info nonetheless). Whether the program used pharmacotherapy or strict behavioral conditioning as most abstinence only programs do, treatment compliance is important to measure. Now if your idea of recovery is limited to abstinence, then of course you'd look treatment compliance with ORT programs and see them as "not really recovery," but that would be a reflection of personal bias.

And along those lines, this is where there is really the biggest challenge with finding good research on this: there is no standard, universally agreed upon definition of recovery. Generally abstinence only communities have a narrow idea of what constitutes recovery (not taking drugs) whereas more public health approach have a more personalized, flexible understanding of what constitutes recovery more akin to how we think of recovery from mental illness. And even within the abstinence only community's more restrictive definition of recovery, there is great variation in terms of what people consider it to be characterized by. Here are to research papers on these points:


There is a LOT of great footnotes to research on recovery and addiction in Chasing the Scream, which I just reread. Sometime I'm going to go through the fantastic list of its resources and post the applicable links to research paper on treatment, addiction and recovery here.
 
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Okay, so I've just come out of rehab. It was a 90 day program and they follow the N.A. 12 step program with some heavy bible bashing that comes with it. Now let me tell you, I think this was now my 11th or 10th rehab since high school I'm not sure I've lost count. I've done it all, medical detox, psychiatrics, psychological approach, cold turkey, the sauna program, the religious shit, the hard manual labour type of place and also believe me I've been to 5 star rehabs where hot chocolate being delivered to you at 3AM is only a call to the house servant on duty away. Posh fancy rehabs don't fucking work. You cannot have the same luxuries that you take for granted. You HAVE TO FUCKING REALISE WHERE THIS SHIT IS GOING TO TAKE YOU. After my 3rd 5 star holiday awat from shit I decided that this won't work. And it still fucking hasn't. Every time I come out I can't stay clean for any substantial amount of time. The last 4 times I went straight out of rehab to the dealer on that same day. I CAN'T FUCK UP AGAIN I WILL FUCKING LOSE EVERYTHING.
 
Well what's going to be different about this time? As in what are you going to do differently? I think the first step to staying sober is identifying why you use. I use to turn the volume down on my mental health problems which stem from childhood trauma. Once you do that you have to start trying to treat that reason or issue. I've begun seeing a trauma therapist who is familiar with addiction.

In my experience threats don't keep me sober. Losing relationships and material things didn't keep me sober in fact it was counterproductive because using numbed the pain of loss.

Feel free to start your own thread if you want to delve into your situation deeper. We are here to try and help.

As far as luxury Rehab vs hell hole is concerned I don't think it matters much. What separates an effective rehab from an ineffective one is the treatment they offer. If all you get is a day full of large group therapy ran by someone with a bachelor's degree then all the hot chocolate room service in the world won't keep people sober. Ideally you should get 1 hour a day of individual therapy with a master's level clinician and the group therapy should never have more then 8 people in it and it should be the same 8 people every session. I am also of the opinion that everything done at inpatient rehab can be done better and cheaper by an outpatient rehab. Most of the astronomical cost is from the hotel aspect of inpatient.
 
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TPD, while I agree with most of what you are saying I have to ask how you would measure successful treatment of a substance use disorder if abstinence isn't the mark of success. Do you believe that it is possible to successfully treat a substance use disorder if the patient still continues to use the DOC or any drug in a manner not prescribed?

Also, as with most disease/disorders, successful treatment can not happen without the willing participation of the patient. You mention diabetes for comparison, if the patient does not monitor their diet and blood sugar or stick to their treatment plan it would not be the treatment plan that is to blame. It seems to me that much of the success in treating substance use disorders is directly linked with the willing participation of the client. I was treated unethically by a psychotherapist at an in patient program but have not relapsed yet. Is my success a product of my own will, the program, or both? If I had relapsed, would it be a product of my own choice, bad treatment, or both? If you blame the treatment for the failures would they not also be responsible for the success? Where does the individual lie in this view?

If abstinence is not used as a measure of success or failure, what is used? What is the ultimate goal of treating a substance use disorder?
 
I'd look for social and economic factors to measure success: stable income, stable housing (that is also a safe environment, free from violence and abuse), nutritional health, mental health, physical health, healthy relationships with friends and family (however family is defined), things like that. I don't see the point of abstinence when it isn't about facilitating accompanied by growth in other areas.

In terms of internal medicine and psychiatry, there are lots of analytical tests which can help quantify these categories. The issue with them is that they're expensive to use, and necessitate broader involvement on the part of the individual than one normally thinks of having to do in traditional understandings of recovery.

Your post raises some great issues though. For one, there is no universal definition of recovery. Different people and different groups have different working definitions. Likewise, the issue of will is also interesting. On these two points, see my post above with links to research on these topics: http://www.bluelight.org/vb/threads...-Treatment?p=14121352&viewfull=1#post14121352
 
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