Why taking drugs to treat addiction doesn’t mean you’re ‘still addicted’

[S.J.B.]

Why taking drugs to treat addiction doesn’t mean you’re ‘still addicted’
Sarah E. Wakeman and Maia Szalavitz
STAT
May 18th, 2017

A patient came to see me after his most recent near-fatal opioid overdose. Once again, he had stopped his prescribed medication, even though we had agreed together that the safest course of action was to continue. Once again, he had relapsed — and had to be revived with naloxone. It wasn’t that he didn’t find the medication helpful or that he had side effects — on the contrary, it had nearly eliminated his cravings and stabilized his mood.

But his family and friends kept telling him he wasn’t “truly sober” or “really in recovery.” And inside, he, too, believed that taking one of only two FDA-approved medications that have been shown to cut opioid addiction death rates by 50 percent or more meant that he was “still addicted.”

My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths.

As the medical director of Massachusetts General Hospital Substance Use Disorder Initiative, I treat patients with addiction; my coauthor, Maia Szalavitz, is a journalist who herself experienced opioid addiction during her 20s. We, and many of our colleagues, are greatly concerned by how common misunderstandings about addiction like this undermine evidence-based care. While semantic issues are often dismissed as trivial, in this case, they are having devastating results.

Here’s what has gone wrong. In 1987, the authors of the Diagnostic and Statistical Manual — the “bible” that lists official psychiatric diagnoses and their attributes — designated two acceptable substance-related diagnoses. They were “substance abuse” for short-term but potentially dangerous problems (think: college binge drinking), and “substance dependence” for the chronic, relapsing condition we typically call addiction.

Read the full story here.

 

[Jabberwocky]

Great article!

 

[Felonious Monk]

Very good, totally something I've seen too. Almost no one understands the difference between addiction and dependence. Especially the legal drug addicts doing their best not to acknowledge their habits. Doesn't help those of us with non-society-approved addictions any good, that's for sure.

 

[cj]

Good article. I gotta comment though that the people pushing pharmaceutical solutions shoot themselves in the foot by over regulation. There is no reason I should have to go to a special clinic to get my methadone and jump through all the hoops associated with it. Suboxone isn't set up like that and it's just as addicting and dangerous to opiate niave people as methadone. My point is if they want to take the stigma away from these drugs they need to be prescribed by a normal doctor in a normal office setting like a normal prescription.

 

[busted.produk]

Great article!!
I was actually just having a discussion about the differences between dependence and addiction using the example of insulin with diabetics.
Its reassuring(in terms of general stigma) to read a published article that doesnt automatically equate drug use with societal ineffectuality.

 

[alpha_centauri]

LOL this article is nothing but addicts making up excuses to still use drugs that they are addicted to, and get high on other drugs, and if they believe that they are not really addicted to the opiate drugs they take they are only fooling themselves.

That addict and his family are correct, he was not sober/clean, and yes it is just substituting one opiate/addiction for another.


Years ago, one of my friends was a drug counselor. She had a masters degree and was working on a PhD. She used drugs regularly, even crack cocaine but she said it was okay since she and some of the other counselors "only got high on the weekends" and it was just to "let off steam." I asked her how she could talk to addicts about getting sober and living sober when she was using drugs herself. It was an ongoing argument until I completely walked away from the friendship. It was hard to deal with a hypocrite. She and the other counselors wound up losing their jobs and dying from overdoses.

 

[Jabberwocky]

LOL, you compare a drug and alcohol counselor who uses crack cocaine on the weekends to someone engaging in what is by and far the most effective treatment for severe opioid use disorder.

Clearly you have yet to get past your own petty personal biases when it comes to understanding modern medicine.

Frankly, it's pretty easy to consider one's self "clean" or abstinent. Just stop taking drugs. It's much harder to get sober. Getting sober at least eventually entails dealing with the kind of selfish, harmful attitudes you have when it comes to other people's recovery.

You might not consider folks on MMT sober, but I don't consider folks with the kind of self-centered attitude you're presenting to be sober. So, I guess we're kind of even

I also get the feeling you only have very limited experience either as or working with folks with severe opioid use disorders... If you did you wouldn't be so quick to poo-poo what is still, for better or worse, their best treatment options.

I also get another feeling: that you didn't actually read the entire article. You're critique is most annoying and superficial, and doesn't actually have much to do with what they're writing about past the first few sentences of the article.

 

[Felonious Monk]

Good article. I gotta comment though that the people pushing pharmaceutical solutions shoot themselves in the foot by over regulation. There is no reason I should have to go to a special clinic to get my methadone and jump through all the hoops associated with it. Suboxone isn't set up like that and it's just as addicting and dangerous to opiate niave people as methadone. My point is if they want to take the stigma away from these drugs they need to be prescribed by a normal doctor in a normal office setting like a normal prescription.

Totally agree. I think the over-regulation has just been the compromise we've been stuck with. The progressives haven't really been willing to stand up for unpopular ideas, so it happens slowly. It's moving though, from what I've seen.

But the other issue is that the Harrison Act of 1914 prohibits prescribing narcotics to addicts, so that's always kind of been a cloud over the head of true progress on the issue of opioid maintenance.