Wednesday, May 6, 2009

Treatment moving forward

I read an interesting blog post in the New York Times this morning by Dr. Mark Willenbring. Here's the question and answer that piqued my interest:

"Q: Why aren’t patients being told of the medical options available to them in addition to AA/rehab? Is it ignorance of doctors? Lingering stigma that alcoholics are somehow “bad” and their only solution is to admit their powerlessness and find a higher power? No other disease relies on meetings in church basements for its primary treatment. I’m a recovering alcoholic who attends AA meetings and takes Campral. Not one AA’er I’ve met thus far has heard of Campral. It has been a tremendous help to me and it’s too bad that it’s not being used more, especially as it relates to reducing relapses. Cew5x


The type of treatment offered at more than 90 percent of treatment programs in the United States consists of group counseling and referral to community support groups provided by non-medical staff. This treatment model was developed about 50 years ago, and it represented a real advance at the time.

However, the treatment field has not kept up with scientific advances in either behavioral or medication treatment. For example, it is about as difficult to obtain high quality cognitive-behavioral therapy for alcohol dependence as it is medication therapy. This is likely to change eventually, but for the time being, people seeking treatment for themselves or loved ones need to be informed “consumers.” Insisting on access to high-quality, scientifically-based care is one way to help drive system change."

What I find interesting about this are a number of things. First and foremost, why haven't we, as an addiction treatment field, continued with the progress seen in other areas of medicine? Since addiction is recognized as a disease, we should be taking advantage of all scientific advantages availed to us. I find it interesting that we are so resistant to change, and that for 50 years we've done basically the same thing in treatment. What is ALSO very interesting is the RESISTANCE to change. It's hard to find a treatment program that is consistent in adopting new methodologies for addressing the brain and medical issues associated with addiction. Within the industry, there is almost a stigma associated with medication in the treatment process.

Why aren't we using every tool available to combat a disease that directly affects 10 percent of our population and countless numbers of family members?

The other point is that a 12-step program works, when instituted and practiced diligently. However, what we've seen with alcoholics and addicts is that a relapse can often completely derail the recovery train. With the help of certain medications and medical knowledge, combined with therapy, support network and 12 step work, our chances of seeing a full and complete recovery should vastly improve. I can only hope that we start to see this before we lose more people.

Here's a video of Dr. Mark Hillenbring:

Here's something funny.

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  1. I have to say, Mike, I find it odd that in your blog below you offer the "buyer beware" advice regarding Naltrexone, then seem to embrace other options here... but I do thank you for talking about these options... this is the point I was trying to make on your previous blog regarding the CNN article about medication.

    It is shameful that treatment centers do not take advantage of all the possible means at their disposal to help people recover, especially when the AA option alone, statistically, is VERY unsuccessful. Why do clinicians, doctors, and sober folks all eschew medicine and science as a tool in the recovery toolbox?

    My very humble opinion is that this is in part because of AA's apparent policy of "cornering the market" on recovery - a spiritual program and a higher power being "required" for a lifestyle of recovery. I and others with long term sobriety, living sober, clean, happy, joyous, and free lives, are doing so without praying and "relationships with benevolent HPs" - it can be done and I think many people seeking recovery need to know it, as this is an area that many who wish to recover have a hard time hurdling.

    In my experience, three things should really be a part of every rigorous program:

    1) individual therapy - with a trained professional, preferably one trained in recovery/addiction psychology, to help with diagnosis. For example - I wish I had a therapist when I started my recovery program, because I'd have been treating my codependency alongside my alcoholism if I known that I was also codependent. Self-diagnosis for alcoholism, although necessary, should be guided by a professional.

    2) group therapy - AA is one option of many for this.

    3) medication (if prescribed by a doctor)

    Original Link to CNN Article:

  2. Great story. I've never heard of Campral either, and I consider myself up on treatment options and what is available.

  3. Dan- my basic premise on the buyer beware post is that we as an industry shouldn't look at any one thing as the solution. Same struggles were had when Prometa was introduced to the market. We stand a better chance at improving treatment outcomes when we embrace all of the options available- not just one.

  4. I agree with Dan and with Mike,

    We shouldn't be counting on a single solution. However,we should be looking at all possible options so that if one doesn't work we're immediately ready with another.

    One of the main problems is that there's no standard of care right now. Even worse, patients never know anything about the model being used on them (especially since 90 of it is the support-group AA model and that's it).

    This leaves uninformed patients making uneducated decisions because their providers are often undereducated themselves.

    Of course there are exceptions, but the above IS the rule. That's the first thing we need to change.

    AA's cornering the market impacts not only what people hear about, but also what's available. When every sober AA member opens up a sober living house, it seems that 12-Step is all there is.

    That's just false!

  5. Just a few short years ago, I found myself placing judgment on the medical establishment for using medication as a means to assist people in recovery. My argument was that the medications would get in the way of the addict/alcoholic truly getting down to the emotional 'nitty gritty' stuff that needs to be resolved in order for that person to achieve a happy, joyous and free sobriety.

    How I feel today is that I really don't know what the impetus will be for someone to experience a 'psychic shift' that leads to a beautiful life for them in the long term.

    One of the most important things for me is knowing that I'm not alone in this deal. Identifying with others who have found a better way to live is extremely beneficial to my recovery. Also, there is no room for shame in my opinion, either. That's a real killer emotion that will add some unnecessary weight to recovering person's world.