Science should be the main element in addiction treatment, yet myths and misinformation continue to run rampant among patients, loved ones, and those who are trying to help. Non-scientific programs and philosophies sometimes help people beat addiction, but science needs to be our guide and should be the most important influence.
One of the struggles I have as an addiction psychiatrist is dealing with the misinformation patients and families have about substance-use disorders. I often hear claims made by “experts” or addiction counselors such as, “You have the addiction gene that was turned on the first time you used.” Yes, genetics may play a part, but there is no single gene that causes addiction. Myths of this nature are common in 12-step programs such as Alcoholics Anonymous (AA).
While some people benefit from 12-step programs and similar philosophies, there is danger in positing addiction as a moral and personal failing. Many believe that endless and repetitious meetings to support total abstinence is the only way to deal with “personality flaws” and one’s subsequent dependence. These programs are also inconsistent with what we know about the natural course of alcohol abuse. The fact is that many who are diagnosed with alcoholism quit on their own or ultimately develop controlled drinking behaviors. The 12-step claim that alcoholism is a “lifelong disease that never goes away” is flawed. Indeed, patients and their families often reported to me during my medical training that decades-long heavy alcohol use ended abruptly or decreased dramatically after a heart attack or in response to other significant medical problems. The habit changed course with no treatment whatsoever, yet many people believe that habits can only change through 12-step programs.
Science tells us that addictions and solutions are not the same for everyone. We don’t treat different infections with the same antibiotic, or different types of cancer with the same form of chemotherapy, so why would we treat all addictions identically? Attending support groups and fully abstaining from alcohol best serves some individuals, while others succeed through controlled consumption and use of prescription medication to curb alcohol consumption. Some addictions may only be treated by psychosocial approaches such as AA or the non-profit, self-help program Smart Recovery, but other disorders, such as opioid-use disorder, are most effectively treated first with medical intervention. Psychosocial approaches can help, but without medically assisted treatment such as Buprenorphine or Methadone, the odds of recovery are very low.1
Unfortunately, when it comes to opioid-use disorder, this fact gets ignored. People are often “detoxed” in rehab centers and then expected to remain completely free from opioids with the help of education and group support. This occurs despite a wealth of evidence that “abstinence-based treatment” does not work for opioid addiction and medically assisted therapy reduces overdose deaths.2,3 Very often, those with opioid-use disorder are provided with treatment that is no more successful than no treatment at all, and may be worse. Some studies have shown that you if you’re addicted to opioids, you’re more likely to die of a fatal overdose within a year of “successful’’ completion in rehab of 14–30 days than if you had no treatment at all.4 This means we may be putting people at risk by lowering their tolerance to opioids and then putting them at higher risk for a fatal overdose when relapse occurs.
When we ignore science in favor of what we think works or hope works, we often do a disservice to the people we’re trying to serve. While we can employ varying approaches—evidence-based and philosophical—science should be foremost in any treatment.
John Sorboro, MD, ABPN, is a consultant for Health Services Advisory Group, a diplomat of the American Society of Addiction Medicine, and medical director of the Restorative Health and Recovery Clinic. Additionally, Dr. Sorboro will be a keynote speaker at the upcoming day-long conference on March 21st “The Painful Truth About Opioids”. Tell us what myths you’ve heard about treating opioid addiction. A conversation about the health issues in our communities is the first step in making our way to the Healthiest State in the Nation!
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-11SOW-C.3.6-03072019-01.
- National Institute on Drug Abuse. Effective Treatments for Opioid Addiction. Accessed March 4, 2019. https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction.
- Mattick, RP, et al., Methadone Maintenance Therapy Versus No Opioid Replacement Therapy for Opioid Dependence, Cochrane Database of Systematic Reviews, July 2009. CD002209, http://www.ncbi.nlm.nih.gov/pubmed/19588333.
- Schwartz, RP, et al., Opioid Agonist Treatments and Heroin Overdose Deaths in Baltimore, Maryland, 1995–2009, American Journal of Public Health, May 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670653/
- Strang, John, et al., Loss of Tolerance and Overdose Mortality After Inpatient Opiate Detoxification: Follow-up Study, BMJ, May 2003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC153851/