Opinion by Maia Szalavitz : We Try More Drugs than Anyone Else, and 9 Other Ways Addiction Is Different in America

“We Americans like to think of ourselves as exceptional, the land of the free and the home of the brave, the City on the Hill and all that. When it comes to the politics and culture of drugs, we are indeed special—or at least dramatically different from the rest of the Western world. Too often, however, we are special for the wrong reasons.”

  1. We Try More Drugs Than Anyone Else
  2. We Incarcerate More People Than Anyone Else
  3. We Use More Opioids Medically (But Not for the Reasons You Might Think)
  4. We’re in the Middle of the Road on Alcohol
  5. We Have the World’s Highest Legal Drinking Age
  6. Our Treatment System Is Dominated by 12-Step Programs
  7. Coercion Is a Common Route to Treatment
  8. We Spend the Most Money on Addiction Research
  9. We Determine What Is and What Isn’t Legal Worldwide (But for No Rational Reason)
  10. We’re Not Very Good at Measuring Addiction

http://www.psmag.com/navigation/health-and-behavior/try-drugs-anyone-else-9-ways-addiction-different-america-85093/

Source:Pacific Standard – July 4, 2014

 

ASAM Article: Twelve Step Recovery and Medication Assisted Therapies

“You’re not clean and sober if you keep taking that medication from your doctor!”

“You’re just substituting one drug for another.”

“You are depressed because you are not grateful enough.”

These and other statements are often made to 12-step members who are legitimately prescribed and taking FDA approved medications to treat their addictions and other co-occurring illnesses. Unfortunately, this so- called “advice” from well-intended but misinformed members is not founded in scientific or 12-step philosophy and violates a long held 12- step policy of ” AA members should not give medical advice to each other.”

http://www.asam.org/magazine/read/article/2014/06/12/twelve-step-recovery-and-medication-assisted-therapies

Source: American Society of Addiction Medicine – June 12, 2014

Naloxone ‘Stigma’ a Barrier to Prescribing?

“Although giving out naloxone to patients at high risk of overdose sounds like a good idea, researchers who work with the drug say the stigma surrounding its use may be a barrier to wider uptake among both patients and doctors.

Patients may feel they’re being treated like addicts and that their opioid prescriptions will be tempered, while doctors worry that just talking about naloxone may scare patients away, said Caleb Banta-Green, PhD, MPH, of the University of Washington in Seattle. “Both doctors and patients feel like they’re under the microscope,” Banta-Green told MedPage Today. “It’s a very sensitive time.”

Banta-Green and his colleagues are enrolling patients at high risk for opioid overdose — both heroin users and patients on prescription opioids — in a randomized trial to test whether providing naloxone, along with education and counseling, can reduce overdose.”

http://www.medpagetoday.com/Psychiatry/Addictions/45164

Source: MedPageToday.com – April 9, 2014

Viewpoint: Confronting the Stigma of Opioid Use Disorder—and Its Treatment Published Online in Journal of the American Medical Association

jama-logoIncreasing numbers of overdoses from prescription opioids and a more recent increase in heroin-associated fatalities have caused heartbreak in communities across the country.

Given the severity of this national epidemic, it is time to confront the stigma associated with opioid use disorder and its treatment with medications. By limiting the availability of care and by discouraging people who use opioids from seeking effective services, this stigma is impeding progress in reducing the toll of overdose.

Health care practitioners can counter stigma by adopting accurate, nonjudgmental language to describe this disorder, those it affects, and its therapy with medications. States can promote the provision of comprehensive health services in opioid treatment programs and expand access to effective therapies in the criminal justice system. The public can fight back against the rising threat of overdose by supporting broad access to effective treatment with medications.”

Viewpoint by Yngvild Olsen, MD, MPH; Joshua M. Sharfstein, MD

http://jama.jamanetwork.com/article.aspx?articleID=1838170

Source: The Journal of the American Medical Association – Online February 26, 2014

Crime Does Not Increase Around Methadone Clinics in Baltimore

crime purchased shutterstock_78337543“Citizens’ concerns that methadone treatment centers (MTCs) might be focal points for serious crime are unwarranted, a recent NIDA-supported study suggests. Dr. Susan Boyd and colleagues at the University of Maryland School of Medicine in Baltimore found that crime rates in the immediate vicinities of that city’s MTCs were level with the rates in the surrounding neighborhoods.

The researchers used Baltimore City Police Department records from 1999‒2001 and global positioning data to plot the distribution of FBI Part I crimes (homicide, forcible rape, robbery, aggravated assault, burglary, larceny theft, motor vehicle theft, and arson) within a 100-meter (328-foot) radius of 15 MTCs. A statistical analysis of the plots showed that the crimes were no more frequent within 25 meters of the MTCs than they were 75 to 100 meters away.

In contrast to the case with MTCs, the likelihood of Part I crimes rose with closer proximity to convenience stores. The researchers suggest that the high volume of foot traffic around these stores provides opportunities for criminals to find victims. Consistent with this surmise, the frequency of crime declined near mid-block residences, where foot traffic is relatively sparse.

The study MTCs included all but one of the 16 centers located in Baltimore. They were situated in diverse communities, including inner-city, working-class, and middle-class neighborhoods, according to Dr. Boyd. The convenience stores and residences were located in neighborhoods that closely resembled those of the MTCs in demographic and social features that influence crime rates.

“There’s no evidence from our study of increased reports of crime around the methadone clinics,” says Dr. Boyd. She and colleagues are now analyzing data on actual arrests around the study sites to see whether drug sales and possession increase with proximity to methadone treatment centers. The researchers hope that demonstrating that MTCs are not hot spots for crime will reduce public resistance to the building of new centers, and thus remove an impediment to making methadone treatment more widely available.”

See graphs available at: http://www.drugabuse.gov/news-events/nida-notes/2012/12/crime-does-not-increase-around-methadone-clinics-in-baltimore

See related blog available from the Institute on Research, Education and Training in Addictions (IRETA) available at: http://iretablog.org/

Source: National Institute on Drug Abuse (NIDA) Notes – January 2014, IRETA – February 13, 2014

From the Publisher—Special Issue on Recovery From Opioid Addiction

people-sunlight

For six decades methadone maintenance has been an approved treatment for opioid addiction. People who are taking methadone are no different from those who manage their diabetes by taking insulin: they are in recovery. Yet some policymakers—and even some medical, and yes, some addiction authorities—don’t believe it. Although that may change as more and more professionals buy into the scientific fact that addiction is a brain disease, and therefore it can be treated, and people can recover from it.

The federal government, from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the Office of National Drug Control Policy (ONDCP), states that medication-assisted treatment (MAT) is recovery. In this issue, we write about a comprehensive literature review funded by SAMHSA demonstrating the efficacy of MAT. And we cover an article by William L. White describing the stigma and other obstacles methadone patients face when joining 12-step groups—and the important role these groups could play in helping patients in recovery. We also interview Walter Ginter, peer, patient, and advocate, who spoke before the ONDCP in December on the topic of recovery and MAT. Mr. Ginter, a methadone patient in long-term recovery, is an articulate spokesman for methadone and for patients, helping to guide peer services across the country from his position at MARS, in New York City. We also interview Zac Talbott, based in the less-welcoming South, about his work as an advocate.

Not all of the news is good: In New Jersey, a state that strongly endorses methadone as a treatment for opioid-dependent pregnant women, a woman is facing child abuse and neglect charges simply for being in a methadone program while pregnant. The Supreme Court is due to hear the case, and legal and medical authorities are hopeful that the court will not in effect ban MAT for pregnant women. The woman was in recovery, doing the right thing for herself and her baby, yet was reported, and was held by a lower court to have committed child abuse and neglect by being on methadone while pregnant. On the bright side, the best legal and medical minds who know about MAT have filed a friend of the court brief on the mother’s behalf.

In Philadelphia, where AT Forum attended the AATOD conference last fall, recovery transformation is happening in a solid way, moving from treating addiction as an acute episode to a continuum instead, in which someone enters recovery as a person, not a patient. Roland Lamb discusses efforts to help opioid treatment programs (OTPs) provide what is needed for recovery, with more of a focus on the person than on the dosage and the monitoring. Methadone is a way to recovery—that’s why it was created—but the person taking it is the point of recovery.

Finally, a new evidence-based document from ASAM provides guidance for safe methadone induction and stabilization in OTP patients. This is the first time this vital information has been brought together in one place. Our article by Stewart Leavitt is recommended reading for everyone interested in methadone maintenance treatment.

I hope you enjoy this issue, and we look forward to your comments and feedback.

Sue Emerson
Publisher

At The White House, Learning How Not To Talk About Addiction

White House“We don’t refer to someone who has anorexia or bulimia as having a “food abuse” problem. We say they have an eating disorder. So why do we refer to someone who is addicted to alcohol or pain pills as having a “substance abuse” problem?

Harvard’s John Kelly, director of the new Recovery Research Institute at Massachusetts General Hospital, made that point this week at what was billed as the first-ever White House summit on drug policy reform. The Obama administration has moved far from the old “war on drugs” model. The current federal drug czar, Gil Kerlikowske, wrote in his email invitation to the summit: “Drug policy reform should be rooted in neuroscience, not political science.” And “it should be a public health issue, not just a criminal justice issue. That’s what a 21st-century approach to drug policy looks like.”

Dr. Kelly, an associate professor of psychiatry, spoke to the summit-goers about the stigma around addiction — so pervasive it can even be seen in language. I asked him to elaborate; our conversation, edited.”

http://commonhealth.wbur.org/2013/12/language-substance-abuse-addiction

Source: CommonHealth.WBUR.org – December 13, 2013

NIMBY and Other Problems: Still an Uphill Battle For OTPs, But Hope Seen In Patient Advocacy

advocacyThe NIMBY (Not In My Back Yard) syndrome is one significant challenge for opioid treatment programs (OTPs), which can’t operate if they can’t get approval from municipalities. Methadone maintenance treatment has been proven effective and producing good outcomes for five decades, but that isn’t preventing politicians from pandering to prejudice and discrimination. Still, the field is forging ahead, opening new programs and providing access to treatment to needy patients.

Sally Friedman, legal director with the Legal Action Center, said that local authorities often try to zone out drug and alcohol programs in general, but it’s even more difficult to site a methadone program. “It’s challenging to site any type of facility that serves people who folks don’t want around,” she said. “I’ve seen this from examining case law—there’s NIMBY for everything, the elderly, group homes, communities want to keep out all types of social services.”

But a special place in NIMBY-land is reserved for OTPs. In 1977 the Legal Action Center won a landmark discrimination case in which a federal court prevented White Plains in New York from zoning out alcohol and drug abuse treatment programs—and while it wasn’t specific to OTPs, OTPs are included. “Stereotypes and myths” play a part in the NIMBY decisions, said Ms. Friedman.

The Americans with Disabilities Act (ADA) clearly supports OTPs and their patients, and municipalities and their lawyers can easily lose in federal court since the law is so clear. “But there’s a lot of political calculation,” said Ms. Friedman. Local politicians think they have more to gain politically from keeping the facility out, so they’re willing to risk the lawsuit and let the court tell them what they have to do.

MAT First

One point that the substance abuse treatment field in general needs to make more strongly is that medication is the first-line evidence-supported treatment for opioid addiction. “Myth and misunderstanding continue to plague not just methadone alone but medication-assisted treatment [MAT] in general,” said Michal Botticelli, deputy director of the White House Office of National Drug Control Policy [ONDCP]. For opioid dependence in particular, medication is the “first line in our arsenal,” he said. “We have to make sure people understand that this is the standard of care.”

Mr. Botticelli added that there is an opportunity to create a greater consumer voice in favor of MAT. “People have done exceedingly well on methadone maintenance.” Some people need more than medication—other social supports and the structure of an OTP—but others don’t.

As states continue to express concern about prescription drug abuse and overdoses, mainly surrounding opioids, the ONDCP is increasing its stress on the importance of access to methadone and buprenorphine, as well as social supports provided in an OTP. “If we really want to deal with overdose deaths, we need to make sure that we have adequate access to MAT.”

The same myths and stereotypes that bolster NIMBY apply to the criminal justice system, which routinely denies access to medication-assisted treatment. The biggest myth is the one that methadone and buprenorphine are “substituting one addiction for another,” which couldn’t be farther from the truth. Patients in MAT are not addicted—they are not pursuing drugs, they are in recovery, employed, productive members of society. But proponents of discrimination don’t understand how the medications work.

Lack of Negative Impact

It’s also easy to demonstrate the lack of a negative impact in NIMBY siting cases. Jerry Rhodes, chief operating officer of CRC Health Group, said it’s important to bring out studies that show crime goes down when clinics are deployed. “There is science that shows methadone treatment has good results,” he said. But here’s the problem: the issue is an emotional, not a logical, one.

The studies showing that methadone works have been ignored by many public policy makers. And while OTPs had been hoping to enlist government officials and regulators in support of MAT, that isn’t working either. “We’ve had the rug pulled out from under us,” said Mr. Rhodes. “We’re trying to get a more robust commitment.” 

Support From Patients

One thing OTPs could do better is to involve the support of patients, said Mr. Rhodes. “There are often compelling personal stories around the need for treatment, and the effectiveness of MAT.”

In general, the OTP field has done a poor job of rallying patients. But Mr. Rhodes understands that it’s hard to get patients to come forward. “You could lose your job, your neighbor could say something, there’s a fear of being seen as a patient in a clinic.”

The field is beginning to recognize that OTP patients, like other people in recovery, can be a significant voting bloc. For example, there are 5,000 to 6,000 OTP patients in West Virginia. In a small state like West Virginia, 5,000 votes—in some places, even 1,000 votes—can swing an election. When there is no access to MAT, patients—and prospective patients, who also vote—suffer. “This is a job for the National Alliance for Medication Assisted Recovery  (NAMA),” Mr. Rhodes said.

Collaboration

Another good advocacy tactic involves collaborating with other groups. Mr. Rhodes cited the effectiveness of the autism advocacy movement, which is spearheaded by parents who are fierce advocates for their children. Drug addicts, alcoholics, people with mental illness need the same kind of advocates, but have always been treated as marginal populations, which is what drives the stigma. “We can do a better job of working with other constituents,” he said.

Even as a field, various types of treatment are fragmented—medication, no medication, alcohol, drugs—and OTPs could benefit by these groups working together and bringing OTPs into the tent.

Back to NIMBY

The bottom line is, OTPs need facilities, and that means they need certificates of occupancy. Mr. Rhodes warns clinics against going into a community to develop a clinic and not garnering support first. “You can’t do this and not deal with NIMBY, but you can do a better job of trying to support these efforts.”

Here are some of the things you can expect to hear when you try to site a program. “This isn’t our problem.” That’s pretty easy to refute, because an OTP usually has done research and knows that there is an opioid problem. For example, at one meeting, someone stood up and said, “I don’t want this town becoming a methadone mecca.” A physician who was there then said, “You don’t understand, this town is already a heroin mecca.”

The OD Bandwagon

Despite the many newspaper articles about prescription opioid abuse and overdoses, there are rarely any discussions of the cure—treatment. “People don’t understand how prescription opioid abuse relates to methadone treatment,” said Mr. Rhodes. “We rarely address the cure, we just talk about the magnitude of the problem.”

“Education is key,” agreed Ms. Friedman. “We need to explain how the disease works, how the treatments work, and how we produce successful outcomes.”

Commentary by Dr. Tom McLellan: Getting Past the Stigma and Treating Addiction as a Chronic Disease

“According to the Food and Drug Administration’s standards for effectiveness, there are presently four prevention interventions, five medications and more than a dozen behavioral therapies that can be called effective in preventing, intervening early and managing substance use disorders.

We know the best outcomes are achieved when the disease is identified and intervened upon early in its trajectory. But even serious, chronic cases can be treated effectively. Self-managed, continuing recovery can, and should, be the expectable outcome from all addiction treatments.

Yet many physicians and counselors have never even heard of these medications or of many other “evidence-based” behavioral interventions and most were never trained in how to manage substance use disorders. Many specialty addiction treatment programs are not staffed to provide anything other than basic group counseling. Other programs are not licensed or funded to provide these more effective but more costly therapies and medications. And still, other programs refuse to provide them on ideological grounds. For example, there are currently three FDA-approved medications for the treatment of opioid addiction, yet less than 30 percent of addiction treatment programs offer addiction medications, and less than half of the eligible patients in those programs ever receive them.”

http://www.drugfree.org/join-together/addiction/commentary-getting-past-the-stigma-and-treating-addiction-as-a-chronic-disease?utm_source=Join%20Together%20Daily&utm_campaign=352b19c266-JT_Daily_News_Getting_Past_the&utm_medium=email&utm_term=0_97f4d27738-352b19c266-221281549

Source: DrugFree.org - July 19, 2013

From “Angels” to “Liquid Handcuffs”—MMT Patients Use Metaphors as Tools to Aid in Recovery

owlInvestigators in this study explored the experiences of patients in methadone maintenance treatment (MMT) for opioid addiction in order to better understand the challenges of maintaining a sustainable recovery. Study participants used spontaneous, picturesque metaphors to illustrate their experiences, feelings, challenges, and successes, enabling investigators to identify key turning points in substance dependence and recovery. Investigators show “how participants made sense of treatment and how their communicative framing had important consequences for recovery.”

Study Group

  • 68 participants from four racial/ethnic groups in six major metropolitan communities, divided into eight focus groups
  • Patients had minimal education; most were unemployed, in their 40s or 50s

Metaphors as Tools

Metaphors compare things that are different but have an important quality in common. Simple examples include “he’s a night owl; she’s an early bird.” “Her hair is a golden river.” “His home is a prison.” But the study authors aptly defined metaphors as tools for expressing issues that are “confusing, complex, hidden, and difficult to state analytically or literally,” and for conveying topics that are largely unacknowledged, or too emotionally shattering to articulate. By teasing out the implications of patients’ metaphors, the authors shed light on challenges in substance abuse recovery.

Drug Use. Patients described drug use in lively metaphors—“hustling,” “chasing down a fix,” “scoring,” and “shooting.” They spoke nostalgically of hits, highs, and slams, admitting that they’d enjoyed getting high, but, in general, deeply regretting their actions. One described his first heroin use as “that’s a wrap,” and quoted the “wrapping” line from the film Casablanca—implying an end to other relationships, and linking drug use with glamour and love and a difficult choice.

Transition and Motivation. Seeking treatment was for some a court mandate, for others a personal decision, and for still others, a miracle —like the “angel” who intervened in a woman’s behalf at a clinic. “Money in my pocket”—encompassing both “the good life” and the monetary benefit of MMT—emerged as a spontaneous metaphor in all eight focus groups.

Recovery and MMT.  Patients saw methadone as a continuing “safety net,” “life saver,” “security blanket.” But stigma made methadone also “a crutch,” something to “dose down” from. Patients spoke of “going straight,” “being detoxed,” and “getting clean.”

Maintaining Recovery.  Most patients saw recovery as simply meeting their needs for food and shelter—a far cry from their lively metaphors of drug use. Patients wanted to avoid “slipping” back and being “dope sick” (going through withdrawal). They feared “being detoxed.” Although grateful for methadone, they regretted needing it. “Liquid handcuffs,” one woman called it. She explained that if she suddenly had an opportunity to go to China and get rich, she couldn’t do it; she’d get sick without methadone.

Downward Spiral.  At each step—from drug use to recovery—patients’ language became increasingly passive. Patients used avoidance as a tool, and spoke of being acted upon, instead of acting. They saw recovery as “bleak, lonely, difficult, and boring,” a time of relinquishing power and control.

These findings pointed to the need for clinicians to promote patients’ self-efficacy, help patients develop active language and capability, and create “narratives of success, healing, and hope.” A key step was to develop treatment strategies with clinicians and patients setting goals together.

Goals are easier to reach when stated affirmatively and broken into small pieces. An avoidance goal, “I will maintain my recovery by not taking drugs and staying away from my former drug partners for the rest of my life,” becomes instead, “I will take X milligrams of medication each day this week,” hoping to decrease it “by X percent next week,” and “I’ll attend three meetings per week to maintain my recovery.” Missing one meeting or dose-decrease becomes one misstep, rather than a total failure at recovery. Thus, constructing better narratives can create positive paths for patients to follow, provide motives for them to change, and help them transition between the cultures of addiction and recovery.

 *     *     *

Redden SM, Tracy SJ, Shafer MS. A metaphor analysis of recovering substance abusers’ sensemaking of medication-assisted treatment [published online ahead of print May 6, 2013].  Qual Health Res. 2013; May 6. doi:10.1177/1049732313487803.

American Society of Addiction Medicine Urges an End to Interference with Physician-Patient Decisions on Addiction Medications

Doctors 613The American Society of Addiction Medicine (ASAM) stated on April 30 that treatment decisions on the use of FDA-approved medications for addiction to opioids such as pain medicine and heroin should be made only by skilled physicians. Limits by governments and insurers on addiction medications can lead to patient relapse, crime, overdose and death, ASAM said in a major policy statement.

The action by the medical society of addiction specialist physicians is in response to the growing trend of state governments to place arbitrary limits contrary to medical necessity on FDA- approved addiction medications that treat opioid use disorders, including buprenorphine, buprenorphine/naloxone, extended-release injectable naltrexone and methadone. These actions by governments and some commercial payers reinforce stigmatization of the disease of addiction and prejudice against the use of addiction medications, which ASAM stated must be made available as needed by physicians treating opioid use disorder patients.

“State governments and insurers should not be involved in setting limits on types or duration of treatment for addiction,” said Stuart Gitlow, MD, ASAM President. “Governments and insurers would never interfere with physicians prescribing FDA-approved medications for any other chronic disease, such as diabetes or hypertension. Interfering with the treatment of addiction threatens the life and health of patients and disrupts families, workplaces and communities.”

ASAM’s Public Policy Statement on Pharmacological Therapies for Opioid Use Disorder stated that evidence-based treatment for opioid use disorders should be individually tailored, and usually requires chronic disease management that includes a combination of psychotherapeutic, psychosocial and pharmacological interventions. Decisions on which therapies will work best “should be made only by knowledgeable and skilled physicians, in whom patients have placed their trust and well-being,” the statement said.

Some people with opioid addiction can maintain long-term recovery through psychosocial treatment alone, but others cannot. For these people, research shows that FDA-approved addiction medications can significantly reduce death from overdose.

“Every effort should be made by the patient, the treatment provider, policy-makers and payers to maintain the optimal level of treatment for patients with an opioid use disorder, for the benefit of the patient, their family, the community and our society,” the ASAM statement said.

In addition, the statement said, arbitrary limits on the number of addiction patients who can be treated by a physician or the number and variety of therapies used by addiction medicine physicians should not be imposed by law or insurance practices. Currently, federal laws limit the number of opioid-dependent patients that physicians can treat with buprenorphine in an office- based setting.

“There’s no scientific basis for current limitations on addiction medications and specialist physicians who prescribe them,” Gitlow said. “These limits, and the public stigmatization of addiction medications that they arouse, are costing the lives of patients who relapse and overdose.”

ASAM recently launched a year-long project, Advancing Access to Addiction Medications, to analyze the effectiveness of medications used to treat opioid use disorder and to survey public and private payers to identify policies that limit patient access to these medications and policies that offer optimal medication benefits. The initiative will result in a major research and policy report, expected to be released this summer, which will provide the most extensive examination to date of the efficacy of opioid dependence pharmacotherapies and public policies regarding these medications. For more information about opioid dependence therapy and about this effort, please visit http://www.accesstoaddictionmedications.org/.

http://www.prweb.com/releases/2013/4/prweb10681365.htm

Source: PRWeb.com – April 30, 2013

Terminating an Addicted Employee

Question: “We have an employee who is a chronic prescription drug abuser. He has not been performing at work but every time we try to terminate him for cause, he immediately enters a drug rehabilitation program in order to avoid termination under the ADA, claiming that he has a disability. Does the ADA require that we keep this under-performing employee on our payroll just because he is enrolled in a drug rehabilitation program?

Answer: No, it does not. Although an employee’s status as an alcoholic or a recovering drug addict may merit protection under the ADA in certain circumstances, including when the employee is in rehabilitation and is no longer using, an employee or job applicant is not “a qualified individual with a disability” if he or she is “currently engaging in the illegal use of drugs.”

For a detailed explanation go to: http://www.hreonline.com/HRE/view/story.jhtml?id=534355361

Source: Human Resource Executive – May 22, 2013

5 Myths about Addiction that Undermine Recovery

“Honest, courageous and insightful aren’t words typically used to describe drug addicts. But if given the chance, many addicts end up developing these qualities and contributing to society in a way they never imagined possible. These successes occur in spite of major obstacles, from the ever-present threat of relapse to the pervasive stereotypes addicts encounter along the way. Even with three decades of myth-busting research behind us, some of the most damaging beliefs about addiction remain.” The five myths include:

  • Addicts are bad people who deserve to be punished.
  • Addiction is a choice.
  • People usually get addicted to one type of substance.
  • People who get addicted to prescription drugs are different from people who get addicted to illegal drugs.
  • Treatment should put addicts in their place.

http://www.psychologytoday.com/blog/where-science-meets-the-steps/201305/5-myths-about-addiction-undermine-recovery

Source: PsychologyToday.com – May 14, 2013

Bob Newman is Retiring, But You Haven’t Heard the Last From Him

BobNewmanphotoLegendary methadone treatment advocate Robert G. Newman, MD, is retiring. But, he hastens to add, he is not leaving the field. “What I’m leaving,” he told AT Forum in February, “is the office.”

Dr. Newman announced via a January 26 e-mail that he would be giving up his “formal role” as director of Beth Israel’s Baron Edmond de Rothschild Chemical Dependency Institute. He will continue to work through June, but Hindy Bernstein, his assistant of the past 25 years, will be leaving in April. “Hindy is leaving me for Florida,” he said. Although he will no longer have the financial support of Beth Israel, he will continue advocacy efforts.

An Advocate

“The challenges are at least as great today as they were 40 years ago when I started my advocacy work,” Dr. Newman said. He will continue to be a fly in the ointment, but he does want to see more “noise” from the rest of the opioid treatment program (OTP) community.

His days will continue to begin and end the way they have for years, he told AT Forum. “I go to the Internet, I get the Google alerts, which very often have some particularly horrendous feature that I’m obliged to respond to.”

There is a lot of “bad news” for Dr. Newman to blog, write letters to the editor, and send e-mails about. And he does so very articulately. For example, some states are cutting off methadone treatment arbitrarily, trying to limit it to one or two years. Regulators are confounding addiction and dependence, not recognizing that maintenance medication is treatment, not a “substitute” for heroin. Unbelievable as it is that this non-science is going on today, some 50 years after medication-assisted treatment (MAT) has been proven effective, and in the face of federal officials, Dr. Newman sees it happening. And he isn’t going to be quiet about it.

NIMBY

NIMBY—the “not in my back yard” phenomenon in which even people who claim to support MAT don’t want programs in their neighborhoods—is illegal, violating the Americans with Disabilities Act (ADA). But despite the various ADA wins that OTPs have achieved, they are never “precedent-setting,” and therefore need to be fought over and over again. “This is terribly frustrating to me,” said Dr. Newman.

Dr. Newman said the opioid-treatment field can help with this fight. “There are many reasons for NIMBY, and some of those reasons have to do with the field, how we have allowed our treatment, our patients, our services to be viewed,” he said. “It isn’t just misperception on the part of communities and politicians. Some of the anti-methadone- patient bias reflects the way the field has chosen to isolate itself and adopt and embrace unique practices that make this treatment separate.”

 Office-based Methadone

 Dr. Newman is glad that buprenorphine has been made available to OTPs and to office-based opioid treatment (OBOT) providers, as a treatment tool for caring for opioid dependence. He notes that more than 40 years ago he proposed that private physicians be permitted to offer methadone maintenance, in addition to OTPs. And now that buprenorphine can be utilized in OBOT, why not methadone, he asks rhetorically. Dr. Newman also notes the extremely limited willingness of office-based physicians to become “waivered” to prescribe buprenorphine. “I think some of the practices of programs are so foreign to what is done in every other field of medicine that medical colleagues view this as something that is from Mars and refuse to get involved in any form of opioid-dependence treatment.”

In fact, the requirement that patients go to a clinic every day is a barrier to care. Dr. Newman is skeptical about the effect of the Affordable Care Act (ACA) on OTPs in particular. “I have seen repeated references to the notion that under the ACA, there’s going to be a sudden upsurge of demand for addiction treatment,” he said. “Increased demand, maybe,” he said. “But how is that demand going to be met? You can have all the insurance you want, but an awful lot of people who need treatment will avoid OTPs because of the requirements and the stigma, and there are not that many OBOT providers.”

Nevertheless, he noted that hundreds of thousands of patients do go to OTPs for MAT, which shows how motivated these patients are. “How many people would have the motivation to deal with obesity, smoking, hypertension, or a great many other medical problems if the treatment regimen required many months of daily attendance and a host of other demands? The fact that there are 300,000 people enrolled in MAT is amazing.”

 Methadone Safety and Dosing

With an appropriate dosage schedule, methadone is an extremely safe medication, said Dr. Newman. But he warned that some OTPs give induction increments that are too great. The federal regulations state that the dose on the starting day must not be more than 40 milligrams—the first dose has to be no more than 30, and an additional dose that day can be 10, said Dr. Newman. But after that, there are some programs that raise the dose too quickly. “Some programs have induction protocols of 30, 40, 50, 60, 70,” with the dose going up daily, he said. The rule of thumb—“start low, go slow, aim high”—needs more of an emphasis on “go slow.”

 Federal Exclusions

Finally, Dr. Newman would like to see more support for methadone treatment at the federal level. The insurance plans of the federal Department of Veterans Affairs and the Department of Defense have an exclusion against methadone and buprenorphine maintenance treatment, something Dr. Newman has long railed against. “Tom McLellan (then deputy director of the federal Office of National Drug Control Policy) and other very high-level officials have said the exclusion is bad, and that they were trying to change it,” said Dr. Newman. “But it persists, and that’s inexcusable and shameful. “

What Dr. Newman wants advocates to do is to speak up. “Silence equals death,” he said, citing an oft-used slogan of AIDS activists years ago. And he is not going to be silent. “There are a lot of windmills still out there.”

NASADAD Issues Consensus Statement Endorsing Medication-Assisted Treatment

health insurance approved1The top state officials in substance abuse treatment approved a consensus statement in December that states that medication-assisted treatment (MAT) should be paid for by public and private health insurance plans. This was the first time that the board of directors of the National Association of State Alcohol and Drug Abuse Directors (NASADAD) approved a statement that endorsed MAT as evidence-based treatment. The statement was released January 15. It focuses on MAT for opioid addiction, and is essentially an anti-stigma document, aimed at supporting single state agencies (SSAs)—the authorities over the Substance Abuse Prevention and Treatment block grant.

The consensus statement is footnoted and includes the following assertions:

  •  Dependence on alcohol and drugs is a complex but treatable disease that affects brain function and behavior.
  •  No one treatment protocol is appropriate for everyone.
  •  For some individuals, use of medication is recommended as a recovery tool.
  •  Where clinically appropriate, use of medication as a recovery resource should be utilized as an adjunct to other treatment services.

 Medications such as methadone, buprenorphine, and naltrexone (both oral and extended release injection) have been shown to reduce opioid use; and naltrexone, disulfiram, and acamprosate have been shown to be effective in the treatment of alcohol dependence. The appropriate use of these medications allows individuals to experience sustained recovery from opioid and alcohol dependence, including through long-term management using medication maintenance. The medications should be made available to individuals who could benefit from them.

 It is recommended that any medication-assisted treatment be combined with psychosocial and behavioral strategies that are clinically matched to the severity of the individual’s addiction.

 Longitudinal studies show that treatment initiated in the criminal justice system and continued in the community garners lasting reductions in criminal activity and drug abuse. This includes medication-assisted treatment (e.g., methadone, buprenorphine/naloxone, and injectable naltrexone) for some prisoners with opioid dependence.

 “There is still ambivalence around the use of addiction medications,” says Belinda Greenfield, PhD, the State Opioid Treatment Authority (SOTA) for New York. “That’s why NASADAD and the Opioid Treatment Network say MAT is important to be considered as a treatment option.” The SOTAs became part of NASADAD last year when the association formed the Opioid Treatment Network (OTN). Dr. Greenfield, president of the OTN, is also director of the Bureau of Treatment, Addiction Medicine & Self Sufficiency Services of the Office of Alcoholism and Substance Abuse Services (OASAS) in New York State.

 The problem—not accepting MAT—is particularly significant outside of the methadone field, but even in the substance abuse treatment world, a substantial number of providers espouse “drug-free” treatment, says Henrick Harwood, research director for NASADAD. “Many public-sector programs feel on principle that drug-free is the best approach,” he says. . However, he points out that over the last several years, many have been changing their point of view. “There’s been growing support for MAT.”

 Fight Stigma from Within

Dr. Greenfield says that opioid treatment programs (OTPs) themselves could be better advocates for MAT: they need to be vocal about the fact that patients in MAT are in recovery—they should be called “drug-free” because they’re taking a medication, not seeking a drug. “People in MAT are stable and drug-free, and are maintained on an addiction medication.”

Unfortunately, to some degree, Dr. Greenfield says, patients don’t consider themselves part of the recovery community, and that’s something that OTPs should be working to correct, partly by educating staff. “OTPs should be really actively involved in ROSC functions,” she says, referring to Recovery-Oriented Systems of Care.

 It also would help for OTPs to acknowledge that it is not only methadone that constitutes treatment, but buprenorphine, and behavioral therapies as well, says Dr. Greenfield. “We need to consider addiction medications as one of the options. We can’t say we use only methadone. Patients aren’t that cookie-cutter anymore.”

The Medical Mainstream

Stigma relates directly to the mainstreaming of OTPs, says Mr. Harwood. “It’s important to communicate that methadone treatment has moved in the direction of mainstream medication.” Accreditation by the Joint Commission and CARF are helping to promote the fact that OTPs are in the medical mainstream, he says.

Dr. Greenfield also says part of making MAT better accepted means involving patients more—something that is being encouraged in the rest of medicine, as well. “The language around patient-centered care needs to be better integrated in an OTP setting,” she says, noting that patient advisory committees can be helpful in implementing patient-centered care.

Finally, OTP staff need support as well, because they feel stigmatized, says Dr. Greenfield. They should be proud to tell their family and friends that they are working in an OTP, with patients on MAT. “As long as working in an OTP setting doesn’t seem desirable, this is a problem,” she says. “How do we elevate the cachet of working in an OTP and having staff feel proud of the work we do?”

Challenges for SOTAs

In some states, SOTAs themselves have challenges promoting MAT with their own governors and legislature.

“SOTAs are doing everything they can to advocate within their own states,” says Dr. Greenfield. The problem is that despite the scientific literature, methadone isn’t well understood—the fact that it prevents relapse. “Why can’t this rest with the clinicians and physicians?” she asks. Unfortunately, there are places where the legislature and state administrations oppose methadone and OTPs. This hasn’t been a problem in New York. “But the SOTAs and the SSAs in many states have a huge undertaking and a huge task in trying to advocate for methadone.”

One argument that might help sway some MAT opponents is cost-effectiveness. Mr. Harwood notes that the literature documents the cost-effectiveness of methadone and OTPs. “This is something that advocates need to keep in mind,” he says. “It’s not just that MAT is effective. It’s a win-win for society and communities to provide MAT, especially for opioid addiction.”

For the consensus statement, go to http://nasadad.org/wp-content/uploads/2013/01/13-January-15-NASADAD-Statement-on-MAT.pdf

Seeking and Getting Substance Abuse Treatment: Barriers Women Face

BarrierOur first article in this series, “Becoming Addicted: It’s Different—and Riskier—for Women,” delved into the vulnerabilities that challenge women who have an opioid use disorder (OUD).

Now we examine the potentially daunting barriers women face in seeking and getting substance abuse treatment. Some barriers are largely internal, based on the woman’s attitudes; others are generated by society; still others exist within treatment programs.

As noted in the first article, few women misuse a single substance, so many studies we cite yield data for substance use disorders (SUDs) rather than for OUDs alone.

Finding Treatment

Barriers to treatment confront women from the outset, and it’s no surprise that most women with an SUD are never treated for it. Compared to men with OUDs, women are likely to be at a socioeconomic and educational disadvantage, to be underemployed or unemployed, and to have primary child-care responsibilities. Their OUD comes on more quickly, and they progress more rapidly to serious consequences. Yet women tend to see their substance abuse as stress-related, a temporary crutch that will go away without treatment.

Women are less likely than men to know how and where to get treatment. Typically they refer themselves, sometimes prompted by family or friends, or are referred by the criminal justice system or social service agencies. Men usually are referred by employers, doctors, or the legal system—sources generally considered more knowledgeable about treatment options.

Women may consider private residential clinics too time-consuming, expensive, and tightly regulated to be an option. Television and print media lead many to think that treatment means substance withdrawal, and that methadone is a drug to avoid (see Hearing Bad Things About Methadone Treatment? Thank “Dr. Drew”—Summer 2012 issue).  So it’s no surprise that women account for less than half of treatment admissions for opioid abuse.

Internal (Patient-Related) Barriers

According to Susan M. Gordon, PhD, in addition to misperceptions about programs, internal barriers include low motivation for treatment, denial of problems, psychological problems, internalization of negative social attitudes toward women with SUDs, self-definition, and independent attitudes about help-seeking and self-reliance. Dr. Gordon is director of research at the Caron Foundation Treatment Center in Wernersville, Pennsylvania.

In particular, depression and anxiety may lead women to delay or do without treatment. Studies suggest that high levels of estrogen can enhance the stress response in subcortical regions of the brain, contributing to the higher prevalence of depression and anxiety in women.

Many women with an SUD have a history of sexual, emotional, or physical abuse, as well as suicidal thoughts and attempts. Post-traumatic stress disorder is common, resulting from trauma or abuse. If a woman with an SUD has a history of emotional, physical, or sexual abuse perpetrated by men—and most do—the very idea of a treatment environment that includes men can be distressing.

Women are more likely than their male counterparts to have a drug-using partner supporting her drug use. These women generally receive little encouragement to enter treatment, and may instead encounter resistance.

Health professionals are less likely to identify substance abuse in women than in men; often they refer women to mental health care providers instead of treatment programs. Women themselves are partly responsible; they often choose psychological or psychiatric help rather than substance abuse treatment. Shame and guilt, or lack of awareness of the significance or severity of their addiction, may keep them from sharing their substance history with the mental health provider. So their true problem may go undiagnosed, and they lose the opportunity for treatment for their SUD.

Social Barriers

Society stigmatizes women who abuse substances—especially women who have children or are pregnant. Communities and families often fail to provide the support women need, including child care and encouragement to enter treatment.

“Once a woman has developed an addiction, she deviates more from the female norm, compared with a man with an addiction,” according to Drs. Dorte Hecksher and Morten Hesse, writing in Women’s Issues. She’s viewed by some—and often by the woman herself—as a “fallen woman.” She worries about the disapproval of friends, family, co-workers, and employers, if she enters substance abuse treatment, especially if she is pregnant, or a mother. Her concerns about providing child care and the possibility of losing custody are a heavy burden.

Treatment Program Barriers

Denial. “Breaking the denial is a necessary first step to assisting substance-dependent women to get into treatment,” according to Ozietta D. Taylor, PhD, MEd, LCPC, assistant professor at Coppin State University, Baltimore, Maryland. The Taylor reference below discusses ways of using methods of intervention to help get a woman into treatment.

Socioeconomic barriers. Substance-abusing women are less likely than men to have insurance or full-time jobs, and public funding often means a long wait. Getting to a program is another issue; many don’t have a car or driver’s license, or even money for public transportation.

Therapies and relationships. Men tend to enter treatment with an aggrandized sense of self, according to addictions and trauma expert Claudia Black, PhD, while women are more likely to have a diminished view of themselves, because of their primary role as caregiver. Dr. Black is a senior fellow at The Meadows, a trauma and addiction treatment facility in Wickenburg, Arizona.

Women entering treatment have different needs than men. According to Mary Jeanne Kreek, MD, of The Rockefeller University, “a strong positive correlation exists between troubled relationships, family violence, sexual abuse and poor self-esteem as integral factors in substance abuse among women.” These factors don’t apply to men, and lack of gender-specific services in treatment programs is a definite barrier for women.

Women with SUDs benefit most from supportive therapies and a relationship of mutual respect, empathy, and compassion, according to TIP 51, but “the type of confrontation used in traditional programs tends to be ineffective for women, unless a trusting, therapeutic relationship has been developed.”

The Meadows in Arizona uses a multidisciplinary approach “to address women who present with more complex trauma and addiction issues, and more dual diagnoses,” according to Nancy Bailey, PhD, clinical director, who has commented that many programs still focus on one primary issue.

Overcoming Barriers

Programs can do little to overcome barriers generated by the patient and by society, but the opportunities are many once women reach treatment. TIP 51 and the Taylor reference below offer many excellent suggestions.

In particular, women need substance abuse treatment that is multimodal and addresses social services such as vocational rehabilitation.  Comprehensive services can mean the difference between treatment failure and success.

Factors encouraging treatment retention include supportive therapy, a collaborative therapeutic alliance, and onsite child care and children’s services. For women who have lost child custody, comprehensive services can be a powerful motivational tool to stay in therapy. Pregnant women especially need comprehensive services. It’s estimated that as few as four percent of women are pregnant when entering treatment, and the services they sorely need are difficult to come by.

Successful treatment often means walking a fine line. Some women believe they are expected to maintain relationships, even abusive ones, and dependency or economic factors may motivate them to do so. If a woman’s drug use has involved a relationship with a spouse or significant other, OUD treatment may threaten that relationship—and the woman’s physical well-being.

Caregivers need to keep this in mind, and avoid focusing on maintaining relationships while excluding women’s other important needs. Dr. Black has stressed the importance of a woman’s building support and relationships with female peers. The insight of other women in treatment can help her work through a troublesome relationship, and, if necessary, break it off.

According to Dr. Gordon of the Caron Foundation, programs that increase the chances women will complete treatment comprise mixed-gender programs, services for women, and integrated treatment for co-occurring psychological and physical conditions.

Dr. Gordon believes that “internal and social barriers present more daunting obstacles” than treatment program barriers, and she calls for a change in public attitudes, “if women are to reduce their own feelings of shame and sense of denial.”

She maintains that these are not impossible goals. “Public education campaigns have eliminated the stigma from cancer, and have increased dramatically the numbers of people who are screened, diagnosed and successfully treated for this disease. We can achieve the same results for addiction in women.”

*     *     *

Sources

Back SE, Payne RL, Wahlquist MS, et al. Comparative profiles of men and women with opioid dependence: Results from a national multisite effectiveness trial. Am J Drug Alcohol Abuse. 2011;37(5):313-323. doi: 10.3109/00952990.2011.596982.

Center for Substance Abuse Treatment. Substance Abuse Treatment: Addressing the Specific Needs of Women. Treatment Improvement Protocol (TIP) Series 51. HHS Publication No. (SMA) 09-4426. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2009. http://kap.samhsa.gov/products/manuals/tips/pdf/TIP51.pdf

Goldstein JM, Jerram M, Abbs B, Whitfield-Gabrieli S, Makris N. Sex differences in stress response circuitry activation dependent on female hormonal cycle. J Neurosci. 2010;30(2)431-438.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827936/

Gordon SM. Barriers to treatment for women. Counselor. 2007; 8(3):22-29.

Hecksher D, Hesse M. Women and substance use disorders. Women’s Issues. 2009;7(1):50-62. doi: 10.4103/0973-1229.42585. PMID:21836779.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151455/

Jamison RN, Butler SF, Budman SH, Edwards RR, Wasan AD. Gender differences in risk factors for aberrant prescription opioid use. J Pain. 2010;11(4):312-320. doi:10.1016/j.pain.2009.07.016.

Kreek MJ, Borg L, Ducat E, Ray B. Pharmacotherapy in the treatment of addiction: Methadone. J Addict Dis. 2010;29(2):200-216. doi:10.1080/10550881003684798. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885886/

National Abandoned Infants Assistance Resource Center, UC Berkeley. Prenatal Substance Exposure. Fact Sheet. http://aia.berkeley.edu/media/pdf/AIAFactSheet_PrenatalSubExposure_2012.pdf

Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2000-2010. National Admissions to Substance Abuse Treatment Services. DASIS Series S-61, HHS Publication No. (SMA) 12-4701. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2012. http://www.samhsa.gov/data/2k12/TEDS2010N/TEDS2010NWeb.pdf

Blog – News Outlets Behaving Badly: Appalling Article by Bloomberg

“I don’t know if any of my readers caught that awful article on bloomberg.com, criticizing methadone clinics and their patients. I’m not going to post a link to it because it doesn’t deserve a link. But I did write to the editor, the writer of the story, and a comment to their post:

I read this disjointed and error-ridden article with sadness. I wish you could spend a day with me, talking to the patients I treat with methadone for their opioid addiction. You’d hear how, for many patients, methadone has been a life-saver. Most of my patients are ordinary people who became addicted before they knew what was happening. A very small number are criminals, and those few get media attention, propagating the myth that all methadone patients are irresponsible criminals. This just isn’t true. My patients are housewives, blue collar workers, secretaries, and schoolteachers. Anyone can become addicted.”

The blog can be accessed at: http://janaburson.wordpress.com/2013/02/09/news-outlets-behaving-badly-appalling-article-by-bloomberg/

Source: Janaburson’s Blog – February 9, 2013

Addiction Expert: Treatment Providers Can Perpetuate Media Stereotypes of Patients

“Stereotypes about addiction, perpetuated by the media, can be unintentionally reinforced by addiction professionals, according to a New York addiction expert.

“When you go to a diabetes clinic, you don’t expect your doctor to have diabetes. But many people treating those who are addicted have themselves been treated for addiction, and tend to use the same lingo as their patients to make them feel more comfortable,” Dr. Edwin A. Salsitz, MD, Medical Director, Office-Based Opioid Therapy at Beth Israel Medical Center, said at a recent meeting, “Solutions to the Addiction Crisis.” “They use terms like ‘dirty’ or ‘clean’ to refer to a urine drug test, instead of the more medical ‘positive’ or ‘negative.’ Using slang in addiction medicine can be confusing and demeaning, and reinforce the stigma attached to addiction.”

http://www.drugfree.org/join-together/addiction/addiction-expert-treatment-providers-can-perpetuate-media-stereotypes-of-patients

Source: JoinTogether.org – February 5, 2013

Blog: The Deadly Stigma of Addiction – Is it Possible to Separate the Disease of Addiction from the Stigma? Here Are Eight Life-changing Reasons We Should Try

The American Society of Addiction Medicine characterizes addiction as a “primary, chronic disease of brain reward, motivation, memory and related circuitry.” The National Institute on Drug Abuse defines addiction as a ‘chronic, relapsing brain disease” that changes the structure and functionality of the brain. So why do so many people still think of addiction as a moral failing? Why do they still refer to victims of substance misuse disorders as meth freaks, alcoholics, junkies, crack heads and garden-variety drunks?

The answer is simple as it is depressing: because that’s the way it’s always been.

http://www.thefix.com/content/professional-voices-addiction-stigma-lethal70023

Source: TheFix.com - December 5, 2012

Hearing Bad Things about Methadone Treatment? Thank “Dr. Drew”

Why is it that most opioid-dependent patients aren’t enrolled in medication-assisted treatment (MAT), despite its proven effectiveness?

One reason is the link between so-called reality television and negative perceptions about methadone and buprenorphine. That’s the thinking of the authors of “Messages About Methadone and Buprenorphine in Reality Television: A Content Analysis of Celebrity Rehab with Dr. Drew.” Published online in Substance Use & Misuse, January 8, 2012, the article analyzes all episodes in the first four seasons of Celebrity Rehab with Dr. Drew.

First aired in January 2008, the show features Dr. Drew’s interactions with celebrities being treated at the Pasadena Recovery Center, a residential facility in California. One wonders what motivates patients to go “on camera”—such as the woman who allowed her withdrawal convulsions to be shown to hundreds of thousands of viewers.

Linking reality TV and attitudes toward MAT seems logical. TV exposes us to nuances—tone of voice, facial expression. When a fatherly “Dr. Drew” softly confides, “methadone just takes your soul away. It’s no way to live,” people listen intently, and many take it to heart.

Study Design

Researchers analyzed the quantity and slant of the show’s messages about treating opioid dependence with methadone and buprenorphine. They watched all 39 episodes of the first four seasons of Celebrity Rehab with Dr. Drew, and coded the data using scientifically accepted methods.

Results

Of the 33 patients portrayed, 13—about 40 percent—were using or had used opioids. Of these, 4—about 30 percent—used methadone or buprenorphine.

The two main messages: methadone and buprenorphine are primarily drugs of abuse, and are not acceptable treatment options.

References to Methadone and Buprenorphine

 
Methadone
Buprenorphine
Times referred to
20
8
As a drug of abuse
17 (85)*
7 (87.5)
Rejected as a treatment option
13 (15)
1
Endorsed as treatment option for opioid dependence
0
0
*times (%)
   

 
Mentions of methadone and buprenorphine in Dr. Drew’s show “highlighted harmful effects and focused on how and why patients should stop using them,” the authors found.

For example, Dr. Drew advised a patient trying to cope with opioid withdrawal symptoms that methadone can create another addiction. Thus he “reaffirmed a negative perception that has been cited as a reason for forgoing enrollment in medication-assisted treatment,” the authors noted. Dr. Drew also said some patients develop severe methadone withdrawal that “leads to medical and psychiatric complications that require hospitalizations.”

Authors’ Comments

The authors found that Celebrity Rehab with Dr. Drew reinforces negative stereotypes, presents misinformation, may perpetuate existing stigma toward addiction and its treatment, and undercuts support for its expansion.

Roose R, Fuentes L, Cheema M. Messages about methadone and buprenorphine in reality television: A content analysis of celebrity rehab with Dr. Drew [published online ahead of print, 2012]. Substance Use & Misuse. doi: 10.3109/10826084.2012.680172.

http://www.vh1.com/search/?q=dr+drew

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AT Forum Opinion: What’s Behind Dr. Drew’s Attitude

What’s behind Dr. Drew’s attitude? Surfing the Web and watching him in action provides clues. The folksy “Dr. Drew” (“Dr. Drew Pinsky”) is at times a showman, at times a controlling father-figure, and at times seemingly a friend—but always an authority who is not to be questioned.

Dr. Drew is fully credentialed: board-certified by the American Board of Internal Medicine and American Board of Addiction Medicine, licensed private practitioner, assistant clinical professor of psychiatry at the University of Southern California.

In his 2009 book, The Mirror Effect, Dr. Drew admits that he has some traits of a “closet narcissist,” having scored a 16 on the Narcissistic Personality Inventory. He has been a TV series actor. Has starred on several reality shows, including Sex . . . With Mom and Dad. The New York Times has described Dr. Drew’s combined career in medicine and mass media as requiring him to navigate “a precarious balance of professionalism and salaciousness.” In a 2009 interview, the Times questioned Dr. Drew about his practice of paying addicts to attend rehab—asking if luring cast members with promises of money and exposure didn’t cast doubt on their commitment to sobriety. “My whole thing is bait and switch,” Dr. Drew explained. “Whatever motivates them to come in, that’s fine. Then we can get them involved with the process.”

But where are the data for his methods? Dr. Drew doesn’t cite any studies in the huge body of evidence matching patients with treatment. Nor does he mention the ASAM criteria, which list methadone and buprenorphine as treatments of choice for opioid addiction.

There’s a big difference between obtaining exposure and publicity, and providing treatment for substance use disorders. We shouldn’t confuse them, as Dr. Drew does—buying exposure in the guise of treatment.

If there’s a place for the methods and opinions of the Dr. Drews of this world, it’s not in the realm of evidence-based addiction medicine.

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