Medical Model of Substance Abuse Treatment?

The reason for this article is to stimulate thought about where a pure medical model of substance abuse treatment seems to be taking us.  The medical model of substance abuse treatment has arrived. It has probably not even scratched the surface of where it is heading. Neither First Step, nor the writer or this article, are against the medical model being included in substance abuse treatment, along with good therapy and peer support in some cases.  Much research and attention are given to the “medical model” of substance abuse treatment.  Much more research must be, and is being, done.

Research has been conducted in attempts to prove that the right medication will cause a person to become abstinent indefinitely, maybe a lifetime.  When the patient is off the substances there is medication to get them through withdrawal.  There is another medication to assist in preventing cravings and desires to use. There is another medication that will lessen or neutralize the effect of using – so there is no high. Medication like methadone actually replaces the previously used substance, but it does give a high and is more difficult to detox from than heroin.  In sufficient doses, people become dependent on medications like methadone.  More medication is necessary if someone’s moods swing from down to elevated from time to time.  Mood stabilizers are prescribed to combat mood changes. And, of course, a sleep disorder arrives; medication for sleep.

Once all this is in place, there is medication if patients become depressed, and more medication if there is anxiety along with the depression. Once the patient has used a few medications mentioned above for a while, tolerance becomes problematic. The medication then has to be adjusted, increased, replaced or other medications added.  The need to adjust or change medication will usually be required as long as the patient is on the medication.  New medications are being developed almost daily so there will be a never ending supply of new medications to try. It is almost like an addiction nirvana. There is a pill/are pills/will be pills that will make me feel okay being me.

Practically every person with a long history of significant substance use goes through distressing mood fluctuations. They are a natural part of PAWS – Post Acute Withdrawal Syndrome.  PAWS occurs in a few weeks to few months after the last use. It is different for most every person. After the initial withdrawal from the substances used has passed, many patients feel good, focused and know that sobriety is the right thing. Then suddenly, they will feel depressed, almost despondent – life has nothing to offer. This normal experience can sometimes recur and fluctuate over a few months or more. It is a difficult time, not to be minimized, but to be seen for what it is, often it is PAWS.

Grieving the loss of a previously enjoyed lifestyle and identity  is common. Until this period is past, medication is sometimes appropriate.  The questions become: When is a psychotropic medication appropriate? For how long is it appropriate? Forever? How frequently will they need to be adjusted? How many will be added over the years? What are the side effects of these psychotropic medications? How much is known about long-term effects of combinations of these brain altering psychotropic medications? Practically every person who is/was truly dependent on substance use will go through emotional, mental and physical changes upon achieving abstinence.  Many emotional changes are experienced as extremely difficult.  How do we reduce the emotional challenges of difficulties patients experience? What happens with those who choose to take the medication and never experience the emotional changes & personal growth, of early recovery?

There is a theory among many mental health and substance abuse trained professionals that an addict stops maturing emotionally once the substance use begins. There are those, too, who believe when a trauma affects a person, they, too, could have developed dysfunctional coping mechanisms at a young age.  How does medication treat this?  Will a person whose emotions are controlled by medication achieve the expected emotional maturity of adulthood? So many questions!

–   Will medication replace the personal and emotional growth that people in treatment and recovery programs typically achieve?

–   Will medication teach people the social skills many want, or need, to improve on or will it just numb out the desire to learn the skills?

–   Will medication heal the brain circuitry like recreation, laughter, fellowship, good therapy, a solid recovery program?

–   Will medication help the patient become mindful of himself/herself and others?  Will medication facilitate or prevent spiritual growth?

–   Will medication heal the effects of trauma that often precedes addiction? Or will it just numb it out temporarily?

–   What happens when the medication is no longer working?

–   Does it matter whether or not an addict has an emotional and personal healing if prescribed medication makes them feel okay [not to be healed]?

–   What is the quality of life for patients who take daily psychotropic medications for many years?

These questions, and many more, are frequently asked.  We know many people can “tough it out” without medication, with a lot of support, determination and a good recovery plan. Is this desirable?  We also know many people need medication assistance; that is not the question posed here. The question is this: is it a good idea to treat everyone, or anyone, with a lifetime of various, potentially dangerous, medications and no therapy? Or is it better to eventually position the patient to need neither treatment nor medication.  The person desiring to recover with no medication will be more likely to take necessary medication only as is absolutely necessary, and grow towards complete self sufficiency.

Initially, and for the short term, addiction medication is possibly cheaper (several hundred dollars a month) than substance abuse treatment. Taking medication is certainly a whole lot easier, than the rigors of working a thorough substance abuse intensive out patient (IOP) treatment program.  But what is it worth more long term?  What is the best service we can provide for the people we serve?  It is our goal to provide the optimal opportunity for patients to never need psychotropic medication or substance abuse treatment again. How do we demonstrate the lifelong value of a solid treatment and recovery program compared to relief from medication?

“I came to First Step at the suggestion of the Resident Doctor at Holly Hill.  I knew nothing of the program and expected it to be another religion based 12 step program.  In short, I needed help but I was cynical about this place.  My biggest goal at the time was to stack my resume with positive actions to address a legal situation, but it turned out to be a life-challenging experience in far more ways than I imagined.  I’ve discovered triggers, learned coping skills, made lasting friendships and discovered that I’m not alone.  First Step has the single greatest impact in my recovery thus far and it’s pointed me in the right direction during a time when I didn’t know North from South.  Perhaps most importantly, I understand my disease now and have the tools and courage to take self-inventory.  Hold myself accountable and push forward with my recovery.” Anonymous

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