Addressing the Controversy: Including Medications in Substance Use Disorders Treatment

Posted on 09/06/16 04:46:pm

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By Michael M. Miller, MD, medical director of Herrington Recovery Center at Rogers Memorial Hospital–Oconomowoc

While methadone, naltrexone and other medications were approved decades ago to treat alcohol, opioid and tobacco use disorders in the United States, the controversy surrounding their inclusion in treatment plans unfortunately still remains.

Some clinicians believe medications are never appropriate and they simply substitute one addiction for another. Some grudgingly accept them as part of current approaches. Others view them as a major advance and new opportunity that wasn’t previously available to help individuals with substance use disorders. However, recent research and policies from professional and government organizations, such as the American Society of Addiction Medicine(link is external) (ASAM) and National Institute on Drug Abuse(link is external) (NIDA), explain the best patient results occur when integrating medications and psychosocial treatments(link is external). In short, these methods are better together and the mindset that one is the right method is not helpful.

As clinicians, our own biases should not deprive people of alternative treatment options. To address this issue, a committee of national experts through the American Medical Association(link is external) (AMA) developed performance measures for addiction treatment. (link is external)Those measures state that every patient with an opioid use disorder should be informed by their clinician that both counseling and medications are available treatment methods.

Currently in the United States, most residential facilities for substance use disorders treatment don’t allow medications and some feel very strongly about defending the 12-step recovery method. At Rogers’ residential Herrington Recovery Center, we incorporate the 12-step recovery method and encourage involvement in 12-step groups. But, we also offer other evidence-based therapeutic methods in combination with medication management because we believe addiction treatment should not be an either/or approach to care.

Supporting the patient

We clinicians realize that many people with a history of prescription drug abuse don’t trust themselves with medications because they’re afraid they’ll lose control. But with structure and support from a well-informed treatment team, patients will be able to develop the confidence they need. Talking out the situation with the patient is also helpful, because it decreases the chances that he or she will act on those thoughts.

So how can we, as clinicians, provide the support our patients need and develop a balanced method for prescribing opioids? The AMA suggests developing a clear understanding of:

· The various forms of patient pain

· Addiction and the range of substance use conditions

· Balanced prescribing practices

· Connections among drug availability, patient vulnerability and addiction

· Improved pharmacotherapy of pain and pharmacotherapy of addiction

Of course, no one treatment works for every patient and medications are absolutely not a universal solution. Doing the hard work of therapy in combination with medication is the best, scientifically proven approach.

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