A bad idea that won’t go away

Time has an article lending credibility to the idea of treating stimulant addiction by placing addiction on a stimulant maintenance program. I’ve posted about this idea before.

What is there to say? Didn’t we give up on treating alcoholism with benzos a long time ago?

It’s argued that stimulant maintenance reduces drug use among participants and that abstinence-based programs only work for about a 1/3 of participants. This begs at least 2 questions:

  • How many of those patients get treatment of an adequate duration and intensity?
  • How many of the other 2/3 reduce their drug use? Is she using the same measuring stick for the two?

Ideas like this are rooted in despair, rather than hope. (see here, here, here) We get overwhelmed by the problem. (here) We’re too cheap to offer adequate help. (here) We don’t believe that these people can recover. We think they have no chance. We’re scared that they’ll hurt us and get us sick. (here)  So, we offer them these kinds of interventions. Often, these programs represented in the name of choice, (here) when, the addicts themselves, want better from us. (here, here) They actually want to get well, but often lose hope that it’s possible for them. The system starts patting them on the head an encouraging them to be more realistic. (here, here, here) What they need from professional helpers is for us to lend them our hope to cultivate some of their own. (here, here) They need a system that stops talking about if they recovery and starts talking about when they recover. (here)

The article acknowledges that recovery rates for stimulant addicts are the same as for other drugs. We know what works. Recovery rates are very high when we offer long term treatment with longer term monitoring and swift re-intervention in the event of relapse. Some people respond, “Well, that’s with addicted health professionals. It won’t work with other addicts.” How would we know? We don’t try it.

If we truly tried everything and nothing worked for a sizable group of addicts, I might feel differently. But context matters, and the current context is ugly. We’ve had an explosion in incarceration and, in a period of explosive growth in health care spending, private spending on treatment has dropped and overall spending has grown at a rate much lower than other health care spending.

It’s also worth noting that the writer is a frequent critic of treatment, AA, and the disease model. (I’m not suggesting that her criticism has no basis, but that she frequently paints with a broad brush and that there is a bias against specialty addiction treatment.)