I’ve previously expressed concern about the medicalization of addiction treatment as health care reform takes effect. Here’s an ASAM member’s complaint that addiction medicine physicians have not sufficiently medicalized their treatment services:
I also respect those individuals who have suffered from the disease of addiction and have found help with 12-Step based programs. I understand their desire to recommend the treatment that worked for them to others, but enough is enough. Peer support groups and the 12-Step philosophy are fine, but they are not medical treatments and they are not counseling.
If ASAM wants to move forward as a professional organization, and become the voice of real addiction treatment, we must move past this never-ending discussion about, and homage to, 12-Step programs. Evidence-based treatment is medically managed withdrawal (not “detox”), and, if available, medication-based stabilization for as long as necessary. This needs to be combined with appropriate, evidence-based psychosocial interventions such as cognitive-behavioral therapy and motivational enhancement techniques that can be brief, mostly carried out on an outpatient basis, and focused on relapse prevention.
Notice the exclusion of twelve step facilitation in the list of evidence-based practices. (In spite of the fact that it has been found to be just as effective as CBT and MET, and more effective than either with the heaviest drinkers.)