Drugs and alcohol in the NY Times

The NY Times had a couple of pieces on alcohol and drug problems this week.

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First, an audio story about a Maine doctor operating a MOUD clinic in a county jail.

Her commitment and advocacy are admirable.

There are a couple of striking things to the story.

First, she makes a case for the long-acting version of buprenorphine (Sublocade). This is interesting because, anecdotally, I’ve noted a fairly cool reaction to Sublocade.

• She notes that Sublocade patients were nearly 3 times more likely to continue treatment after release from jail;
• she also noted advantages related to side effects and the absence of diversion; and
• the steady release prevents fluctuations in drug levels and is reassuring.

The second striking thing was the absence of any reference to counseling, mutual aid, or any intervention other than the Sublocade. (There may be more to the program, but nothing is reported in the piece.)

What does this say about the media’s understanding of addiction, treatment, and recovery? Particularly with an incarcerated treatment population where we can reasonably expect higher problem complexity and possibly higher severity and chronicity.

The notion that a monthly appointment for a Sublocade injection is an effective “program” or model, is troubling. An important element of a program? Sure. In and of itself, an effective program for complicated, severe, and/or chronic cases? No.

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Second, a story on the “soberish lifestyle,” which refers to drinking less or drinking more mindfully.

What I found striking about this is that there’s nothing new about these consumption patterns. They’ve historically been called moderation or normal (as opposed to problem) drinking.

What does it say when we come up with this kind of label for moderate or “normal” drinking?

• Does this reflect increases in excessive drinking? (Specifically among women. All of the subjects of the article were women.)
• Is it an example of social entrepreneurship and public health messaging to promote healthier drinking patterns?
• Is it an example of social media influencer culture and lifestyle entrepreneurship?
• Is it part of a cultural trend wherein people self-diagnose disorders or identify with traits associated with disorders? *

One more thing that’s worth noting, nothing here is contrary to AA:*

Moderate drinkers have little trouble in giving up liquor entirely if they have good reason for it. They can take it or leave it alone.

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If anyone who is showing inability to control his drinking can do the right- about-face and drink like a gentleman, our hats are off to him. Heaven knows, we have tried hard enough and long enough to drink like other people!

Source: Alcoholics Anonymous: The story of how many thousands of men and women have recovered from alcoholism

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* late additions to the original post