In Bill Stauffer’s latest post, which he titled “The Real Gold Standard Addiction Treatment”, he stated,
Interventions that sustain limited gain over the short-term simply cannot be considered as gold standards. They should be summarily rejected until they demonstrate significant improvements in global health and functioning that are durable over time.
I’ll share two areas of my thinking in response to that post from Bill.
- The first area concerns the very nature or essence of addiction treatment itself.
- The second area concerns a proposal for change in research and clinical practice overall.
The nature or essence of addiction treatment
These thoughts are from a previous post I’ve shared here on Recovery Review.
Opioid maintenance therapy (OMT), also called medication-assisted treatment (MAT) or medications for opioid use disorder (MOUD), is known as a gold standard addiction treatment.
The model of care used for Public Safety-Sensitive professionals (such as pilots, those working in healthcare, etc.) is also known as a gold standard addiction treatment.
But what do those two gold standards really accomplish?
The “gold standard” method known as MOUD and the “gold standard” methods for those in public safety-sensitive roles focus on disease management, symptom suppression, and promote wellness-related improvements including personal goal attainment and recovery management. And both use multi-year models. Those methods are sound.
But both of those “gold standard” approaches permit and essentially overlook cigarette smoking.
By default, then, both of those gold-standard approaches permit and overlook dying later due to continuing one’s cigarette addiction while the person undergoes their addiction treatment.
If a person dies of emphysema from continuing to smoke cigarettes during and after their “addiction treatment” – did we really treat their addiction illness? Or did we merely address their disordered use of, for example, opioids or alcohol?
What does it even mean to claim to do addiction treatment for someone while they continue their active addiction illness the entire time they undergo their addiction treatment?
We could state we currently have no “gold standard” addiction treatment model. And we could work to improve both our standards and our methods.
Is an addiction treatment a gold standard addiction treatment if it treats one substance use disorder while ignoring or allowing another – during the treatment?
One may wonder who coined the term “gold standard.” And who decides what criteria must be met to claim it. And how such a claim is decided.
Proposal for change in clinical practice and research
These thoughts pertain to: 1) the development of a 5-year continuing care system, and 2) major changes in research, training and clinical service. And they can be found in the links below.
Envisioning Radical Change in Research, Clinical Training, and Service for Severe SUDs.
Suggested Reading
What should be the gold standard for addiction treatment: A little more. – Recovery Review
