One of my most memorable patients was a middle-aged man named Mike who came to treatment for his third drinking and driving offense. At the time, I was a young intern just learning how to connect with patients. He sat down in my office and before I could even begin my customary introduction to the clinic, he proceeded to tell me that I could not possibly have anything to offer him.
Mike’s story
During the last decade his wealthy parents had invested over $150,000 in the nations most prestigious alcohol treatment programs, and none of them had helped him. “Nothing against you,” he said dismissively, “but you’re an intern. Just tell me what I need to do to get out of here.”
I may have been an intern, but I was already deeply engrossed in understanding how science and research could inform my clinical work. My internship took place at a community-based treatment program which was part of a large university teaching hospital. On days where my patient load was light, I headed for the library and read the latest addiction journals.
The year was 1997 and my curiosity led me to a fascinating medication called Naltrexone that had been used for a number of years to treat opiate addiction, but was now approved for the treatment of alcohol dependence. The only other drug available at the time was Antabuse (disulfiram) that caused sickness when alcohol was ingested. Most of the studies I read about naltrexone suggested that when combined with psychosocial therapies, outcomes were significantly improved.
What the treatment program(s) missed
As Mike sat there in front of me, half expecting that his deep reservoir of treatment experience would get him off the hook.
The Intern:
I said flatly, “How did Naltrexone work for you?” At first he looked at me quizzically, but then quickly became more serious and said,
Mike:
“Oh yea, that stuff…I tried it but was still able to drink on it.”
The Intern:
Calmly I replied, “I think you mean Antabuse. No, I am talking about Naltrexone, the medication approved by the FDA a few years ago to treat alcoholism”. Now he really looked confused.
Mike:
“You’re shitting me aren’t you? If there was a new drug that would help me stop drinking don’t you think I would have heard about?” He said with frustration.
I too was actually amazed that despite all the treatment episodes this guy had been through, and the fact that he had done time at some of the best in the country, that he would have heard about naltrexone. But he hadn’t.
I went to my file cabinet and began pulling out journal articles to make my case. By the end of the session we had arranged an appointment for him to see our psychiatrist for a trial of naltrexone, and I was no longer just an intern in his eyes.
Use of addiction medications
I would like to say that more than ten years later things have dramatically changed and addiction medications are well known and used appropriately in treatment programs across the country. But sadly, many who struggle with addiction still have no clue that a handful of powerful medicines have been approved by the FDA.
My doctoral dissertation explored this topic in some detail, but if you want to skip to the chase I have also extracted the section that provides an overview of these medications.
Although I strongly believe those who struggle with addiction should be made aware of addiction medications and decide for themselves whether to try them, let me be crystal clear:
No medication will solve the problem of addiction
As I have discussed in other blog posts, addiction ultimately is about relationships. Medications can help manage cravings and decrease relapse so that therapy can more successfully focus on the developmental catch-up work necessary for long-term success.
Your post really encouraged me! I’m a CADCI and was totally unaware of this medication! I’m going to start researching some of this information. :)
Excellent! These medications can really be helpful for folks who continue to struggle despite multiple treatment attempts.
What a powerful blog entry. I just read about 10 of your entries and they all are very insightful and intriguing . I just wanted to post a comment about this entry. All that extra hard work reading in the library paid off in this situation and I can guarantee that wasn’t the first time that happened either. As you mentioned in the last few sentences, the drug itself is not enough to “defeat” addiction. It takes those important relationships and therapy to maintain the behavior and ultimately terminate it forever. I have enjoyed reading your blog.
Adam, thanks for the nice feedback. I find it a bit discouraging that so much of the recent brain research is aimed primarily at medication development. Even if we want to push addiction as a brain disease, it’s important that we not lose sight of the important of human interaction.
J
I was surprised to hear in this CNN clip that only 1/10 addictions patients hear about medication! It makes me wonder how much higher rates of recovery would be if every patient that is treated for addictions had the information and resources to use addiction medication. I think success rates for recovery would be significantly higher.
On the other hand, a concern I have is that the more our society used medication to treat addiction, the more we must be aware that this is not a viable replacement for individual therapy. Just because agencies may administer affective drugs, doesn’t mean they should provide any less therapy to these patients. It seems like this could be a potential problem in the next few decades as people continue to replace human beings with objects, which often include drugs. There is less face to face interaction among individuals and communities, and more interactions with inanimate objects in our current technological revolution. These objects can include prescription drugs. Essentially, one could argue that we are just helping addicts replace objects with other “safer” objects.
Gosh this is such a hard one. I am struggling with it in my personal life. I have been clean and sober for many years. I have friend, who I have been helping or trying to help get clean after many years of being in her addiction. She is insistant in doing it with methodone. I have really had a hard time with this. I got clean by doing 12 step meetings. I went to 3, 4 or 5 somedays. I stayed in treatment and even though I was very sick the first years I was clean. I did use antidepressants. Sometimes it felt as if I was taking a handfull of pills each day and night–this was something I struggled with back then.
I am usually very patient and loving toward people as work with my clients. I cannot find the same patience or love and tolerance when trying to work with or for my friend. I get surley and down right mean at times. I believe fully that whatever works for someone is what they should. If they are able to find sucess, as the fellow in the CNN video. I know that I believe that is really what is important. Whatever works that is all that matters. Harm reduction is a viable outcome. It is a sucess. Drug and Alcohol Addictions is devastating. Any success is monumental. I know this to be true on some many rational levels.
Why then; when it is about someone I personally care about I end up acting like such as ass?
I agree completely with the last paragraph. Medication can help with ones addiction, but rarely will it help them quit. Having someone by your side and supporting you through the quitting process is a lot more helpful. However, to get out of an addiction, you have to find a healthier addiction. Whether it’s love, the gym, or staying active.
In Mike’s case, he came into each new rehab center with the mindset of just going to go. Due to this mindset, he’s setting himself up for failure. Also, he could of been going to the wrong doctors. The ones who lose confidence in helping him after seeing the mindset that he has, and knowing how many different rehab centers he’s been to.
I believe that the notion that “No medication will solve the problem of addiction” is a lacking concept regarding mental health treatment in general. In the United States, an excessive number of people are medicated for mental health disorders, in particular, depression and anxiety. This definitely contributes to the societal difficulty with drug use and abuse, considering many of the abuses are of prescription medication. Similar to the experience of patients hoping that a medication can “cure” their addiction, we see that chemical fixes are utilized as a crutch to avoid problems or attempt an easy, thus non-comprehensive, fix. While these medications can be extremely helpful for some people, and can be used very effectively to work through problems, the reliance on these medications creates an expectation that they are the fix – rather than addressing the root causes, such as relationship deficiencies. I appreciate your comprehensive approach and acknowledgment of the benefits of medication as well as the drawbacks.
thanks for you comment, I agree
J