The drug crisis in America is a wildfire raging out of control. Over 23 million Americans (aged 12 and over) are addicted to alcohol and other drugs according to the National Council on Alcoholism and Drug Dependency. More people are dying of drug overdoses than from any non-natural cause including guns, suicide and car accidents. And according to SAMHSA (the Substance Abuse and Mental Health Services Administration) under 11% of addicts received care for their addiction at a treatment facility in 2012.
Politicians, pharmaceutical companies, drug cartels and physicians are variously being held responsible for the rising rate of addiction and overdoses. But while the blame game continues, the problem is worsening. 63 600 people died of a drug overdose in 2016, 65% of which were OxyContin, heroin and other opioid overdoses. Additionally, almost three times that number died of causes related to the most commonly abused and widespread drug: alcohol. Statistics for 2018 are predicted to be higher as very little progress has been made in the struggle to reverse this escalating crisis. There is no question that people with drug addictions are in need of support, but why aren’t more people seeking treatment?
If politicians aren’t successful in their attempts to address the crisis, can we rely on the addiction treatment system? The answer, it seems, is no. Certainly, the statistics for traditional interventions are not encouraging.
Only 11% of addiction sufferers are receiving help at a drug rehab center for their addiction, And the majority of those entering a drug rehab centers (and specialist alcohol rehab centers) are confronted with archaic care. For the past 40 years, the addiction treatment industry has been based on the 12 Steps of Alcoholics Anonymous, a simple a self help system developed by and for over 80 years ago when neuroscience was just being established.
Many programs routinely reject science choosing to embrace a one-size-fits-all approach to treatment that has no scientific backing. The range of so-called treatments is staggering; from passing talking sticks to batting horses with Nerf noodles. Some programs focus on ‘confrontation therapy’ which includes forced participation in the 12 Step program (the foundation of almost every program). And while support groups are helpful to some, if made compulsory, they can alienate a large portion of addicts. Lance Dodes, the Director of the Alcoholism Treatment Unit at Harvard’s McLean Hospital, notes that the majority of treatment plans in the US are based on the 12 step program and the stats for AA aren’t encouraging. These programs only work for around 5 – 10% of participants, meaning that over 90% of addicts are likely to relapse after leaving a rehab center. Also, patients that exhibit symptoms of their disease such as relapsing or breaking the rules are routinely prohibited from re-entering the program which greatly reduces the chance of a person overcoming their addiction.
Finally, most patients that are admitted to a treatment program are not assessed for co-occurring psychiatric disorders; this is despite the facts that and a psychiatric disorder almost always accompanies life-threatening drug use. If the disorder is not addressed the chances of relapse increase dramatically.e-threatening drug use. If both illnesses aren’t addressed, relapse is likely.
The length of the treatment program is arbitrary, often decided by what the patient can afford. My facilities offer a 3 or 5-day detox which cannot be considered as effective treatment. Most residential programs are 28 days, but research suggests that a month is not enough in most cases to treat the disease. While some treatment residents do manage to stay sober for the month, they often go on to relapse soon after discharge and there is often very little in the form of formal aftercare once the patient has been discharged from a treatment center.
There is no easy cure, but there are interventions that have been scientifically proven to help addicts including the use of Cognitive-Behavior Therapy, Motivational Interviewing and the prescription of addiction medications. Through the application of a more rounded approach that These are statistically more likely than the traditional treatment programs to help addicts recover and stay clean.
Cognitive-behavioral therapy is a form of psychotherapy treating problems such as addition by modifying unhelpful emotions, behaviors and thoughts. It is solution-focused encouraging patients to confront distorted perceptions allowing them to change destructive behavioral patterns.
Motivational interviewing is a method of counseling that helps to target and resolve a person’s insecurities and negative feelings allowing them to find the internal motivation that they need to change their behavior. It’s practical and generally short-term in nature and takes into account how difficult it can be to make changes in one’s life.
A study conducted in 2015 found that patients with an opioid dependency receiving only psychological support were twice as likely to suffer a fatal overdose as those being treated with opioid replacement medications. In contrast to this, there are many studies that support the improved outcomes for opiate addicts who included medication in their recovery protocol. This includes a report by the WHO which showed that when Spain relaxed it’s law governing medical assisted intervention for opiate addiction rather than relying on traditional abstinence programs, there was a significant reduction in the rate of deaths due to overdosing (as well as fewer incidences of HIV). But in the US of 75% of opiate addicts are treated without the use of medication. Yet SAMHSA has found that three-quarters of all opioid-dependent patients in the U.S. are still treated without the use of medication.
Primary care doctors’ offices, health clinics and health clinics are how most people enter the medical care system. Currently, doctors in these environments have little to no training on addiction (66% of US medical schools require an hour or less of addiction treatment training).
Doctors need to be equipped to recognize addictions and treat them immediately. Practical programs such as SBIRT (Screening, Brief Intervention and Referral to Treatment) should be made standard practice as they can easily to implemented in a general healthcare setting. The program includes 3 counseling sessions and has proven effective for many people as an early intervention.
Doctors should also be certified to prescribe buprenorphine (a medication that decreases craving and prevents opioid overdoses). Current limitations on the number of patients that can be offered opioid addiction treatment by doctors should be removed.
Patients requiring higher care must be referred to addiction specialists such as psychiatrists and psychologists who have been trained to diagnose and treat individuals with a substance abuse disorder.
ASAM guidelines offer patient placement criteria for determining whether a patient should be treated by a doctor, intensive-outpatient or in a residential drug or alcohol rehab center setting. The length of treatment needs to be decided based on necessity, not whether the patient can afford it and addiction medications need to be included in opioid addiction treatment.
Programs should address the fact that patients with drug addictions often have an interrelated psychiatric illness and should undergo clinical evaluation. Additionally, all treatments need to be followed up by aftercare by an addiction psychiatrist, psychologist or physician.
Society has been quick to blame politicians, drug dealers, and pharmaceutical companies for the drug overdose crisis. And they may well be correct. But millions of addicted Americans need help right now. It’s clear that the number of people entering drug rehab centers needs to increase dramatically and that the programs offered by those centers needs to adopt wide-ranging reforms, implementing modern evidence-based intervention. The most pressing concerns are the education and equipping of primary-care doctors who are the first step in the care of people with addictions.
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