An undiscussed problem in addiction treatment
There’s a problem with addiction treatment that no one’s talking about. It’s that we’re making it harder and harder for people to get off drugs.
Although recent studies show a decrease rate in overdose deaths, opioid addiction is at an all-time high. This isn’t a gauge of treatment effectiveness because not everyone who suffers from addiction receives treatment. The only way to measure the effectiveness of treatment is by comparing relapse and remission rates, and this would need to be done over an agreeable period. One would first decide what was considered “success” and whether this was measured by lifelong abstinence or another agreed-upon duration of time. This factor would dictate the necessary length of study to paint an accurate picture.
Several other factors make this a complex problem. There are multitudes of different forms of treatment available. Many of these are challenging to study, and outcome monitoring systems aren’t in place to accurately determine success. Anonymity is yet another barrier. Basically, there’s no status quo, so we’re left comparing apples to oranges with no real way of keeping track of them. ¬
Ax examination of Medically Assisted Treatment
But what’s amazing is that the new medically backed model, Medically Assisted Treatment or MAT, disregards solving these variables. Studies have been published and interpreted to show that it’s reducing rates of treatment recidivism and post-treatment relapse. Considering the lack of long-term research, inherent flaws in logic are being overlooked in these interpretations. Yet the therapy is being resoundingly cited as fact-based.
Most notable of these flaws is that a treatment where a person is being given an addictive medication cannot be accurately compared to an abstinence-based model in order to prove retention. Certainly, one would be less likely to leave a situation where they are given a drug that prevents opioid withdrawal syndrome. The person leaving an abstinence-based model would experience no direct worsening of symptoms, whereas the MAT patient would. That’s a simple risk vs. reward problem which the addict is already familiar with. But even more importantly, just because the MAT patients stay more, doesn’t mean they’re gaining anything of value. The argument of effectiveness simply because more people stay with the treatment means nothing when they’re possibly staying just to continue taking the drugs.
Secondly, the claims around post-treatment relapse are invalid due to a few factors. In MAT therapy, one is only considered relapsed if they go back to using their illicit drug of choice. Again, taking a chemically equivalent medication reduces this for obvious reasons. But further, the abstinence-based group would be forced to measure relapse in different terms, as taking anything would constitute such an event. Included in this would be taking any of the drugs that are used for MAT therapy. This also fails to account for people who seek treatment for addiction to the exact same drugs as are given in MAT, which occurs often. Finally, MAT is often lifelong, so there’s technically no post-treatment period even after person has been discharged from a treatment center. They are still receiving MAT drugs, so they are still in “treatment.”
Dependence vs. Addiction
Finally, let’s not ignore the distinction between dependence and addiction. Dependence occurs in anyone who takes opioids long term, yet not everyone becomes addicted. But the use of opioids to treat opioid addiction only furthers dependence, while psychologically solidifying the mental mechanism of drugs being the “answer.” This is the addiction component, which is left completely untreated in MAT. While MAT studies claim an increased willingness in patients to receive treatment this is likely only a comfort factor to avoid withdrawal. In the long run, it’s only making everything harder should the person ever want to become completely drug-free.