One Size Does Not Fit All – Jun 2016

As the nation scrambles to combat the unprecedented opioid epidemic—now claiming more lives daily than fatal traffic accidents or death by gunshots—several progressive initiatives underscore just how far some of our long-held beliefs about treating addiction have changed in what seems like a blink of the eye.

Consider the following:

• Who could have predicted even a short time ago that traditional addiction and recovery programs—the majority of whom believe fervently in AA’s and NA’s abstinence-only approach—could ever endorse, let alone promote medication-assisted treatment.

• Who would have imagined that our field would ever be open to even the possibility that those of us who struggle with alcohol addiction could ever return to moderate or social drinking, or take medications to control their craving. And, although harm reduction is still a dirty word in some quarters, the fact is that most of us have come to understand and accept that one size does not fit all when it comes to addiction treatment.

• The $35 billion per year treatment industry has proved resistant to integrate the new drug or behavioral approach, but in the wake of the unprecedented deaths from overdose, the tide has turned.

• Combating a raging national heroin epidemic seems to be one issue where Republicans and Democrats find agreement.

• Last month, President Obama proposed $1.1 billion in new federal spending to fight the growing epidemic of heroin and prescription opioid addiction. His 2017 proposed budget designates $920 million for states to expand access to drug-assisted treatment over the next two years. It also calls for more prescription drug monitoring programs and increasing the use of naloxone. 

• In another hugely important happening, addiction medicine has been recognized not only as a preventable and treatable disease, but as a new medical subspecialty which will provide a new career option for medical students, residents, and physicians interested in specializing in the treatment of addiction. 

The question of effective treatment for alcohol and substance use disorders is more pressing than ever. According to a recent article in The New England Journal of Medicine, the number of Americans admitted to treatment programs for prescription opioids more than quadrupled from 2002 to 2012 (Compton, Jones, & Baldwin, 2016). Deaths from heroin overdoses nearly quadrupled from 2002 to 2013, the Centers for Disease Control and Prevention reported (2015).

In addition, an estimated eighteen million Americans have alcohol use disorders, according to the NIAAA (n.d.), and a study published in Journal of the American Medical Association last year found that the number of Americans who drank to excess was rising (Grant et al., 2015). 

Without question, medication-assisted treatment (MAT) is at the forefront of the latest options being championed for addiction treatment and perspectives are dramatically changing in Twelve Step programs. 

No one represents our shift in perspective better than Michael Botticelli, President Obama’s “Drug Czar,” who is featured in Bill White’s interview in this issue. In Twelve Step recovery himself, Botticelli recognizes that we’ve come a long way as a recovery community, knowing that there are multiple paths to recovery and that medications for many people are an important part of their path. 

In another recent interview, Botticelli says, “We are really seeing a diminution of this arbitrary line between people who are in recovery who are on medication and those who are not. As a Twelve Step community, as a recovery community, we understand there is no one right path and that each person has their right to their own individual path to recovery. I feel optimistic that these kinds of dividing lines are falling away, and the opioid epidemic is really accelerating that change in beliefs for many people” (Lavitt, 2015). 

Indeed, the times they are a-changin’.

Centers for Disease Control and Prevention (CDC). (2015). Today’s heroin epidemic. Retrieved from http://www.cdc.gov/vitalsigns/heroin/

Compton, W. M., Jones, C. M., & Baldwin, G. T. (2016). Relationship between nonmedical prescription opioid use and heroin use. The New England Journal of Medicine, 374(2), 154–63.

Grant, B. F., Goldstein, R. B., Saha, T. D., Chou, P., Jung, J., Zhang, H., . . . Hasin, D. S. (2015). Epidemiology of DSM-5 alcohol use disorder: Results from the national epidemiologic survey on alcohol and related conditions III. JAMA Psychiatry, 72(8), 757–66. 

Lavitt, J. (2015). Interview with Michael Botticelli, Obama’s “recovery czar.” Retrieved from https://www.thefix.com/obama-drug-czar-michael-botticelli-now-recovery-czar?page=all

The National Institute on Alcohol Abuse and Alcoholism (NIAAA). (n.d.). Alcohol use disorder. Retrieved from http://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders