Addiction Medication: The Great Debate

by Marcus Abernathy

There is an ongoing debate in the field of addiction medicine over long-term versus short-term treatment utilizing the medication buprenorphine (aka Suboxone or Subutex) for opioid addiction.  The American Society for Addiction Medication prefers long-term treatment with buprenorphine, in most instances, to any form of withdrawal or detoxification treatment.  It is argued by many medical professionals that addiction is a disease, and the treatment of a disease is done with medicine that counters its physiological symptoms.  Buprenorphine, an opioid agonist some deem as a “miracle drug,” is a successor to methadone which has been used for decades to help heroin addicts kick their habit.  Buprenorphine eliminates many of the physical and emotional symptoms of opiate withdrawal, without producing euphoric side effects unless abused.  It is worth noting that the elimination of Buprenorphine from an addict’s body will produce the same, and possibly worse, withdrawal symptoms as heroin or other prescribed pain medicines.

Then, there are the non-medical professionals who work in the field of recovery who are against the use of such medication.  They claim that switching from addictive substances such as heroin, or the increasingly popular oxycodone, to an opioid agonist like buprenorphine is nothing more than trading one addiction for another.  And they have a valid point.  Many addicts report experiencing harsher withdrawal symptoms while tapering off of buprenorphine than when kicking dope, and many have stated they would rather taper off heroin than the buprenorphine.  A friend of mine recently called me after finishing a long term Suboxone taper, and said he was “considering buying some oxy, and just self-tapering off of that.  This sub detox is worse than any time I kicked dope.”  Recovery professionals believe that addiction is a disease of the mind, body and soul, and a more desirable approach to getting clean involves psychotherapy, cognitive and behavioral modification, 12-step programs such as AA or NA, and/or spiritual practices such as meditation and mindfulness while abstinent from substances altogether.  And although these professionals have plenty of anecdotal evidence supporting this approach, those in the medical field are still very critical.  Dr Mark Willinbring (Director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism/National Institutes of Health) makes the point that you wouldn’t treat a cancer patient “with a macrobiotic diet instead of chemotherapy.”  But, cancer isn’t a disease of the mind, body and soul; it is a disease of the body.

Those in medicine would say that the spiritual recovery approach does not address the physiology of the problem, and medicine is the only proper treatment. Let me pose a question.  If addiction were purely a physiological disease of the body, then why do people relapse once the withdrawal period is over, and the physical cravings are gone?  It’s because the mental incapacities that existed, which led to the self-medicating in the first place, haven’t been dealt with.  The physiological symptoms of addiction occur only after the drug is consumed to the point that the body develops a problem.   Something to consider is that some of us may be looking at addiction all wrong.  Instead of viewing the addict’s substance use as the problem, consider that use is the addict’s solution to a deeper problem.  The problem being whatever mental or emotional dysfunction is so unbearable that the addict knows no other way to cope.  Using drugs alleviates this inner turmoil, and then the drugs wear off causing more turmoil, which the addict only knows how to medicate with more drugs.   And while this cycle continues, so does the physiological dependence on the drug.  Long-term buprenorphine use very likely reinforces this behavior, and may not allow the addict to properly learn to deal with their emotions free of a chemical crutch. It can be argued that since the strictly physiological treatment approach does not require behavior modification, the thought processes that led the addict to use in the first place stays intact.  I would offer a hybrid solution, which involves a short-term taper off of buprenorphine combined with proper psychotherapy to assist in the cognitive behavior modification necessary to disassociate feelings of discomfort and unease with drug use.  The short-term taper, which –if done properly- will quickly eliminate physical withdrawal symptoms and allow the addict to experience and manage the emotions that come with a substance free life.  And the ongoing therapy and counseling increases the likelihood that the addict successfully adapts to their new lifestyle.

 

Marcus Abernathy is a recovering drug addict pursuing a Master’s Degree in Clinical Psychology, specializing in Addictive Behaviors.

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