Eighty addiction professionals have signed onto a letter advising President Trump on how to end the nation’s addiction epidemic using the most up to date, effective treatment approaches.
We point out that the dominant addiction treatment system in the United States, with its insistence on abstinence as the only acceptable goal and often with a commitment to abstinence as a condition for entering and remaining in treatment, has failed to help the overwhelming majority of people with substance use disorders. At the moment when most people realize that they have a problem with drugs, they are neither willing nor able to commit to abstinence. This leads to delays in seeking treatment, and as we have seen from the tragic rise in addiction and overdose, these delays can be deadly.
In this letter, we seek to bring to the President’s attention the most effective means to help those who struggle with addiction and prevent further unnecessary suffering and death.
The letter suggests four elements of an effective drug treatment strategy: biomedical, psychological, social, and harm reduction.
Biomedical strategies include the most recent and effective medical treatments to prevent overdose and relapse: access to Naloxone for reversing opioid overdose, methadone and buprenorphine for detoxification and relapse prevention, and the option of naltrexone. The treatment industry’s failure to use these medications effectively has resulted in many an overdose as opioid patients leave rehab facilities just as their cravings hit the highest point and their tolerance is at its lowest. Medications can not only make the detoxification process bearable, they can provide longer term support to prevent relapse and overdose.
The psychological strategies we suggest seek to address the underlying emotional issues that drive addiction. Evidence-based interventions including Relapse Prevention, Cognitive-Behavioral Therapy, the Community Reinforcement Approach, Mindfulness-Based Interventions, Motivational Interviewing, Contingency Management, Trauma-focused therapy and Psychodynamic Psychotherapy can each play an important role in a comprehensive approach to addiction treatment. Failure to address the trauma and self-hatred that both spur and stem from addiction increases the chances that relapse will occur. In our own practices, we have seen these evidence-based interventions provide the foundation for lasting recovery.
Social approaches seek to address the fact that the addiction epidemic is largely a result of the breakdown of families, communities and social support. The failed Drug War has only made this problem worse by incarcerating hundreds of thousands of nonviolent drug offenders, breaking up families and leaving children without parents. Interventions ranging from keeping schools open as 18 hour a day social spaces to housing first approaches to homelessness can help address the lack of community and desperate poverty that drive people to turn to drugs.
Harm reduction is a radical departure from the punishment and criminalization that has dominated our nation’s failed drug policy and from traditional abstinence-only treatment. Harm reduction seeks to help people live as safely as possible, causing minimal damage to themselves and society, whether they are using drugs or not. A realistic approach to addiction recognizes that abstinence-only treatment has not worked – most people are not ready to completely give up their drug until they have begun to address the biomedical, psychological and social factors that drive their addiction. Harm reduction approaches can help treatment providers build an alliance with patients and work toward the entire range of positive change goals including safer and reduced use, moderation and abstinence. Preventing deaths by allowing community access to Naloxone, lowering rates of disease transmission and deadly infections by making needle exchange legal, and encouraging treatment providers to meet patients where they are instead of insisting on abstinence as the only goal of treatment will help stop the progression of the addiction epidemic. We need not wait until people who use drugs are homeless, sick or living a life of crime to give them the tools to get well.
We hope to begin a dialogue with the Trump administration so that we can find a way to implement these principles and practices. We offer our expertise and experience as resources in our nation’s fight against the ravages of drug and alcohol addiction and the overdose crisis.
Photo credit: Donald Trump (Mike Blake/Reuters)