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Medication is not a 'silver bullet'

December 1, 2007
by Ronald J. Hunsicker, DMin
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Medications can help people move toward recovery, but they should not replace traditional addiction treatments

For more than 50 years the most widely recognized approach to treating alcoholism and other drug addictions has been the pathway that leads to abstinence. Recognizing alcoholism and other drug addictions as a chronic disease that causes premature death if left untreated, addiction professionals often have held out abstinence as the ultimate goal of addiction treatment. This thinking is coupled with the belief that for an individual to truly participate in abstinence, he/she needs to have a life-transforming experience—namely, recovery. Abstinence traditionally has been viewed as the doorway to recovery.

When these concepts were introduced, they were a true miracle for individuals with the disease of alcoholism and other drug addictions. Those who work day after day with persons with the disease of addiction have been in awe of the power of recovery and its regeneration of life and vitality.

Yet accurately describing this transformation, this recovery, this regeneration in terms that make sense to those unfamiliar with addiction treatment and the 12 Steps can be difficult. Because recovery is not easily explained or understood, the general public has been quite skeptical of viewing alcoholism and addiction as a disease, preferring instead to view alcoholics’ and addicts’ behavior as willful misconduct and as a lack of willpower.

Addiction treatment never has been about precise dosages or well-established clinical pathways. Addiction treatment has been about providing a safe and secure setting so that it is more likely a person will experience a transformation and that his/her recovery will follow. Addiction treatment has been about providing the best possible opportunity for the recovery process to begin, and providing individuals with tools to allow them to continue in recovery for the rest of their lives. Addiction treatment never has been about fixing people. It always has been about healing people.

However, our impatient and instant-gratification culture has continued to push for something quicker, something easier, to address alcoholism and addictions, some silver bullet to reduce the effort and cost involved in “fixing” alcoholics and addicts. Fueled by the belief that alcoholism and addictions are not a real disease and by the suspicion that people can quit simply if they want to, the silver bullet search has accelerated. Yet a disease that responds better to healing than fixing may not be an ideal candidate for a silver bullet approach.

Thus, it's not surprising that those looking for a silver bullet have turned their attention to medications as their latest hope. During the past several years, the FDA has approved promising medications for the treatment of alcoholism and opiate addiction, and others are undergoing testing. But while pharmacologic agents might reduce the number of heavy drinking days or cravings for substances, they are not a silver bullet because they do not lead directly to recovery and abstinence.

Pharmacologic approaches to addiction treatment are here to stay. Several promising agents have been introduced, and many more are at various stages of development. Yet we need to consider how they are being used. Are medications being embraced as a silver bullet? Are we settling for reduced drinking days as the outcome of treatment? Are we casually brushing aside the past 50 years of experience and the hundreds of thousands of transformed lives who have contributed so much to society because of their recovery?

If we don't have an open debate about the role of medication in addiction treatment, if we don't honestly ask the hard questions, we are on a dangerous path leading to a point where outcomes such as reduced heavy drinking days will be seen as good enough. Let's always remember that one heavy drinking day for an alcoholic is one too many.

Medication is an asset, not a silver bullet. It can and has helped persons move toward a transforming experience, a healing experience, and recovery. Medication can and should be used to increase the likelihood that people will be healed, not just to reduce their cravings.

Ronald J. Hunsicker, DMin, is President and CEO of the National Association of Addiction Treatment Providers. He is also a member of Behavioral Healthcare's Editorial Board.

To contact Dr. Hunsicker, e-mail rhunsicker@naatp.org.

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