One of my students stated this very opinion in a recent class. We had been discussing the use of addiction medications to treat addiction. She was initially opposed to the idea, and voiced that resistance in a demonstrative manner. But, at the same time, she seemed intrigued with the possibility of treating drug problems with drugs.
This is not the first time this topic has been voiced in our field, but I had not heard it for some time. Observing this reaction within three feet of my face, it got me to thinking. After some reflection, I wish to add some thoughts to the fray.
As long as I can remember, there have been a segment of folks in our field who have been adamantly opposed to using any type of drugs within the boundaries of addiction recovery. If you have been in this field for any length of time, you known them too. This segment of folks tells recovering folks to get off all drugs, even life sustaining ones. That is terribly unethical. Without medical credentials, no one should be offering medical advice of this nature.
But, my student wasn’t referencing these individuals. She was specifically referencing drugs created for addiction treatment like Naltrexone. She is not alone on this position. Many professionals and grass roots folks also advise against such drugs. In terms of the student, she just could not fathom how such drugs could benefit addiction recovery.
Why does this belief persist in the addiction field? As near as I can figure, the very notion of treating someone with drug problems with drugs just sounds inappropriate. Why inappropriate? There are a number of reasons. For one, drug addiction is perceived as ‘negative’ in many minds, and this negative sensitivity transforms all drugs into something equally negative. So, even the good drugs get tossed into the negative bin. That is a mistake. There are indeed good drugs for addiction treatment, and in the cases where it is needed, this intervention should not be withheld.
In addition, the standard paradigm in recovery is abstinence. Pure unadulterated abstinence is the order of the day in the majority of treatment programs across the country. Folks who hold this view sometimes perceive any drug use as an implied indication that such use will somehow lead into a return of illicit drugs. In this style of thinking, drugs even the good drugs are thought to somehow lead to relapse. There is really no research out there to back this claim, yet the belief persists.
I think part of this ‘lead to relapse’ thinking has to do with the belief that relying on drugs is simply not in the best interests of staying sober. The thought springs from the fact that reliance on drugs was and is the case in active addiction. Thus those in recovery, especially those in early recovery should not rely on any drugs. Relying is bad. So, the thinking goes, relying on any drug will eventually lead to relapse.
Intermixed with this potential relapse belief, is a notion that recovery achieved without resort to drugs is somehow a better caliber recovery than if drugs are used in concert with treatment as usual. It would appear that in many minds, there is a belief in the hierarchy of recovery. The best type is done minus drugs. This line of thinking leads to grading a recovery process. You pass if your recovery is accomplished without use of drugs. You get a C- if your recovery has been assisted with drugs. If both approaches lead to recovery, why would the method matter?
Next, this general no drug use “logic” has a very anti-intellectual tone to it. You sometimes sadly hear it in 12-Step meetings. “Those doctors don’t know anything about addiction. Don’t talk to anyone outside the program. They don’t know what they’re talking about.” This anti-intellectualism has always been prevalent in the grass roots recovery movement. On the one hand, it does have the advantage of binding some people together. For those who hold tightly to this belief, it does give a sense of group cohesion and comradely, an “us against them” kind of thing. Some people who hold this belief have stayed sober for years even decades. It somehow gives these folks strength and resolve. However, it has made for some bad blood between those who “came up the hard way” in recovery process versus doing it with the ‘pompous’ intellectuals. Too bad all that hasn’t been resolved by now. I think it would make for a overall better recovery practice, having many options to select from not just one or two. This is especially true for clients who need different options.
There is also a pinch of ego intermixed with all this. Some anti-drug folks really believe they understand recovery and they know it better than practically all others. They sometimes come off a bit smug and overconfident. Little do they know that such pride clouds perception as does a cataract cloud physical vision. Those with the ego problems have forgotten that humility is a cornerstone of quality recovery. Humility allows fresh air into minds as well.
Then there are the critical thinking fallacies that play a role in the belief that no one in recovery should take good addictive drugs. The first fallacy is called the conformation bias. Here the thinking tendency is to search for and or interpret information that is always consistent with one’s prior perceptions. This includes only hearing client stories about the harm caused by inappropriate prescriptions, or merely listening to others who harbor similar thoughts.
This fallacy dovetails well with the Semmelweis fallacy. Here the tendency is to reject new evidence that contradicts an established paradigm. Such as rejecting all the solid evidence that good addiction drugs do indeed help some people.
Next is the erroneous belief that helpful addiction drugs are somehow addictive. While there no evidence for drugs such as Naltrexone being addictive, this belief persists and is rather strong in certain circles. The anti-drug idea is to best leave all drugs alone just in case they might be addictive. (But granted, there has been some reported side-effects from Naltrexone.)
This erroneous belief leads squarely to the following.
Folks who adhere to the position of no drug use have to tackle an ethical issue. They have to adequately explain the point of withholding perfectly good treatment (e.g., good drug prescriptions) from those who could conceivably benefit from it. Withholding perfectly good drugs from those who might benefit from them, just because you don’t believe it, is an ethical issue.
For those who continue to oppose all drug use in addiction treatment, you need to provide a detailed logical explanation of why you object. I would suggest you start this way. “Perfectly good drugs should not be used to help someone overcome the ravishes of an active addiction. The good drugs should be avoided because …” (Be sure to add well documented research to this claim, back your conclusion with solid premises, avoid fallacies, and your personal biases.)
In the long run, fallacies, biases, lack of knowledge ought not to play a role in providing the best treatment for our clients.