Medication in Addiction Treatment – myths, facts and guidelines; Addiction Survivor; Sharing Solutions about CRAFT; Empathy
Drug overdoses killed more than 72,000 Americans in 2017, a rise of about 10 percent from the year prior, according to new preliminary estimates from the Centers for Disease Control. That’s the statistical equivalent of a plane filled with 197 people crashing every day.
“Medication-assisted treatment (MAT) – the use of medication combined with counseling and behavioral therapies – is one of the major pillars of the federal response to the opioid epidemic in this country. This type of treatment is an important tool with the potential to help millions of Americans with an opioid use disorder regain control over their lives.”
“These drugs stabilize brain chemistry, reduce or block the euphoric effects of opioids, relieve cravings, and normalize body functions. In fact, patients receiving MAT cut their risk of death from all causes in half, according to the Substance Abuse and Mental Health Services Administration (SAMHSA).”
Note some Myths and Facts about Medication in Addiction Treatment for Opioid Addiction
The Legal Action Center published a concise set of Myths and Facts about Medication-assisted treatment (MAT) for opioid addiction “to provide a whole-patient approach to treatment.” I formatted their content below:
MAT should not be long term.
There is no one-size-fits-all duration for MAT. The Substance Abuse and Mental Health Services Administration (“SAMHSA”) recommends a “phased approach”:
- Beginning with stabilization (withdrawal management, assessment, medication induction, and psychosocial counseling), and moving to a
- Middle phase that emphasizes medication maintenance and deeper work in counseling.
- The third phase is “ongoing rehabilitation,” when the patient and provider can choose to taper off medication or pursue longer term maintenance, depending on the patient’s needs. (Reference 7)
- For some patients, MAT could be indefinite. (Reference 8)
- The National Institute on Drug Abuse (NIDA) describes addiction medications as an “essential component of an ongoing treatment plan” to enable individuals to “take control of their health and their lives.” (Reference 9)
- For methadone maintenance, NIDA states that “12 months of treatment is the minimum.” (Reference 10)
References excerpted from the Legal Action Center’s publication “Mediation-Assisted Treatment for Opioid Addiction”
- OFFICE OF NATIONAL DRUG CONTROL POLICY, MEDICATION-ASSISTED TREATMENT FOR OPIOID ADDICTION, 3 (2012), available athttp://www.whitehouse.gov/sites/default/files/ondcp/recovery/medication_assisted_treatment_9-21-20121.pdf.
- SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION, MEDICATION-ASSISTED TREATMENT FOR OPIOID ADDICTION IN OPIOID TREATMENT PROGRAMS: A TREATMENT IMPROVEMENT PROTOCOL TIP 43 (2008), available athttp://store.samhsa.gov/shin/content/SMA12-4108/SMA12-4108.pdf.
- NIDA, supra note 1, at 1.
- NIDA, UNDERSTANDING DRUG ABUSE AND ADDICTION, (Feb. 2016) available at
To read more Myths:
- Medication-assisted treatment “substitutes one addiction for another.”
- Addiction medications are a “crutch” that prevents “true recovery.”
- Requiring people to taper off MAT helps them get healthy faster.
- Courts are in a better position than doctors to decide appropriate drug treatment.
LEGAL ACTION CENTER | (212) 243 1313 | WWW.LAC.ORG
225 Varick Street, 4th Floor, New York, NY 10014 | AUGUST 2016
Even though it is clear medication in addiction treatment saves lives, there are attitudes, ideology and sometimes simple ignorance about medications which has caused treatment providers and policy makers to limit what medications can be used and for how long.
You may notice I refer to MAT as Medication in Addiction Treatment – my version of MAT, because MAT is not a philosophy, it is just medication in addiction treatment. Medication is a clinical tool for addiction. It is not a belief system. Some people need medication for a short time; some people need it for a lifetime to achieve recovery outcomes.
Consider these guidelines to help determine how long to keep a person on medication in addiction treatment
How long do you keep a person on medication? This depends on what outcomes the patient and the practitioner want. Collaborate with patients and the treatment team and decide together on what medication to use, and for how long.
Here are some guidelines:
- A patient with opioid use disorder may NOT be interested in addiction recovery.
Despite trying to do motivational work, the person repeatedly shows s/he is not responding. Perhaps an agency or practitioner decides it is best to keep an individual on MAT for purely public health reasons: to stop spread of HIV/Hep C, not sharing needles etc… These then are the outcomes targeted; and MAT continues so long as those public health and safety goals are being reached.
- If thepatient WANTS an outcome of recovery (Medication Assisted Recovery, MAR), then some patients may need MAT for a lifetime, or for however long they need it to reach recovery goals.
- If they choose to go to abstinence via Narcotics Anonymous or other self-help/mutual help, and do well with that, they may want to come off medication.
- Others may be benefiting from the same mutual aid groups, but may find that medication for them, is also needed to maintain recovery goals. We know what Recovery looks like and if that is the goal, it can be measured.
- If apatient is AMBIVALENT about recovery but needs to be on MAT to stabilize themselves: As long as Dimension 4, Readiness to Change issues are addressed in counseling and motivational enhancement services, then it would be up to the agency, practitioner and patient to decide if, and when medication should be continued or phased out.
After some time with motivational work, It may become clear that the patient is not interested in recovery. Then you are back to #1 above.
- Finally,MAT for addiction should never be restricted to a certain length of timeby a payer or State authority or Drug or Treatment Court based on a policy, unless they also do so for antidepressants, anti-psychotics, insulin and anti-hypertensives etc. (Parity issues).
The length of time to be on medication in addiction treatment depends on what outcomes are wanted by the patient, practitioner and agency: public health safety; full recovery; or time to work on ambivalence about recovery.
stump the shrink
This was a particularly timely question for National Recovery Month.
Lee Harrison introduces a new way to think about people in long-term recovery:
Here is Lee’s message and questions:
Someone asked me a question that I thought I had the answer to until I reflected on my response and the feelings it generated for me.
The person asked me if I was still addicted to cocaine after almost 20 years in ‘long term recovery’ (as I have described my journey for almost ten years). My response was that I don’t really know, and I choose not to find out. Upon reflection, I think my personal truth is that my choice to not use mood or mind-altering substances is now a personal lifestyle choice (rather than one dictated by a desire not to experience the consequences of doing so) and that the definition of addiction (the fact or condition of being addicted to a particular substance, thing, or activity) is not applicable because there is no longer any empirical evidence to support that I am addicted (or an addict, for that matter).
I am often called upon to share my recovery story and experience and I find myself wanting to be more truthful/factual about where I am on my journey at this point in my life.
I am more inclined to describe my status as ‘an addiction survivor’. The facts are that, with treatment, I have survived my disease and have experienced no symptoms for an extended period of time, as is true for many other diseases. My ‘recovery’ has been from drugs, alcohol, tobacco and other unhealthy behaviors. I believe I have ‘recovered’ from many things and my life at this point is about moving forward and growing as a person, rather than getting back to where I was or wanted to be. I think I’ve accomplished that.
I believe you have referred to recovery as the disease of addiction on its way to or in remission. Would it not also be true that we can be addiction survivors, rather than in perpetual ‘recovery’? I think that is my personal truth and the message that I would like to share when asked.
My hope is that you have some insights about this and the labels that we continue to use for ourselves and those we serve. The terms ‘addiction’ and ‘recovery’ are still very much misunderstood and misused, I think. In my opinion, we have developed a workable understanding of addiction and its underlying causes.
The conversation about ‘recovery’, while not complete, may be at a stage where we (treatment providers and people in recovery) could consider some refined thinking (as in my case) and new descriptors, such as ‘addiction survivor’ which may be more understandable and relatable (for today’s mainstream understanding of the term ‘survivor’), less stigmatizing and closer to the truth.
Thank you, in advance, for your consideration and response.
Lee Harrison, OCFA Consumer and Family Liaison (WOC)
Wellness Recovery Action Plan (WRAP)® Advanced Level Facilitator (WALF)
Certified Alcohol and Drug Counselor-(CADC-CAS)
National Certified Peer Specialist (NCPS)
Office of Consumer and Family Affairs
Behavioral Health and Recovery Services
San Mateo, CA 94403
I think your idea of “addiction survivor” is a good direction to move towards. I think a person in “long term recovery” works too. Some people say “recovered” not “recovering” to show they have reached a level of stable functioning and physical, mental, social and spiritual health.
Since I don’t have lived experience with addiction as a person in recovery, I’m not sure what feels right to those who are in “long term recovery” or are “addiction survivors” as you say. But I support your ideas.
Is that an original term, “addiction survivor”? Or have you seen it elsewhere?
Thanks for writing and I think you raise some very thoughtful and thought-provoking issues I’d like to share with the readers of Tips and Topics.
Lee’s second message:
Good Morning, David.
I’m grateful that you took the time to respond and share your thoughts with me. Thank you for continuing to offer thought-provoking insights and questions about addiction and recovery treatment. I appreciate your responses and agree that each person in recovery should have the right to identify in whatever way has meaning and feels right for them.
“Addiction Survivor” is original. It came to me as I was reflecting about what is my truth and reality regarding my stage of recovery and my journey at this point in time.
Again, thank you!
Lee, Addiction survivor and a person in long term recovery.
Last month I gave a brief overview of Community Reinforcement and Family Training (CRAFT).
(By the way, we are still working on improving tipsntopics.com, so not all past editions are uploaded yet….stay tuned.)
Three readers responded with more resources to advance your knowledge about CRAFT.
Both Michael McGee and David Koss recommended the same two books for further reading:
“There are two very good books on CRAFT I recommend to families and to our staff:
- Get your Loved One Sober. By Meyers, et al.
- Beyond Addiction. By Foote et al.
You may want to share these resources with your readers.
Michael D. McGee, M.D.
Chief Medical Officer, The Haven at Pismo
Author of “The Joy of Recovery: The New 12 Step Guide to Recovery from Addiction”
Board Certified, General Adult Psychiatry, Addiction Psychiatry, and Psychosomatic Medicine
“FYI, the CRAFT method, initially developed by Robert J. Meyers and Brenda L. Wolfe in their 2003 book Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening and further developed in Beyond Addiction: How Science and Kindness Help People Change (2014), written by clinicians at the Center for Community Change, has been the cornerstone and the basis for SMART Recovery’s Family & Friends program, and relied upon during SMART Recovery Family & Friends face-to-face and online meetings and in its Family & Friends Handbook.
All the best,“
Trained Meeting Facilitator
Delaware – District of Columbia – Maryland Region
Joe Gerstein wrote the following letter Sharing Solutions for family members:
September 16, 2018
Your coverage on helping families with addiction in the August newsletter is timely and presents excellent guidance based on the CRAFT program. As you say, we can’t wait for the people we love to hit “rock bottom” when that could be death, especially for those with opioid use disorders.
SMART Recovery has incorporated CRAFT into our Family & Friends program, which we launched in 2010 with online meetings. Since then, we have added in-person meetings across America and in Canada and the UK. SMART offers a Family & Friends Handbook for People Affected by the Addictive Behavior of a Loved One, along with a Family & Friends Facilitator’s Manual for those who lead the meetings. Our facilitator training program includes a module for those who want to lead SMART Family & Friends meetings.
The Family & Friends program combines the behavioral-change focus of SMART with the empathetic and non-confrontational methods that CRAFT uses to help loved ones seek treatment and recovery support. In our program, people must focus first on self-care before they can help their loved ones. They must learn, for example, how to manage the anxiety, frustration, anger, despair and other intense emotions that arise in such relationships. They must build a support network and change their lives in much the same way people must change and restore life balance to overcome an addiction.
As they regain life balance, family members are better able to help their loved ones overcome addiction problems. Using CRAFT, they learn to establish healthy boundaries in their interaction with loved ones. For example, they might say they prefer to share activities only when their child or spouse is sober because they can interact better and have more fun. The challenge is to set these limitations in a non-judgmental and loving manner.
As they reconnect with loved ones through healthy activities, they can better communicate concerns about unhealthy addictive behavior. They might say the reason they prefer not to interact when their loved one is intoxicated is that it hurts them, and they want the family member to recover out of love – not because he or she is a bad person. Shaming someone who has a substance use disorder makes them feel worse and impairs their ability to make the changes needed to recover.
Your readers should know that the CRAFT program has been scientifically validated as evidence-based and has a better track record in getting loved ones into treatment than alternatives such as the Johnson Intervention.
Your newsletter mentions the Center for Motivation and Change as a great resource. SMART also works closely with Robert J. Meyers, Ph.D., who pioneered CRAFT.
Readers can learn more by visiting the Family & Friends pages on our website (https://www.smartrecovery.org/family/).
President SMART Recovery
You probably have not heard of the Governance Institute. Through their Leadership Conferences, they offer current information about big picture trends in healthcare- the aim: to improve governance and achieve optimal hospital board performance.
It was a stimulating conference. I heard excellent, informative presentations on:
- Population health versus fee-for-service payment models
- What consumers and patients want from healthcare
- How healthcare is ripe for disruption, just like Uber disrupted taxi cabs; Amazon disrupted sellers; and Netflix disrupted Blockbuster Video.
One speaker particularly inspired me. Jim Diegel, the CEO of Howard University Hospital in Washington, D.C., is only the second white CEO in a predominantly black staff and hospital culture. I learned so much from his experiences as a senior executive in hospitals and health systems for almost 30 years (and 20 of the 30 years as a CEO.)
To change culture, meet people’s needs, and transform healthcare, Jim spoke of one major starting point – Empathy. That’s an easy word to say and not a new concept. What so impressed me was how Jim lives that:
- His home is blocks away from the hospital and he doesn’t have a car. The nearest grocery store is over a mile away. Jim doesn’t Uber there. He walks over a mile; buys only what he can carry; and walks back home, meeting neighbors along the way to get to know what their life is like.
- He became tired of a homeless woman always asking for a dollar or two all the time. So once a week, he takes her to dinner, feeds her and learns of her life.
- At the hospital, staff had gotten used to looking for someone to blame if something goes wrong. He instituted a justice approach: this looks for what systems went wrong, rather than looking for a scapegoat to blame.
I talk & train about empathy all the time. Jim showed me what it means to walk the talk (literally.)