An introduction from Addiction Professional's
This is the third in a series of six articles designed to provide you with the latest information on the use of medications in alcohol dependence treatment. Medications (pharmacotherapy) used as adjuncts to counseling techniques and biopsychosocial, educational, and spiritual therapies are an increasingly important part of a comprehensive treatment approach for alcohol dependence.
Expanding knowledge of how medications may interact with and complement counseling techniques will help the addiction counseling community optimally coordinate care of patients with other treatment providers. Thus, the article series Pharmacotherapy: Integrating New Tools Into Practice will not only provide the latest efficacy and safety data on these medications, it will also explore how we can build better relationships among addiction professionals and medication prescribers. The series will also examine the current barriers to medication use in treatment while offering potential solutions.
The series began in the January/February 2007 issue with an article by Carlo C. DiClemente, PhD, who discussed recovery from alcohol dependence as a process of change and examined how medications might facilitate that process. The series continued with an article in the March/April 2007 issue by Carlton K. Erickson, PhD, who looked at what some of the most important study results from recent years have told us about the approved medications for alcohol dependence treatment. In this third article, Christopher W. Shea, MA, CRAT, CAC-AD, examines how clinical professionals can help overcome a variety of biases and other barriers against greater use of medications in the treatment of alcohol dependence.
In my years of chemical dependence counseling and teaching at the collegiate level, I have encountered many people who have not only heard myths about chemical dependency and counseling, but who also believe these myths without question. Blind belief of myths, propagated by both clinicians and patients, can create barriers that prevent comprehensive and effective treatment of alcohol dependence. In some cases, the beliefs of clinicians may be better termed “misconceptions” or “misperceptions.”
For example, for many years I have taught an “Introduction to Pharmacology” course to chemical dependence counseling students, many of whom have lamented having to learn about medications and neurobiology when their goal was simply to counsel addicts and alcoholics. These students understand and believe that addiction is a disease, yet they experience a disconnect when they fail to consider medications as a form of treatment. This article will explore some of the common myths or misconceptions surrounding medication use for the treatment of alcohol dependence, and will provide solutions based on research and practical experience to overcome these barriers to pharmacologic therapy.
Treatment provider barriers to medication use
Addiction counselors tend to be more familiar with behavioral counseling approaches to alcohol dependence treatment than with pharmacologic treatments and, therefore, are less likely to recommend medications.
1 For example, about 40 to 54% of counselors in one study reported that they did not know much about the efficacy of oral naltrexone.
1 Perhaps this lack of understanding about medications contributes to a concern among counselors that medications will negate and replace their role in the recovery process. However, medication efficacy has virtually always been studied in combination with psychosocial therapy and thus is defined by its role as a component part of treatment. The fact that alcohol dependence is a disease with several contributing factors manifesting in both physical and behavioral symptoms demands a comprehensive approach to treatment, since exclusion or elevation of one aspect of the disease fails to help distressed patients fully.
Christopher W. Shea
This is an important point for consideration among clinicians who believe the use of medication is inconsistent with the philosophy of total abstinence, or who view the use of medication as a crutch that takes away from the “necessary” pain a person needs to feel in early recovery. I do not presume to change another's programmatic philosophical opinions, yet isn't a “crutch” a tool? The crutch, in and of itself, does not heal or negate need for treatment. The use of medication to curb physical symptoms, such as cravings, serves only to allow the patient the mental capacity to learn from his or her past and thus develop new, rational thought processes, which can be fostered through cognitive-behavioral therapy or other forms of counseling. Counselors need not fear medication interfering with the importance of their role in the therapeutic process.
Many beliefs and “myths” held by patients are, in fact, patients' perceived realities based on their past experiences. Understanding this concept becomes vital to assisting our patients in moving beyond their current perceptions and challenging them to new outlooks. Patient concerns or misconceptions that challenge the use of medications in treatment include concerns regarding medications' efficacy, addictive properties, and necessary duration of use. Thus, one of the counselor's roles is that of educator to allay patient concerns.