I take exception to several points in Keith Berger's letter about medication treatments in the March/April 2006 issue. The first is the statement referring to medication-assisted therapy as an “easier, softer way.” In 1956 the American Medical Association declared alcoholism to be a treatable illness, just like asthma or diabetes or hypertension. My question to Mr. Berger would be: Should the diabetic tough it out without insulin? Is antihypertensive medication the easier, softer way? Of course not; it would be ludicrous to think that.
The statement that taking prescribed medication is just substituting one drug with another is appalling. It clearly indicates a lack of understanding of the brain processes that occur from a long-acting medication such as Suboxone or methadone. Therapy is still necessary, but use of medication that stabilizes the brain so that treatment can succeed makes good sense. To watch a person with the disease of opiate addiction be freed in 24 to 36 hours by the magic of Suboxone is truly wonderful.
Remember the comment of Bill Wilson, cofounder of AA: “We should always be inclusive and not exclusive.” We have initiated hundreds of people into Suboxone treatment in the practice where I work. The phrase I continue to hear from patients is “miracle drug.” The results look very promising.
Anyone who meets the requirements to receive medication-assisted treatment knows what pain is. These individuals wake up sick everyday. It is unfeeling for Mr. Berger to say that we are cheating them out of the pain of withdrawal. Does he realize that some people die from withdrawal? Are we cheating them out of death, because that is some people's bottom.
Buprenorphine is an excellent medication that allows sick people the opportunity to get well. Mr. Berger should consider his use of language when he states that someone's heroin habit was substituted by a 20-year methadone habit. The last thing methadone patients need is more negative language, especially from someone in the field of helping against the disease of addiction.
Barry Schecter, LCSW, CASAC, MAC, Owego, New York
Keith Berger's letter has merit as far as it goes. Suboxone, like nicotine replacement therapy for nicotine-dependent individuals, functions to minimize opioid withdrawal. Of all the addictions I have treated, physiologic dependence on opioids is the most difficult to treat successfully. The opioid addict's brain has been conditioned to have an alarm reaction at the first sign of any physical pain or discomfort—which always occurs even after a short-term inpatient detox (the HMO's idea of a successful treatment episode). Even when the addict receives thorough information about triggers and managing cravings, primitive brain functions unfortunately overrule recovery knowledge, and withdrawal urges predominate. Mr. Berger is correct in his assertion that the addict simply should have to apply a rigorous outpatient treatment program and self-help commitment to recover successfully. However, if we strive to increase treatment retention, I have found Suboxone to be an aid—provided that the client is sufficiently motivated to work a genuine recovery effort.
Peter C. Venable, MEd, LPC, CCAS, Winston-Salem, North Carolina