Questioning the perspective of article about ASAM
In reference to Lee Tannenbaum, MD's article appearing in the July/August 2011 edition, undoubtedly the contributions made by physicians to the chemical dependency treatment field, especially in the area of detoxification protocols, have been noteworthy. Significant contributions have been and continue to be made by a long list of enlightened physicians beginning with the late William D. Silkworth, MD. However, in light of the historical track record regarding many other pharmacologic/medical model interventions, rather than having the last word on the subject it has been argued that the larger physician community has yet to redeem itself.
Andrew D. Bennett, CADC II
EDITOR'S NOTE: Bennett wrote an article in the March/April 2011 issue on the need to defend the drug-free treatment model.
We are writing in response to the provocative article by Lee Tannenbaum, MD, in which he questioned the efficacy of the recovery model in the treatment of addictive disorders (July/August 2011 issue). Most of us in the treatment community have come to accept that addiction is a medical disease, and the medical community certainly has been doing its part to treat addiction with appropriate medications. In our direct experience with patients, however, we find that the most effective medicine we can prescribe is involvement in peer support fellowships, the most popular of which follow the 12-Step paradigm (Blonigen DM, et al.: Addiction 2011 June 1; Kaskutas LA, J Addict Dis 2009;28:145-57).
Whatever the etiology of addictive disorders, those afflicted with this disease suffer from isolation, which stems from their attachment to the addiction instead of an attachment to people. Effective treatment for these complex disorders involves patients' willingness to avail themselves of a whole community of people able to support the behavioral and psychological changes being sought. This community ideally includes not just treatment professionals, but supportive peers who have sustained behavioral changes themselves, usually through 12-Step self-help programs.
For a few individuals, the more limited model of care involving medication management and brief therapy may be all that is needed for remission. For many others, however, medication treatment and brief therapy are not enough. We suggest that our most important service to our patients is investigating their difficulty attaching to people, including their physicians and therapists. For many patients, this investigation is best accomplished using open-ended individual and group therapy and consistent participation in mutual support groups. Ideally, participation includes not only meeting attendance, but obtaining a sponsor, working the Steps, giving service, and other forms of practicing a new way of living and attaching.
We believe that Dr. Tannenbaum's diminishment of the recovery model does a particular disservice to those contending with process addictions. While these addictions can be every bit as destructive as chemical addictions, effective intervention often defies traditional medication-oriented treatment. In several Asian countries, residential treatment for Internet addiction has become a popular option; providers of these services focus on building and maintaining interpersonal relationships.
The paucity of systematic research on recovery-oriented programs may be more connected to the limitations of research methods than to the limitations of these programs' effectiveness. The American Society of Addiction Medicine (ASAM) was established by physicians who had “walked the walk” of recovery and knew from their own experience that 12-Step programs are effective, but individual testimonials do not help to establish evidence-based practice. We clearly need more research to validate the effectiveness of mutual support groups.
Kimberly Dennis, MD
Timberline Knolls Residential Treatment Center
Jeffrey Roth, MD, FASAM
Medical director, Working Sobriety Chicago
Barney Straus, LCSW, PCGC
Therapist, Working Sobriety Chicago
Addiction Professional 2011 November-December;9(6):11