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October 5, 2011
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ASAM: 12 Steps play crucial role in medical model

Lee Tannenbaum, MD, recently wrote an article in which he described what he sees as the “split personality” of the American Society of Addiction Medicine (July/August 2011 issue). He raised several points but ultimately focused on a question as to whether the 12-Step model has a place in the medical model of addiction treatment.

Addictive disease involves the use of addictive substances but is based upon a genetic substrate that predates addictive substance use. It is further based upon an environmental event or events that also predate the substance use. Once a patient has stopped using addictive substances, the clinician can begin treating the discomfort caused by the combination of the genetic and environmental influences-addictive disease itself, if you will; until then, we are largely treating the direct and side effects of substance use. The direct and side effects of substance use occur in any who take these substances, not all of whom have addictive disease.

With the cessation of use, the discomfort that drove use in the first place becomes the primary focus of treatment. It is this discomfort that will drive relapse unless it is properly addressed in a lifelong manner with sufficient intensity as to reduce risk. The primary modality of addressing this discomfort is via the development of emotional bonds-relationships between patient and clinician, addict and sponsor, and so forth. These bonds are a key component of a standard medical model, which is based upon biologic, psychologic and sociocultural underpinnings. The latter incorporates the spiritual as well, since this is an important component of most patients' culture.

The relationships that the patient develops result in improved skills at coping with the discomfort. The group dynamic and the availability of AA or similar programs give the patient the ability to access support and/or treatment at nearly any time and in nearly any location. This is far more than our overwhelmed healthcare system can provide, and it comes with an acceptable fiscal impact.

Dr. Tannenbaum envisions a day when addiction can be treated utilizing more scientific methods. Group therapy is a scientific method with well-demonstrated efficacy. Indeed one day, we might be able to address the genetic substrate of addiction through use of a targeted medication, but it is unlikely that we will soon be able to address the disease itself in a purely biologic manner.

The American Society of Addiction Medicine has always promoted a scientific approach to the treatment of addictive illness. We are proud of our annual conference's reputation for educating attendees about all aspects of the medical model, not merely the biologic.

Stuart Gitlow, MD, MPH, MBA

Acting president, American Society of Addiction Medicine

Caron CEO adds to criticism of article

I was deeply concerned by the commentary “ASAM's split personality” by Lee Tannenbaum, MD, in the July/August issue. Dr. Tannenbaum's opinion piece reveals a tragic misunderstanding of the disease of addiction and re-emphasizes the need to educate medical professionals about why a comprehensive approach to addiction treatment is imperative.

At Caron Treatment Centers, our evidence-based practices show that treatment requires medical, physical, behavioral, spiritual and psychological intervention. The majority of our patients have tried some form of outpatient therapy or program before they come to treatment. However, they ultimately need to be removed from the people, places and things that trigger the disease in order for a new approach to life to begin. Likewise, families are greatly affected by the disease of addiction and are often just as sick as the addict and in need of their own treatment.

The 12 Steps play a critical role in helping individuals and families achieve and retain long-term sobriety and wellness. Dr. Tannenbaum suggested that there has never been any research to demonstrate the efficacy of 12-Step treatment and that is simply not true. In fact, research shows that abstinence rates greatly increase when an individual attends meetings after receiving treatment. Project MATCH, a nationwide study, found that 12 Step Facilitation is as effective as cognitive-behavioral therapy.

Unfortunately, our current medical culture often insists that a pill is the answer for everything. And while we at Caron believe that there is an appropriate place for medicine to support treatment and recovery, we also know that there is no magic bullet for treating addiction.

Doug Tieman, President and CEO, Caron TreatmentCenters

Wernersville, Pa.

Opposite perspectives on medication cover story

I have been working in the treatment field for 12 years as a chemical dependency counselor and chaplain, and have been a member of NAADAC for eight years. I have appreciated getting your magazine, but I have been concerned about an apparent bias toward medically assisted recovery over the past few years. This came up again as I read the May/June 2011 issue.

I was quite disturbed by the tone taken in the article by Alison Knopf entitled “The Medication Holdouts.” Even the title spoke of a strong bias against those of us who are not running to medications as a way to treat opiate addicts. The bias continued throughout the article. It seems quite disrespectful to question the ethics of highly respected and historically successful programs such as the Betty Ford Center and Hazelden, based on inadequate research into the topic.