In May 2023, CSDAP staff met with Doug Simon, Governor DeSantis’ Director of the Office of Drug Control (a job often referred to as Drug Czar). He commented on the pros and cons of Medication-Assisted Treatment for those addicted to opioids, alcohol or other drugs and what must be done to reduce the state's problems with drugs and addiction.
Medication-assisted treatment is America's primary offering for those who are addicted. But implicit in the word “treatment” is recovery from an illness or other condition—as in "not suffering from that condition any longer." Is medication-assisted treatment really a recovery-oriented therapy? Or is its primary role preventing a person from relapse and overdose? These are questions those involved in addiction recovery should be asking.
In our interview with Dr. Amerling he expressed concerns about the pharmaceutical industry's dominance over medicine, the limitations of evidence-based medicine, and the use of medication-assisted treatment in addiction medicine. He also criticizes medical schools for compressing basic sciences and promoting arbitrary guidelines over critical thinking. Dr. Amerling advocates for physicians to take back their authority, prioritize patients' lifestyle choices and abstinence in addiction medicine, and to avoid over-reliance on pharmaceuticals.
Government agencies like the Substance Abuse and Mental Health Services Administration, the Department of Health and Human Services (HHS) and the National Institute on Drug Abuse (NIDA) are continuously involved in setting the standards for treatment of addiction. They publish guidelines for both drug rehab facilities and those seeking rehab. Therefore, the exact wording of their guidelines is of utmost importance. A subtle shift could result in unintended and undesirable changes in treatment.
In March 2020, Stanford Medicine News Center released a report addressing that question. A Stanford researcher and two collaborators conducted an extensive review of AA studies. Their findings stated that the AA fellowship helps more people achieve sobriety than therapy does.
Globally, the majority of mental health care continues to be provided in psychiatric hospitals, and human rights abuses and coercive practices remain all too common. WHO’s new “Guidance on community mental health services: promoting person-centered and rights-based approaches” further affirms that mental health care must be grounded in a human rights-based approach.
Yet the evidence that the medications improve outcomes is murky. And it is countered by other studies suggesting that maintenance on the drugs may actually worsen outcomes and even cause brain atrophy, though these findings have been debated. The area is devoid of conclusive science, a failure that is a prominent part of a wider problem in biomedical psychiatry: its lack of progress in treating serious conditions, or even precisely diagnosing and comprehending them. “Something has gone wrong in contemporary academic and clinical psychiatry,” a 2019 lead opinion piece in The New England Journal of Medicine stated. “We are facing the stark limitations of biologic treatments,” it argued. “There is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders.”