As an international network of historians and social scientists who study approaches to the management of drugs across time and place, we have noticed the effort to redefine addiction as a chronic, relapsing brain disease (CRBD). The CRBD model is promoted as a route to destigmatize addiction and to empower individuals to access treatment that works within that model’s terms.1 CRBD usefully recognizes that brain-based neural adaptations place individual brains in chronic states of readiness to relapse. But brains are housed inside of people. Substance use is biological, social, and political; our concepts and approaches to complex questions surrounding substance use must be, too.2,3 By overlooking the sociopolitical dynamics and inequalities bound up with substance use, the CRBD model can paradoxically further marginalize people who use drugs by positing them as neurobiologically incapable of agency or choice. We are concerned that the CRBD model paints drug users as individuals whose exclusion from social, economic, and political participation is justified by their biological flaws and damaged brains.
Buprenorphine is approved in many countries for the treatment of opioid use disorder (OUD), but problems with diversion and abuse exist. There is a need to understand how and why patients use diverted buprenorphine, and whether barriers to access contribute to illicit use.
58% reported a history of diverted buprenorphine use, with 37% never receiving a prescription. Approximately one-half (52%) reported using buprenorphine to get high or alter mood, but few (4%) indicated that it was their drug of choice.
What is a mind? Defining the concept is a surprisingly slippery task. The mind is the seat of consciousness, the essence of your being. Without a mind, you cannot be considered meaningfully alive. So what exactly, and where precisely, is it? This new understanding has potentially broad implications for the field of addiction and treatment.
Our treatments for this polydrug epidemic fall into 2 distinctive categories. One started at the Hazelden Foundation in Center City, Minnesota in the late 1950s, with a 28-day residential program followed by patients going to Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) and other recovery support for years, often for their lifetimes. This approach is common in private, often insurance-funded, addiction treatment programs.
The other approach is medication-assisted treatment (MAT) which started with methadone in the late 1960s. MAT now includes buprenorphine and naltrexone. MAT is the major strategy for most public sector addiction treatment programs.
Those two approaches often battle one another in this war between treatment modalities. That war is destructive and unnecessary. It diminishes both approaches. The big losers are our patients and the public health.
This article was authored by Dr. Stanton Peele, a psychologist who has pioneered, among other things, the idea that addiction occurs with a range of experiences and a recognition of natural recovery from addiction. The article highlights several stories of real people who have recovered from drug addiction without any specific interventions. He makes the point that we rarely seem to hear these kinds of stories in the major media, certainly at the level of public debate.
Peele mentions the study of Vietnam veterans experience with heroin addiction where over 90 percent of veterans who reported being addicted to heroin in Vietnam ceased their addiction within a short period on their return, almost always without treatment. The Vietnam experience demonstrates that some people can move past addiction when their surroundings improve, that they are no more likely to use one drug compulsively than any other, and that having fewer positive life options obstructs natural recovery.
The authors of the article are Hal Arkowitz and Sscott O. Lilienfeld serve on the board of advisers for Scientific American Mind. Arkowitz is a psychology professor at the University of Arizona and Lilienfeld is a psychology professor at Emory University.
The authors conclude that more and better research is needed on the potential for self-change to conquer problem drinking and other addictions. Studies suffer from differences in the definitions of important terms such as “addiction,” “treatment” and “recovery.” We also do not know of any studies on self-change with prescription drug addiction.
In a July 2019 interview, two faculty of Boston University proposed that buprenorphine start being distributed without a doctor's prescription, with only a pharmacist’s approval. Easier access means that anyone currently struggling with opioid addiction could obtain this drug whenever they chose. But it also means easing restrictions on a drug that is currently abused, sold on the illicit market and addictive. It's time to look at who might profit from their recommendations.
Tens of millions of Americans have successfully resolved an alcohol or other drug (AOD) problem using a variety of traditional and non-traditional means. Findings suggest a need for a broadening of the menu of self-change and community-based options that can facilitate and support long-term alcohol or other drug (AOD) problem resolution.