The posts answered a message from a practitioner who said "I work as the Medical Director at an "abstinent based" facility. I am Board Certified in Psych and ASAM certified... I am struggling to accept the abstinence based treatment philosophy." In responding to this message, ASAM said (among other statements) that, "Patients appropriately taking a physician prescribed medication are abstinent from their substance of misuse."
President Joe Biden sent his Administration’s inaugural National Drug Control Strategy to Congress at a time when drug overdoses have reached a record high. The Strategy delivers on the call to action in President Biden’s Unity Agenda through a whole-of-government approach to beat the overdose epidemic. It proposes targeted actions to expand access to evidence-based prevention, harm reduction, treatment and recovery services while reducing the supply of drugs like fentanyl.
The typical coverage of addiction treatment and recovery tends to obscure the fact that many people recover from addiction. While the pain and anguish experienced by the families and friends of those who do not recover is undeniable, it is likewise undeniable that many do recover. To the casual observer, who only follows popular depictions, this might not be apparent.
The study is titled: Natural recovery from alcohol and drug problems: methodological review of the research with suggestions for future directions and published in PubMed.gov. Aims: The methodology of studies that reported data on individuals who recovered from an alcohol or other drug problem (cigarette smokers were excluded) without formal help or treatment were reviewed. Conclusions: Based on this review, future natural recovery studies should: (a) report respondents' demographic characteristics at the time of their recovery; (b) describe respondents' pre-recovery problem severity; (c) explore in some depth what factors, events or processes are associated with the self-change process; (d) provide corroboration of respondents' self-reports; (e) examine factors related to the maintenance of recoveries; (f) conduct interviews with individuals who have naturally recovered from cocaine, marijuana and polydrug abuse; (g) include a second interview at a later time to examine stability of natural recoveries; and (h) require a minimum 5-year recovery time frame.
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.
Per the article, the most common approach to recovery is natural recovery. Citing a report from the National Institute on Alcohol Abuse and Alcoholism, the article defines natural recovery as recovery that occurs without treatment or support groups (NIAAA, 2012). When people recognize the cost of their addiction exceeds the benefits and correct this, they become the "heroes" of addiction recovery. The articles notes that we don't hear about these folks too often. Specifically, it proposes that there four key ingredients in any successful recovery process. These are 1) humility, 2) motivation, 3) sustained effort and 4) the restoration of meaning and purpose. These are discussed in detail in the article.