Since the birth of modern American substance abuse treatment over 50
years ago with the introduction of Hazeldenâ€™s Minnesota Model, the U.S.
addiction treatment system has emerged as worldâ€™s gold standard. Today,
our private treatment facilities attract people from the far corners of
the earth seeking a new life based on sobriety and abstinence from mood
Underlying the integrity of U.S. treatment efforts has been the fieldâ€™s alliance with the principles of the 12 Steps of Alcoholics Anonymous, forming as they do the underlying philosophical basis of the Minnesota Model, which itself has, in one form or another, been adopted by the vast majority of treatment centers nationwide. But thrown into the mix lately have been efforts to define the end goal in treating addiction more broadly and less rigorously than total abstinence, a major impetus behind which has recently begun to come from the growing use of pharmacotherapies in the treatment of substance abuse.
Now, to be sure, the entrance of pharmaceutical companies into the addiction treatment arena, accompanied by their research efforts into understanding addiction as a brain disease, is a development that should be wholeheartedly welcomed. The new pharmacological treatments that will come out of this research will no doubt provide a powerful boost for better addiction treatment outcomes, which are sorely in need of improvement..
But in addiction pharmacotherapy clinical trials, abstinence is rarely the end goal of the trial, often being just one of many things measured, including the number of drinking days, the number of heavy drinking days as well as just overall â€œgood clinical outcomes,â€ among other things.
Dr. Edward Nunes, a clinical psychiatrist at Columbia University, told the New York Times recently that these more moderate measures of treatment outcomes are being increasing accepted, partly based on what is being touted as success in drug clinical trials.
Certainly, improvement, not just abstinence, has been measured in outcome studies done by treatment providers attempting to assess the success of their psychosocial approaches, including Hazelden itself. But the treatment industry must be on guard against ever accepting things like â€œfewer drinking daysâ€ as an acceptable end goal of treatment.
And to their credit, those currently offering drug-based treatments for addiction, companies like Cephalon, Forest Laboratories and Hythiam, are all being highly responsible in their sales efforts. They are marketing their products principally as ways to boost outcomes in combination with effective psychosocial care, with the most desirable end goal always being abstinence.
There are many individuals who have managed to moderate their drinking or drug taking in one way or another, but relatively few of these types ever wind up in treatment for addiction. For the vast majority of those in treatment, the possibility of controlled using is absurd and dangerous, with abstinence the only viable answer.