Last week we discussed our friend “Bob” and his realization that there are recovering people all around him and that he been previously unaware. We wondered why it is that we have a general awareness of early recovery but know much less about mature recovery. This week we discuss what long term, mature recovery looks like. The reason Bob does not know about his friends and colleagues is that they have successfully treated this chronic disease substance use disorder.

Most of us work, play, and worship alongside someone in long term recovery and we do not know it about them. It is very common for us to realize that someone is in the early stages of recovery so why do we not know about those in long term recovery? They were once those in early stages after all. This begs the question of what mature recovery looks like. Lets get there through two steps. Today, what are the precedents that cause people to be cautious about declaring their recovery status? Why do we know much more about early recovery yet less about mature recovery?

First attempts at recovery from substance use disorder often result in relapse. This is devastating to the addict and to their loved ones. However, relapse is a part of treatment for chronic diseases and not just substance abuse but type II diabetes, heart disease, and asthma. While we do not think that one should just accept relapse, it is also not the end of recovery but for many the beginning of reinvesting in recovery.

After 200 years of discussing substance use disorder in moralistic terms, and seventy years after the American Medical Association declared addiction a disease, we might think that these stigmas are gone. Sadly, remarks from very public people show us that we are wrong. Thinking of addiction as a moral failing continues. This stigma exacerbates the problem by retarding treatment. It is well time we got over this stigma

Those who lament NIH recommendations on responsible or moderate alcohol use on economic grounds are missing the point. The science is clear that alcohol is a harmful drug that is misused by far too many. At the same time, prohibitionists are pursuing a strategy that we know will not work. The middle ground is responsible drinking. Sadly, at least 50 million Americans over use every month. We should not argue for a substance that kills 178,000 Americans every year because it is good for the economy.

Weight Watchers’ filing for bankruptcy protection resulted from many factors but most acutely from the weight loss pharmaceuticals GLP-1. What implications does the evolution of pharmaceuticals that may come for substance abuse and addiction portend for Twelve Step programs such as Alcoholics Anonymous and Narcotics Anonymous?

Drug overdose deaths have declined by 26.9%. The Centers for Disease Control attributes this reduction to availability of treatment, enhanced interdiction of drugs at the border, and the availability of Narcan that can reverse the effects of certain drugs. Treatment availability has not increased and is woefully inadequate regardless. There has been an increase in arrests for smuggling at the southern border but there is no data saying that the volume of drugs has decreased. Of these arguments the availability of Narcan is the most likely element. Yet, the recently passed House Bill would all but eliminate federal support for the availability of this life saving option.

Addicted Newborns

Estimates are that every year 300,000 American newborns have been exposed to drugs of addiction during pregnancy. 32,000 are born in drug withdrawal. This cruel beginning involves use of similar drugs shortly after birth to avoid seizures and the pain from withdrawal. Adverse outcomes during childhood and adolescents have been well documented. The long term costs to the nation are just now being studied but are predictably damaging.

Clinical Pathway To Recovery II: Pharmacology

In 1966 the discovery of methadone as a pharmaceutical for use with heroin addiction started the search for pharmaceutical solutions to addiction in America. Progress has been limited for several reasons but today there are several drugs in increasingly widespread use. Today we discuss those drugs, their potential and their limitations

Reviewing the Clinical Pathways to Recovery in this week’s article. The Clinical Pathway may be divided in Pharmacologic Approaches and more traditional Psychotherapy Approaches. Today we discuss the psychotherapy considerations. In the main, we believe that these are positive developments, many empirically tested, and offer evidenced-based interventions that have the potential to expand treatment to more than the 20% who currently find that relief.

Recently we discussed Secretary Kennedy’s proposal for therapeutic communities. We did not minimize those approaches but expressed concerns that this promotion, not unlike other efforts by the Secretary, might interfere with progress on evidenced-based treatments. We noted three pathways to recovery. Last week we discussed self-managed approaches.  This week we discuss so-called non-clinical pathways.

The Recovery Research Institute defines three general recovery pathways. Perhaps it will be instructive for the general public to review them over the next few weeks. The “Self-Managed Pathway” is in some respects the oldest and in others the newest approach. While we applaud this new thinking, we also recognize concerns

Given that Secretary Kennedy attributes his recovery from opioid addiction to twelve steps and a belief in God, his promotion of “drunk farms” is curious. On the other hand, his frequent criticism of other, evidenced-based treatments in medicine might suggest that he would be supportive of these back to earth, therapeutic communities. We do not discount these rural community approaches but suggest that they should not come at the expense of continuing research and application of evidenced-based approaches that have emerged and are under study today.

We are occasionally asked, “what would you choose to pursue if we could do only one thing to impact drug abuse in America and its negative effects?”.  The answer; double down on tobacco cessation. Smoking remains the leading cause of preventable death in America killing 480,000 Americans every year. That compares with 178,000 from alcohol and 105,000 from other drug overdoses. Nicotine, delivered by smoking tobacco is by far America’s most deadly drug