Simon Casey Ph.D., LADC, CEDS

For many years, treatment of addiction has been focused on providing various treatment modalities to achieve sobriety. As our understanding of substance misuse disorders evolved based upon medical research and scientific data, the treatment community is still struggling with the concept of recovery. Unfortunately, most treatment facilities as well as therapists, see sobriety as an end all-not part of the process.

Quite often when a patient relapses, the immediate response by the therapist or the center is blaming the patient. Here are some statements collected from patients: “well you were not going to your meeting regularly,” or “why did you stop calling your sponsor,” and, “you need to come back to the center, obviously you need more therapy.” The before mentioned statement therapists make to patients do not necessarily address or admit why or how previous therapy has failed the patient.

Therapist and centers often look at patients as failures; since the established standards in the industry tends to be rigid, “of all or none”, in other words: you are either sober or you are an active addict. In many ways, the bar is set rather high by the therapeutic community-not recognizing the fact that people considering treatment often bring multiple issues to the table. Some examples include: dual diagnosis, multiple addictions, trauma, etc.

The illness of addiction, especially opioid addiction, is complex in many ways and requires multiple therapeutic approaches over extended periods of time. In an ideal scenario, a wide-range of treatment options, including medication-assisted treatments (MAT) would be available to all patients with opioid dependency and other substance use disorders.

However, not every person with an opioid misuse issue requires to be treated with MAT. The treatment protocol best suited for a patient should be left to the patient and their healthcare provider. If and when a person and their healthcare provider determine that MAT is the chosen treatment protocol, it should be readily available rather than making the patient jump through multiple hoops to get it.

For example, current policies in the criminal justice system, along with under educated judges with limited understanding of opioid addiction, dual diagnosis and recovery, prohibit the use of MAT. They would rather put addicted people behind bars, without a wide range of treatment options, including the use of MAT, then ask themselves: why is there a high recidivism rate and is the criminal justice system financially troubled because of the recidivism.

The insurance companies are not any better. They offer insurance plans that make it more and more difficult to get approval for addiction medications; or plans that exclude methadone maintenance therapy entirely from coverage. The attitude from insurance companies is that the patient must exhaust all available approved treatment modalities and fail before they can receive MAT.

Can you imagine telling a diabetic patient that unless they go into a diabetic coma while receiving other treatments, they will not be able to receive any medications, despite his doctor insisting otherwise. Whether it is the criminal justice system or third party providers, state and local governments are consistently failing to recognize that millions of people who are suffering from opioid misuse can be helped, if these agencies would incorporate some common sense into their agenda.

Most of the stigma attached to MAT is created in the addiction field, largely due to ignorance with such statements as ‘medication-assisted treatment is substituting one addiction for another’. Medication-assisted treatment is absolutely not substituting one addiction for another. Many treatment facilities resist suggesting the use of MAT since it conflicts with their philosophy. What ever happened to “do no harm”, and putting the patient’s best interest first, instead of money or philosophy. The field of addiction has advanced in many ways and as health care providers; it is our responsibility to keep up with the changes and to promote best patient care, period. This also includes reducing the stigma that keeps people from seeking help or staying in treatment which is vital to the increased use of MAT.

People need options that can be tailored to their specific treatment needs, just like we try to give them for other health issues. Unfortunately, state and local governments are responsible for providing treatment, prevention, and recovery efforts for substance abuse disorders (a.k.a. addiction). But they have tragically been overlooking a key element that can help millions of people affected by opiate and opioid addiction: prescription medications!

This is the equivalent of telling a cardiac patient that unless he has a heart attack while receiving other treatments, he cannot receive the medications his doctor has said may save his life. Some of these plans exclude methadone maintenance therapy entirely from coverage.

Given the current trends in society, it is time for us as professionals to put down the barriers and provide a responsible and ethical medically assisted treatment for those who are suffering from a chronic illness.

Dr. Casey is renowned as an expert in addiction medicine, psychology and medically assisted treatment (MAT), and in addiction counseling. He is a successful public speaker in this field, speaking nationally and internationally, as well as delivering seminars and providing training. Dr. Casey has been practicing for more than 25 years and is currently serving as the Executive Director at Access Recovery Solutions in Delray Beach, Florida.