The New York Times today includes a moving personal story about overcoming opioid addiction. But while it describes one woman’s triumph, it also illustrates something the Institute of Medicine calls a “quality chasm” between effective addiction care, as supported by scientific research, and the treatments people actually receive.
Journalist Kim Lute writes:
It was my first day at the Peachford rehab clinic for addiction to the prescription painkiller tramadol. I wound up spending 72 hours detoxing in a sparse room where everything but a Bible was bolted to the floor. The blinds were drawn tight against the sun — which, along with just about everything else, inexplicably offended me to the point of tears.
Every nerve ending in my body felt electrified. When I broke the clinic rules by trying to shave my legs on a Monday instead of a Tuesday, I was treated like a criminal, so irresponsible I couldn’t be trusted alone with shoestrings or sharp objects.
Lute had become addicted to painkillers following two liver transplants and bowel surgery. (It bears noting that while Lute’s history is presented as being typical of those addicted to pain medications, in fact, the overwhelming majority of opioid addicts start out as recreational drug users; conversely, the overwhelming majority of pain patients — 97% or more — never become opioid addicts.)
Unfortunately, key aspects of the addiction treatment Lute described were outdated and have been shown to backfire in studies. Research shows, for example, that enforcing strict rules like allowing shaving only on particular days only increases dropout. And “being treated like a criminal” in response to breaking those rules or, as Lute writes, being counseled by someone with “her lips pursed in disdain” isn’t helpful either. Not one study has ever found that disrespecting or humiliating people with addiction is effective treatment. Indeed, confrontation and humiliation actually increase relapse and dropout.
Lute writes that she waited two years to get treatment even after it was clear she needed it:
The shame and guilt, coupled with the fear of having to withstand the pain of withdrawal, sapped what little resolve I had left to reach out for help.
Often, the disrespectful aspects of addiction care add to addicts’ fears of treatment. Only after having “withstood” three days of what sounds like shaming and outdated inpatient rehab care was Lute prescribed the opioid maintenance drug Suboxone (buprenorphine), which is known to be effective.
Although research shows that empathetic and supportive care is far more effective for overcoming addiction, many addicts don’t even recognize that they deserve kind treatment, as Lute’s story shows. Indeed, Lute’s account of her treatment is adulatory; she was not writing an expose. After describing the shaving incident, she concedes, “In truth, I had been acting foolishly.”
But that’s no reason to accept being dehumanized. People with addiction are typically seen as avoiding help because they are “in denial” or because they are having such a great time getting high that they don’t want to stop. In reality, many addicts avoid treatment because they know it will heap further humiliation on them.
Over the last 10 years, the National Institute on Drug Abuse and the Substance Abuse and Mental Health Services Administration have launched several major “research into practice” efforts to attempt to improve treatment and get care to more people who need it. Clearly, there’s still a long way to go.