Pubdate: Sat, 01 Dec 2012
Source: Vancouver Sun (CN BC)
Copyright: 2012 The Vancouver Sun
Contact: http://www.canada.com/vancouversun/letters.html
Website: http://www.canada.com/vancouversun/
Details: http://www.mapinc.org/media/477
Author: Lorne Hildebrand
Page: C9
Referenced: http://www.mapinc.org/drugnews/v12/n563/a03.html

ADDICTS DON'T NEED A NEW DRUG

THEY REQUIRE SUPPORT TO A NEW WAY OF LIFE

I read with interest Evan Wood's opinion (Vancouver Sun, Nov., 3,
2012) of a new drug, unavailable in Canada that could aid in the
battle against addiction. While I would love to be able to support the
notion that Vivitrol (naltrexone) will be a huge asset in the fight
against addictions, I am highly skeptical.

In my experience as executive director of Edgewood, one of North
America's most respected addiction treatment centres right here in
British Columbia, we have yet to find anything that is as effective as
well-structured, long-term, abstinence-based residential treatment. No
pill, injection, short-term detox or therapy-of-the-month has had any
lasting benefit for the majority of substance-dependent people and
their families suffering from this disease.

In his article Wood states, "Vivitrol reduced heavy drinking in
alcoholics by 25 per cent." I find no comfort in the thought that an
alcoholic might only drink three out of four days, or cut back from 40
ounces of Scotch daily to 30 ounces. The terrible impact to an
alcoholic's health, their family and loved ones involved, will not be
significantly reduced by a 25-per-cent decrease in their consumption.
An alcoholic advised by his physician that he will die if he takes
another drink, will still die at 75 per cent of his drinking.
Absolutely there is a critical role for physicians, psychiatrists and
a wide range of mood stabilizing medications in the treatment of
addiction. But our experience is many physicians do not fully
understand the disease of addiction. In fact, most get very little
training in it. It seems treatment often includes substituting one
chemical for another. For example, Methadone, an opiate initially
developed as a pain killer, may indeed reduce some harms! . It is
however, still an opiate. I believe the goal should be to have people
come off opiates completely. And, don't be fooled by the notion that
opiate addicts never get clean. Many who have come through Edgewood
for treatment for their addiction have remained clean for years.

Edgewood has three full-time, physicians who specialize in addiction
medicine. We could not do proper treatment without them, but they are
just part of a multi-disciplinary team that includes addictions
counsellors, nurses, dietitians, fitness specialists, spiritual
advisers and other staff.

It may surprise you to learn that the vast majority of actively using,
substance-dependent people hold down full-time jobs. Yet discussion
and proposed solutions are often focused around addressing Vancouver's
Downtown Eastside issues. While a case can be made for medications
such as naltrexone being prescribed for an at-risk population, it
should not be assumed that this is the solution for the vast majority
of Canadians suffering from the disease.

Post-treatment strategies or "aftercare" plans may include
anti-psychotic or anti-depressant medications, but in most cases, they
do not include anti-addictions medicines. Remember Antabuse? The drug
caused a mild to severely unpleasant reaction when alcohol was
consumed. It also was touted as the answer to alcoholism. Perhaps good
in theory, but in reality the alcoholic, so driven by the disease,
would drink through the sickness or stop taking the medication. It is
now rarely used.

Rather than creating a reliance on another drug to achieve sobriety,
we need to encourage a new way of life, a new emotional reality and
connect people to a strong support system that will keep them from
using.

The questions we need to answer are whether society wants to invest in
the long-term costs of properly treating this disease and whether
substitution therapy or any drug therapy, as quick treatment is an
acceptable solution?

My answer is that many of the most challenging people we have worked
with, in the direst of circumstances, have responded to
abstinence-based treatment. They have regained their lives, their
jobs, their families and their sense of self-respect and self-worth.
They are wonderful human beings in recovery, a pleasure to know and
befriend. I am not convinced medications like Vivitrol will achieve
those same results.

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Lorne Hildebrand is the executive director of Edgewood Addictions
Centre in Nanaimo. For more information see www.edgewood.ca
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