MAT or Abstinence

Joe Schrank: MAT or Abstinence and Why The New York Times Got It Right

The end of the year signals many people to reflect on their past and ponder their future. It’s an element of drug and alcohol addiction recovery that’s practiced every day in those fighting their own battle in overcoming the disease. The New York Times most recent article about opposing methodologies in addiction treatment will not only get traction and raise public debate, it got my attention. Here’s why.

How We Judge Addiction and the Non-Secular View of Recovery

The New York Times article gave a long form and deep dive into the “Hatfield and McCoy” stalemate of abstinence vs. medication assistance. Each side, though well meaning, has its warts.

Abstinence May Not Always Be Holistic

The abstinence side is a wonderful idea because it’s logical. If drugs are the issue, eliminate the drugs. For decades, we have been told drug use in and of itself is a crime or pathology, forget the notion that alcohol somehow escapes that characterization.

Advocates of 12-step life will tell you that a “spiritual shift” is the “only solution”. AA is woven into the fabric of American life; it’s the entity that’s known and familiar. Mention AA and someone is likely to say “Oh my Aunt goes to that,” or some other familiarity that rings endorsement and advocacy. A spiritual solution to a substance misuse issue is great, unless it’s not and then it leaves people searching for another solution, frustrated and angry. And well, they should be.

The $40 billion rehab industry has a success rate of almost nil, an abysmal failure by almost any metric, except for the people who have had their lives saved by their active participation in the subculture of 12 steppers.

Why Medication Assistance is a Battleground in Drug Rehab Industry

There are other crowds out there, harm reductionists, medication assistance advocates, drug user rights groups who look at the solutions to addiction recovery differently than the old school, though notable, 12-step believers.

What medication-assisted treatment (MAT) does have on its side is efficacy. In simplest terms, take two groups of 100 opiate-dependent folks. Treat participants in one group with MAT and the other with fundamental AA dogma. Who’s alive five years later? It’s not the AA group.

So what is the real issue here? Everybody is right and everybody is wrong. There are, without question, millions of people who have found aid and comfort in AA life. And to the contrary, there are millions who have found its basic premise to be cult like and ineffective.

Success in Addiction Treatment Lies in Self-Determination

If there are people who have found recovery through abstinence and others who live it day-to-day with the support of an individualized MAT program, who can say what is definitively right or wrong? There isn’t a solution to the argument other than a foundational social work theory: The individual has the right to self-determine. In other words, the answer is simple. The best solution is the one that’s right for you.

The Benefits of Choice and Exposure

MAT or Abstinence in Recovery

In the quest to finding the right addiction treatment, success rates go more in your favor when you are given more options in the types of programs available. It all comes down to choice and exposure. All people seeking help should be given all of the options available to treat a substance misuse issue. If we say “addiction is a disease”, we must treat it as one.

If someone receives a cancer diagnosis, the patient is informed of various options to slay that beast. If someone seeks addiction treatment, more than likely they will be told “you have to be treated as I was,” well-meaning or not, there is an air of evangelicalism with that kind of rehab culture.

The vast majority of rehabs are run by other recovering people with little or no clinical training. With a malady as difficult as addiction, that’s just not good enough, especially as the overdose death rate climbs to unconscionable levels. (Side note: Alcohol kills twice that of overdoses).

Is There a Middle Ground that Works?

I’m not expecting to change the minds of those who are steadfast in their personal convictions about this subject either way. But for those still sitting on the proverbial fence, you might be thinking, “Do I have to join a camp?”

The truth is that spirituality and science aren’t mutually exclusive. There are intersections of both concepts. Men and women who have dedicated their lives to intellectual inquiry and spiritual pursuit, namely the society of Jesus, the Jesuit order would say “Jesus gave us smart people to figure out medication to treat disease, who are we to reject that?” Pope Pius X issued a papal encyclical string “evangelicalism is a sin, humans have the right to determine their own relationship with God, even if it doesn’t mirror our own”. That is also true of recovery. People have to find their way, be it medication assisted, 12-step spirituality, or a blend of the two.

Remedy Recovery Provides Truly Personalized Treatment Programs

At Remedy Recovery we preach neither camp because we support the individual in a manner to help them find their own way. We educate our clients about community mutual aid organizations, one of them being AA. We support our clients in exploring that as an option for them. If their response is “Not for me,” we don’t preach or mandate but help them explore what feels right for them.

As a medicalized program, our clients receive the best possible medical care from licensed, credentialed, doctors and psychiatrists who specialize in addiction. Our therapists and social workers focus on family dynamics, trauma, individual life goals, and help clients face difficult challenges such as returning to school, ending a marriage, or clearing up a court case. We let doctors be doctors; after all, they went to medical school for a really long time and jumped many hurdles to get there.

A Final Thought

The New York Times article was correct. The addiction treatment industry and public sentiment is fracturing into tribes, but we shouldn’t. We should accept, support, and even celebrate the diversity of the human experience and know that we won’t all reach healthier versions of ourselves in the same way.

Einstein said “Everyone is a genius but a fish can’t climb a tree”.

Let’s let fish swim.