My decision to use medications for withdrawal management and beyond to treat patients who suffer from substance use disorders is based in part on their consistent feedback about how they benefit from this clinical approach.
Many patients I have treated during the past four decades credit medications with having increased their ability to resist returning to addictive substances. They also report a dramatic reduction in cravings, which – even more than withdrawal symptoms – can lead to relapses.
I repeatedly hear reports that buprenorphine (the brand name is “Suboxone”) makes my opioid addicted patients feel “normal” rather than high. In my experience, I have found that it enables them to do the difficult psychological work involved in recovery in a way that I rarely encountered before that medication became available in 2003. This is one key reason why I promote medications for withdrawal management.
Medication is particularly important for those people who choose to start treatment in an outpatient setting. This is because of their daily exposure to reminders about the substances as well as to the actual presence of substances at a time when they are just beginning to learn how to live without them. It can also be useful during continued treatment after discharge from inpatient care.
Addictions are best understood as chronic illnesses, similar to hypertension and diabetes, for which there is no cure. If, however, they are well-managed— medications being an important part of this management — acute crises can be minimized, and the quality of life can be excellent.
However, it is important not to over value medication. The available medications for withdrawal management play a supplementary role and can be compared to the use of anesthesia. Surgery has been done without it, but most people would not make that choice. On the other hand, to have the anesthesia without the surgery would be pointless.
To be effective, medications must be used properly, which means:
- Actively collaborating with patients and carefully supervising them
- Following accepted dosage guidelines, individualized to each patient
- Prescribing in a way that minimizes diversion
- Continuing them for as long as they are useful to the recovery process and then carefully monitoring their discontinuation
Patients should not be required to take medications for withdrawal management against their will, but to not offer them the choice is becoming a questionable medical decision.
I would be interested in learning more about your experiences in using medications beyond withdrawal treatment. I believe this is an area in which the clinical community will need to continue having ongoing dialogue.
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