CNN.com is reporting new research that shows two medications, naltrexone and topiramate, have a significant impact in the treatment of alcoholism. You can read that article here.
Whenever something positive happens in the mental health world, the critics come out of the woodwork. The sad reality that mental health practitioners aren’t all on the same page rears its ugly head as well. When Cognitive-Behavioral Therapy was demonstrated to successfully treat many cases of depression, the Freud fawners called the treatment superficial and “not getting to the root of the problem.” When medications eliminated many of the symptoms seen in various forms of Schizophrenia, nay-sayers argued that the condition is a permanent one and therefore the patients couldn’t have been schizophrenic in the first place if they weren’t psychotic now. And now the Betty Ford Center is saying that these pills are an overly simplified way of treating addiction and probably want no part of the medication regimen. Are they right? Yes and no.
Let’s be crystal clear about one point: there is not a single form of talk therapy, behavior therapy, medication, or any other intervention that will be successful at treating every person and/or every condition. Lexapro does not work for everyone with depression despite its extensive use and research backing. Psychotherapy doesn’t eliminate Panic Disorder in every patient despite its solid track record. In other words, when you meet a “purist” in the mental health field, run for the fucking hills. These people are an embarrassment to the profession. I once met an acupuncturist who swore that there was nothing she couldn’t treat: headaches, acne, Irritable Bowel Syndrome, AIDS, various tumors, Leprosy, Small Pox, Scurvy or even a broken leg. How pins can eradicate a deadly virus is something she couldn’t explain all that well.
Is alcoholism a complex condition? Of course it is. It’s not solely about abstinence. Those who are addicted have a relationship with alcohol and that needs to be understood and altered. This is where the term “dry drunk” comes into play and it has merit.* Those who simply stop the behavior are at a greater risk of relapse than those who are getting help. Whether that be a 12-Step program or something else, those who are exploring the intricacies of their condition are posturing themselves to be much healthier people over the long haul.
That said, if the medications described in the article are helpful to even a single person whose life is/was being destroyed by alcohol, why not embrace it as part of an overall treatment package? The studies are showing that it works and, while the man in the piece could probably benefit from a support group or other type of intervention as well (especially now that he is sober), he is leading a much happier and productive life. Is this man at risk for relapse? Could he engage in Symptom Substitution (i.e., replacing alcohol with another addiction such as gambling, spending, etc.)? Of course these are all possibilities. This is why the pharmaceutical companies shouldn’t be pushing these medications as the end all, be all of addiction work. But the stark, positive reality is the drug has changed his life and is advancing the field. Any professional who wants to take that away isn’t simply a contrarian, he’s a sadist.
When practitioners attempt to push patients into a specific treatment option because of a “one size fits all philosophy,” they aren’t doing it out of altruism. Such logic is based on ignorance and stubbornness. If you’re one of these purists who foist your single method onto your patients, get out of the field now. You’re not only annoying me, but you’re hindering the people who don’t fit your mold. You’re retarding the field’s progress, and that’s simply unacceptable.
* “Dry Drunk” is a term used in Alcoholics Anonymous to describe an addiction sufferer who isn’t consuming alcohol, but hasn’t addressed his/her relationship with the substance, the inherent powerlessness that comes with addiction, as well as the impact of alcohol on his life and the people around him. In other words, A.A. members view this person as someone who is abstinent but still carries the problems and issues of an addict.