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Is Buprenorphine Treatment For Addiction?

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Title: Is Buprenorphine Treatment For Addiction?


1
Is Buprenorphine Treatment For Addiction?
  • Ken Roy, MD, FASAM
  • Addiction Recovery Resources of New Orleans
  • River Oaks Hospital
  • Tulane Department of Psychiatry
  • www.arrno.org
  • kenroymd_at_cox.net

2
The Goal of Treatment
  • personality change sufficient to bring about
    recovery from alcoholism (Addiction)
  • All you have to do is stop using and change
    everything about yourself.
  • Treatment occurs in a chronic medical management
    model (not a surgical model)

3
The Tasks of Treatment
  • Identify and dismantle Denial
  • Identify developmental tasks disrupted by using
    and navigate those tasks anew
  • Identify problems caused by multigenerational
    Addictive Disorder and teach/role model healthy
    nurturing
  • Teach psychopharmacology of Addiction and use
    avoidance strategies (cravings, etc.)

4
Treatment
  • Is defined in ASAM Patient Placement Criteria
    multiple levels of care
  • Often embraces twelve-step recovery but is not
    twelve-step recovery
  • Requires a community to help patients develop a
    Family of Choice
  • A year or more of professional treatment is
    associated with enhanced recovery rates

5
Barriers to Effective Treatment
  • Psychopathology
  • Subacute withdrawal symptoms
  • Medical co-morbidities
  • Pathological support systems
  • Poverty of resources

6
Steps
  • Detoxification
  • Necessary but NEVER sufficient
  • Multidisciplinary assessment
  • If all you have is a hammer
  • Stabilization
  • Necessary for focus on recovery
  • Initiate psychosocial treatment
  • Individualized level of care

7
Subacute Withdrawal
  • Often lasts a year or more
  • Relief often necessary to stabilization
  • Often is best achieved by the use of medication,
    including opioid agonists
  • Programs MUST be supportive of or provide such
    treatment
  • Professionals MUST provide feedback to treating
    prescribers

8
Psychopathology
  • MUST be identified
  • MUST be treated
  • This often requires the use of medication
  • Programs MUST be supportive of or provide such
    treatment
  • Professionals MUST provide feedback to treating
    prescribers

9
Medical Co-Morbidities
  • May be the stimulus for initial use
  • Pain is the largest problem
  • Often requires medication management, including
    opioid agonists
  • Programs MUST be supportive of or provide such
    treatment
  • Professionals MUST provide feedback to treating
    prescribers

10
Pathological Support Systems Poverty of
Resources
  • Attention largely determines level of care
  • Attention may determine recommendation for
    agonist therapy for opioids
  • Attention to the support system is necessary to
    the recovery of the individual
  • Family/support system treatment is key to
    recovery
  • Ongoing professional support system contact is
    key to recovery

11
Summary
  • It is not possible to identify something called
    pure addiction and only treat that
  • Treatment will require attention to the whole
    person and all of their issues
  • This can and should be integrated such that the
    use/non use of medication is an individualized
    decision as part of a comprehensive treatment plan

12
Recommendations
  • The use of medication for subacute withdrawal and
    bioenvironmental psychopathology should be
    welcomed in treatment programs
  • Buprenorphine/Methadone maintained patients
    should be integrated into comprehensive treatment
  • Naltrexone, Acamprosate, Disulfiram,Topiramate
    and pipeline drugs should be used when indicated
  • There is no ethical or philosophical conflict in
    this approach
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