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

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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)

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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.)

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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

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Barriers to Effective Treatment

• Psychopathology
• Subacute withdrawal symptoms
• Medical co-morbidities
• Pathological support systems
• Poverty of resources

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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

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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

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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

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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

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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

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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