Self-esteem and Treatment

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Addiction treatment is often a very turbulent and even painful period in a patient’s life, for reasons that may or may not be directly connected to their treatment. Often patients are driven to seek treatment by a traumatic event in their lives — the death of a loved one, the “intervention” of friends and family, or legal troubles that require them to get “clean”. This
is one reason why my office will recommend counseling to those who want it, since pure medical treatment of the disease sometimes leaves behind emotional and interpersonal issues in a patient’s life that should be addressed.

Every patient’s life is different, but one problem that I see many of my patients wrestling with a lack of self-esteem. If it seems odd that self-esteem should be an issue in addiction treatment, keep in mind that, no matter what kind of treatment is used, overcoming addiction is often a long and arduous process. Even with medication — the kind of treatment that causes the least physical suffering — an addiction patient often has to
adjust their life in major ways; whether it’s finding a new drug-free social circle or dealing with the effects their illness and treatment are having on friends and family, the challenges of addiction treatment can be ongoing and severe. Without some belief in their own strength and ability to cope, some patients can find it next to impossible.

Unlike removing their cravings for addictive drugs, this isn’t a problem I can easily solve for my patients. But it’s clear to me that something needs to be done to help give addiction patients more faith in their own ability to manage their health and cope with the hardships of treatment, they need to be empowered — the same sort of general encouragement that is often available for people recovering from other diseases, like cancer, or from major surgery. It is recognized in these areas of medicine that optimism and self-esteem are valuable tools in recovery, and they are encouraged by medical personnel and by friends and family. In addiction this, like so many other aspects of care, is largely ignored, and many treatment providers still try to shame patients out of their desire to use, which only makes things worse. A person suffering from addiction will most likely try to eliminate feelings of shame and guilt by relapsing to their drug of choice, not by pulling themselves up by their bootstraps to do a better job.
Building self-esteem and self-empowerment in this patient population is a complicated and delicate process. It is best accomplished after patient’s cravings and withdrawal  symptoms have been treated with medications as the relief of these symptoms will at least give patient the ability to refrain from using. Expecting patients to refrain from using in the face of intolerable withdrawal symptoms will only expose them to another potential
failed attempt at changing their lives and will continue to pile on the shame, guilt, and feelings of helplessness and worthlessness. The current most commonly relayed message to those suffering from the disease of addiction by most treatments based on 12 step phiolosphy is still shame, guilt, and helplessness. These messages to those who are addicted must stop before we can make significant progress in treatment. As I’ve said a thousand times before, addicts are sick, not evil; and sick people deserve
treatment, not punishment.

As a physician, I sometimes find it difficult to walk the thin line between encouraging my patients to think positively about the future and giving them false hopes about what addiction treatment is currently capable of. I am also mostly powerless to help them with the consequences of bad decisions in their lives, and the patterns of bad decision-making that may have accumulated over the years of their addiction. Nonetheless, as people with a serious medical condition, addiction patients deserve the same encouragement that  cancer patients routinely receive; that they are stronger than their illness, that they can beat their condition and return to their normal, healthy lives.

Addictive Personalities

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We used to think of addiction as a moral sin — something that happened to people who were weak, or sinful, or broken in some way. Over time, this view grew into the perception of addiction as a moral failing, or some type of personal deficit that made some people become addicts and others not. The first few haphazard attempts to medically describe the disease of addiction still held onto this viewpoint, that addiction was caused by an inborn character weakness; eventually this gave rise to the idea of an “addictive personality”, a vague series of personality traits thought to cause addiction.

The concept of an “addictive personality” as a cause of addiction has been discredited for years, ever since physicians have begun to think of addiction as a physical disease and not an inbred moral issue. It became clear that certain chemicals had the potential to addict anyone, regardless of personality, and before long most serious medical  discussions had abandoned the concept of an addictive personality altogether.

Now, as we struggle with the concept of addiction as disease of the brain, those who work with addicts still have to deal with the many “bad” behaviors that those with addiction display. We have also started to realize that to some extent many people with addiction display many of the same characteristics — poor judgement, poor evaluation of risk/benefit analysis, impulsevenss, easy boredom, craving for excitement, difficulty learning new
behaviors, lying, and others.  These clusters of behaviors seem to be common to many suffering with addiction; in other words, they appear to form a pattern of behavioral symptoms that are linked to the physical disease.

Do these behaviors arise because of the addiction and the neural damage it can cause, which would make them a set of acquired cognitive deficits secondary to the development of addiction?  Or are they a set of dormant, inborn characteristics that exist in our patients that are pre-disposed to developing addictions (which we know have a genetic component)?  We don’t know the answers to these questions, and they will be very difficult to study, partly due to the complexity and misunderstood nature of addiction, and partly because it develops at a very early period of life when a person’s full personality is not yet formed. If, at some point, it can be proven that these behavioral traits come before addiction and contribute to its development, then perhaps there is a definition for an addictive personality disorder after all.

The discussion of a possible “addictive personality disorder” is not about developing a new way to label addicts, or trying to go back to the concept of addiction being some type of inbred defect. If there were a cluster of personality traits that we could recognize as being suggestive of the development of an addictive disorder, then perhaps it would lead to early
recognition of a “pre-addiction” condition that might be amenable to early recognition, intervention, and prevention. Even if we can prove that an “addictive personality” exists, it should still not be seen as a defect or a moral failing; like other potential personality disorders, it is due to factors beyond a person’s control and merits treatment, not punishment.

The brain is such a complex system that there are certainly undiscovered connections between chemicals and behavior still waiting to be uncovered. I am looking forward to physicians and patients moving forward together to advance treatment and prevention of this disease.

The Physician’s Position

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Working in the field of addiction has the tendency to put M.D.s and other health care professionals in a very unusual and often disorienting position; we are expected to give in to the instructions and demands of ‘counselors’ and other self-proclaimed addiction experts who are not professionally  or medically trained. This is often very frustrating to us when we attempt to make our voices heard. We are used to being respected for our education, the number of years that we have put into training, our professionalism, the standards we try to uphold, and our expertise regarding issues of human health and disease. Yet, in this particular field, we are often viewed by others as knowing less than the patients we treat. And it’s all because most doctors and highly-trained professionals don’t have a personal history of addiction.

I have experienced this strange anti-non-addict prejudice many times in my online discussions with representatives of 12-step programs. (In one memorable argument, I was ridiculed for having letters after my name — as though the ‘M.D.’ was a pair of mystic runes that prevented me from seeing the truth.) Trained doctors are relative newcomers in addiction-related fields. Our profession has not, historically, been the one leading the treatment of this disease. In fact, many blame us for ignoring addiction, not understanding it, offering false hopes, enabling it, or in fact being a major cause of it through our prescription pads. And while it’s true that mismanagement by uninformed doctors has been a contributing cause of addiction — particularly addiction to prescription painkillers — that is reason for more doctors to come into the field and get the education to understand this disease and its causes. Efforts to keep physicians out of addiction certainly won’t help us understand and deal with addiction as a disease.

I’ve seen it said often that “nobody understands but another addict”. This attitude does not exist anywhere else in medicine, and I am not sure where it comes from. While it can certainly be helpful and emotionally supportive to speak to someone who’s shared the same problems you have, there is a limit to this idea. Cancer patients don’t refuse to be treated by doctors who have not themselves had cancer. A patient with chronic headaches won’t storm out of a doctor’s office because the doctor doesn’t have chronic headaches and “wouldn’t understand”. Physicians are trained to be able to offer help, understanding, and compassion to patients in many different situations. In fact, a physician who has specialized in treating a particular disease may “understand” better than the patient what the disease is doing to their body, and how to fix it. Most people who have a problem are anxious to explain their problems to others, to make them understand what it is like from their viewpoint, and to seek their understanding and help. Only in this field does there seem to be this rejection of assistance from those who have not had addiction problems.

I believe that the tide is changing, and that physicians do have both a stake in this disease and some very valuable ideas to offer, which is why I write this blog. There are certainly going to be some bumps in the road, and physicians will have to prove that they are compassionate and competent in treating addiction, but there is only so much proof that can be offered. I am afraid that no amount of successful care from trained professionals will convince some of those who cling to ineffective treatment methods and are not interested in learning anything new.

Medication Metaphors

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I have many patients who have been stable on Suboxone for a long time, sometimes for years, who come to me and ask to taper off their dose in the hope that they can get off the medication altogether. I have used blood pressured medication and insulin as examples to explain why Suboxone is a maintenance medication that needs to be taken continuously, but these patients never seem convinced. They feel that they are not ‘succeeding’ or are not ‘sober’ while they are taking the medication, even if they are living full, healthy, happy lives. I’ve talked a lot on this blog about why I believe people come to feel this way, and why I disagree with their reasoning. I haven’t spent as much time talking about the reason why I try to dissuade my patients from trying to taper off. The reason is very simple: it doesn’t work.

With some medicines, tapering off is a valid strategy. Antibiotics work like catapults or bombs; they are a way to kill a large number of invading enemy organisms very quickly. Once most of the invaders are dead, the problem is over, and more antibiotics won’t do any good. There’s no point in firing weapons at an empty field with no enemy soldiers on it. After following the prescribed course, the patient can stop taking the antibiotics and return to their normal lives, feeling perfectly healthy. Other medicines, like non-narcotic painkillers, are given only for a short time because the human body can heal itself without their help. Something you would need to take painkillers for — say, a cut from a surgical procedure, or a broken bone –  will repair itself whether or not you take medication; the painkillers are only to help you feel more comfortable along the way. Once the body’s healing process is finished, there’s no need for you to feel more comfortable, so the painkillers can (and should) be stopped with no ill effects.

Buprenorphine works very differently from either of these examples. Addiction isn’t caused by any invading organism, so taking one massive dose and then stopping the medication won’t do any good. Many people seem to think that buprenorphine will work like other painkillers, and that the brain will repair itself while they take it, but for the vast majority of people this simply isn’t the case. The damage caused by addiction affects a very delicate part of the brain, which won’t heal on its own the way a broken bone will. Our current understanding of the disease of addiction is that  the damage caused by addiction is permanent, so the symptoms will also be permanent, unless they are treated by a maintenance medication like buprenorphine. 12-step and counseling programs sometimes tell their clients that the brain can repair itself after a certain amount of time and counseling, but there is absolutely no solid science to back up such a claim. As soon as a patient stops taking buprenorphine, the underlying damage asserts itself again and the symptoms return, which very often leads to relapse.

A good way to think about this is to imagine the damage caused by addiction as a leaking crack in a dam, and imagine that the dam is holding back a reservoir from flooding the town where you live. It’s fairly easy, and VERY important, to put a patch over the crack to keep it closed; if you don’t, then the water pressure will make it wider, and it will be harder and more difficult to seal up later. As long as the patch holds, life can go on as normal in the town, but the patch isn’t fixing the underlying crack or causing it to “heal” itself magically. All the patch is doing is keeping the damage from getting worse, and keeping the people in the town from suffering the consequences of a break. If the patch is ever removed, the water will immediately start leaking through again, pushing the crack wider and causing a flood.

Using this image, we can think of buprenorphine as a patch over the damaged parts of the brain, holding back the flood of symptoms, cravings, and damaging behaviors that addiction will cause if left untreated. It doesn’t fix any of the underlying damage. It only keeps it from getting worse and keeps it from negatively affecting a patient’s life. In my experience, patients who taper off their medicine because they feel that they aren’t fully ‘clean’ will suffer a relapse in almost all cases.

Providing patients with the complete truth is very important when they have questions or concerns. I always tell my patients that while it is possible for a very few people to taper off Suboxone successfully, for most people it is harmful and counter-productive, and I rarely recommend it. Understanding how buprenorphine works and what it does and does not do is essential to a comprehensive and effective treatment, and I would hope that all prescribers of buprenorphine take the education of their patients and their loved ones very seriously.

Anecdotes and Data

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Of all the people offering addiction treatment, those who are not trained professionals tend to be laypeople who have struggled with addiction problems in their own past. They may describe themselves as “ex-addicts” or still in recovery, but they offer a common reassurance: that they have experienced all the troubles that addiction brings, and they understand what their clients are going through. Often, they market their particular
treatment as something that worked for them personally, which they
want to share with others.

The desire to share something that helped you, so that it can also help others in your situation, is a good and noble impulse. But it often happens that the results of that impulse do more harm than good. Brain chemistry and behavior are complex, finicky things, so much so that even our oldest and best-tested methods of treatment often have wide margins of error. In this field, moreso than any other, what works for one person may do no good, or even harm, to someone else. In this field more than any other, we need large
studies and statistics to collect data on huge amounts of people and categorize it so that we can filter out individual eccentricities and find strategies that will help almost everyone.

Anecdotes, personal stories, and testimonials can sometimes be helpful, but they are not medical data. They are often incomplete, exaggerated, or inaccurate, disregarding the people who have strong financial motives to outright lie. People suffering from addiction are often desperate, frightened, and may be functioning at less than their full mental capacity, which makes them perfect prey for unscrupulous con-men selling a style
that they claimed worked for them. Even those run by honest people who truly were helped by them are often grossly unsuited to help others. Stories and anecdotes tend to be more compelling than statistics, because it is easy to relate to someone telling their story, and the emotional impact of a person standing in front of you telling you about their life is very hard to ignore. But for those same reasons, anecdotes are incredibly unreliable as the basis for seeking medical treatment. Many people distrust statistics, thinking that they might be fabricated or biased, but the fact is that medical statistics from credible sources (such as the CDC or ASAM) go through a much more rigorous fact-checking process than the founding myth of any nonmedical treatment ever will. It is the stories of such that are more likely to mislead their clients or put them in harm’s way.

This is only one more way in which we need to bring the field of addiction up to the same scientific standard as other fields, such as dentistry and cardiology. Very few people would, say, switch to an all-banana diet because they heard a story from a neighbor’s friend who said it had cured his cavities. Yet people routinely pay tens of thousands of dollars for the promise of a nebulous “spiritual transformation”, or for a bizarre regime
of vitamins, horses, sauna treatments, and other provisions that have nothing to do with addiction, all because they have been fed bad information through “patient testimonials” and other stories.

Healthcare and medicine are based on truth; on what, in reality, actually can be proven to help people. I have seen many peoples’ lives improve after they come through Bel Air Center for Addictions, but I won’t ask that people come to my office just because I say that. I prescribe opioid maintenance treatment because its use has been continuously and irrefutably supported by the scientific study of brain chemistry and how it can be altered to improve the lives of people suffering from this disease.

Hurricane Withdrawal

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This weekend, the East Coast was shocked and frightened by the approach of hurricane Irene. Though the hurricane didn’t do as much damage as the news media had forecast, people from North Carolina to Maine feared for their lives and property, and rushed to gather emergency supplies and find somewhere safe to wait as the storm approached.

The hurricane was highly unusual, but the fear and panic that came before it were things I had seen before. For someone suffering from addiction, every day can be like the day before a hurricane. They are constantly living in fear of withdrawal, to the point where every minor headache, cold, or stomach pain is seen as a sign that the storm is about to break, and the wretched withdrawal symptoms are about to hit them with the force of hurricane winds. People who haven’t experienced addiction tend to think of withdrawal as being similar to the flu; it’s uncomfortable, but after a while it goes away and you’re no worse for wear. They don’t realize that one of the symptoms of the disease of addiction is heightened sensitivity to the kind of pain and discomfort that withdrawal brings, to the point where it becomes completely crippling. I’ve had many patients who relapsed because they were unable to ‘wait out’ the withdrawal symptoms, which they say felt worse than a non-addicted person could imagine.

It’s understandable that addicted patients start to panic if they think they are about to experience withdrawal, and that will cause many of them to use. But it extends beyond the panic of a single moment. For addicted patients, withdrawal is always looming on the horizon, and they constantly have to take steps to ensure that they don’t suffer from it. As soon as they get one fix, they have to be looking for the next one. If they have to change cities, or take a trip on business, or deal with some big event like a wedding, they have to ensure that they’ll have an adequate supply of their substance if they don’t want withdrawal to overtake them. The frenzied planning and desperation many patients feel under the threat of withdrawal is similar to what East Coast residents experienced under the threat of hurricane Irene.

Those who say that addicts are ‘dirty’, that relapsing makes them ‘weak’, should consider that perspective before they make their judgements. It is possible for some people to wait out withdrawal symptoms, just as some people were better able to handle the fear and uncertainty produced by the weather predictions last week. But the desire to protect ourselves against perceived future threats is a deeply human trait, and no addiction treatment can be complete without taking it into account. Physicians in addiction treatment must be aware of what the world looks like to their patients, and they must be willing and able to reassure their patients that the storm of withdrawal isn’t a problem. 12-step detox programs attempt to just get their patients through the storm, patching up damage as it occurs and making no attempt to prevent further damage. Wouldn’t it be better to keep the storm from hitting at all?

You Don’t Have to Struggle

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Instead of a blog post this week, I am pleased to announce that my book, The Addiction Conspiracy: Unlocking Brain Chemistry and Addiction So You Don’t Have to Struggle, has been converted into a e-book format and is now available for free on the Bel Air Center for Addictions website.

This book grew out of several slideshow presentations I developed to explain the mechanism of addiction in a way that everyone could understand. I urge everyone with an interest in the treatment of addiction to read it, and I hope that it will help clear some of the misunderstanding around this disease.

The book can be found under the “Addiction Conspiracy” tab on the sidebar.

Philosophy and Hedonic Tone

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During the years I’ve spent in the field of addiction medicine, I’ve heard a lot of non-medical explanations for the symptoms and behaviors of people who suffer from addiction. One explanation that keeps recurring in different forms is the idea that all human beings are somehow born with a capacity for “something higher”. This is often described as “enlightenment” or a “higher plane of consciousness”; one Internet commenter recently described it to me as “sparkles and comfort”. The idea is that a normal, healthy human being is somehow lacking in some mysterious key to happiness, and it is this being destined for “more” that drives addicts to their substance of choice to try and find it.

We can also describe this idea using the more scientific concept of hedonic tone. The hedonic tone is a way of measuring the happiness or contentment a person feels or is capable of feeling. Each person has a unique base hedonic tone — that is, each person has a baseline level of happiness that they return to when their lives are free from great stress or achievement. Anhedonia is a condition in which someone’s hedonic tone is unusually low, so they are incapable of feeling pleasure.

People who argue for the “destined for more” model of addiction seem to be saying that we are all born with a certain hedonic tone — let’s say 50% — which is much lower than our maximum, and that this is something wrong with us. They see this unnaturally low hedonic tone as the real problem, while addiction is just a misguided attempt to self-medicate for the real problem. They therefore suggest that by fixing the real problem, you fix the addiction, which is only a symptom. The same commenter I mentioned earlier insisted that if patients could get their “sparkles and comfort” elsewhere, like from a spiritual or religion, their addiction would no longer be a problem.

The fact is that while we do naturally have a hedonic tone that is less than our maximum, this is normal. By having a hedonic tone lower than the maximum, the brain leaves itself room to increase it in order to reward us for doing things that help us survive. If we were born with a maximum hedonic tone, we wouldn’t respond to any rewards, and we would have no motivation for even keeping ourselves alive.

We can physically see this in action when we study happiness and how the brain responds to it. The brain wants to stay at that ideal 50% hedonic sweet spot over the long run, so while it will reward you with endorphins that raise your hedonic tone, it will eventually return to baseline when they wear off. We see this in people who have achieved some goal that makes them happy, say by buying a new car they really wanted. At first, their hedonic tone is higher, but after some time the brain adjusts the baseline upwards, so that what was once 75% becomes 50% again. This is a way of preventing us from stagnating, and keeping us moving on to the next goal.

We see the same pattern when we look at chemical receptors in the brains of people who suffer from addiction. Normally receptors are active at a baseline level — again, say 50%. Drugs raise the saturation and the hedonic tone, mimicking the feeling of the brain’s reward; it feels good, so the addict continues to do it. The brain wants to be at 50%, so it will eventually adjust the receptor levels, producing more, until what used to stimulate 100% now only stimulates 50%, and to get to 100% requires a greater amount of drugs. This is called “tolerance”, and it’s a phenomenon that many addicts are intimately familiar with. If escalated too long, it can lead to severe brain malfunction, and eventual overdose from the ever-increasing amount of substance needed to reach that 100%.

We can see from this that the “destined for more” model is actually a very distorted way of interpreting real data. It’s true that doing drugs raises the hedonic tone towards the maximum, and that this is the reason addicts first seek it out. Where the “destined for more” model goes wrong is in thinking that humans are supposed to be at 100%, that we are meant to be there, and that being at our natural state of 50% means we are somehow “broken”. It puts a mystical and philosophical distortion over a very real biochemical phenomenon.

Addiction has been around for a very long time, and like any scientifically classifiable disease, it often follows predictable patterns. People with ulterior motives or a lack of medical training have come up with all sorts of theories that claim to explain the nature of addiction, but ultimately fail to hold up under the evidence. It is imperative that all research and treatment of addiction be based on sound science, instead of mysticism, if we are ever to make progress against this disease.

‘Medical’ Marijuana

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In September of 2010, ASAM released a statement expressing what many people considered to be a surprising opinion about the legalization of medical marijuana. The document,  The Role of the Physician in “Medical” Marijuana, came down largely against the legalization of ‘medical’ marijuana that have been enacted by several states. This seems surprising, since many professionals have expressed the opinion that, while it is mildly addictive, marijuana is safer to use than other common, legal recreational drugs like alcohol and nicotine. In fact, it’s not the legalization of marijuana itself that ASAM and other professionals are objecting to; it’s merely the haphazard way in which the ‘medical marijuana’ system is constructed.

According to this article from Time magazine, only about 10% of those who use marijuana become addicted, as compared to 25% of heroin users and 15% of  alcohol users. The overwhelming majority of marijuana use is recreational, and occurs in people who are not (or are not primarily) addicted to it. To this population, marijuana is still illegal, but is also desirable, and they will try to obtain it through the ‘medical’ system where such a system is in place. This leads to the main point of the ASAM paper; though marijuana is supposed to be dispensed in a medical capacity, it isn’t regulated like an ordinary medicine. It hasn’t been tested thoroughly by the FDA; there is a lack of real dosing guidelines, especially for smoked marijuana, where the amount administered is less easy to control; and the potency, usually measured by THC content, can vary widely, making proper dosing even more difficult. There are no specific illnesses which marijuana has been proven to effectively treat. In short, the ‘medical marijuana’ system is not very medically sound.

It seems that the ‘medical’ system is designed largely to exclude the ‘potheads’, those who are addicted to marijuana or only use it recreationally, from obtaining it. As I’ve written previously, patients who are addicted or have a history of addiction act very differently from other patients, and by making a prescription necessary to obtain this drug, the system gives these patients a strong incentive to lie to their physicians, who may not be prepared for this behavior. Physicians untrained in the field of addiction are now having to deal with people who might be suffering from addiction, instead of whichever disease marijuana is meant to cure. This will lead largely to misdiagnoses and over-prescribing of the drug.

This has also shifted some of the focus of the marijuana legalization debate to physicians, who are in no position to deal with it. Since there are no real protocols or procedures for the administration of marijuana in a medical capacity, physicians are being forced to make decisions about its use based on little or no scientific information. They have been made unwilling gatekeepers, which brings with it a great deal of responsibility and liability.

I am not opposed to the federal legalization of marijuana for recreational use; as I mentioned earlier, marijuana is no more dangerous than alcohol or nicotine. With proper regulation, and age-limit laws like those in place for alcohol, I see no particular reason why it shouldn’t be legal. If we’re going to make it legal, though, widespread regulation is absolutely essential. The ‘medical marijuana’ system is largely uncontrolled, ineffective, and full of loopholes which are ripe for abuse.

Buyer Beware

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I recently heard the story of a woman in California who was lied to by a Scientology-based addiction treatment facility, Narconon, and is now suing them to try and regain some of her lost money.

I went to investigate the website of the facility in question, the Narconon facility in Vista Bay, CA. The website is impressive and appears very professional, and uses many of the buzzwords common to nonscientific treatments, including vague promises of “lifelong recovery”, warnings against medication, and an unspecific list of treatments including “vitamins, exercise, and… our sauna”. They claim several times that their method is “proven”, but nowhere on the site do they offer any scientific journals, papers, or research studies that support this claim, and a few of the statements about addiction supposedly made by M.D.s on the Narconon staff are dubious at best. One of many opposing sites, Narconon Exposed, makes an attempt to catalog the problems with Narconon, especially those relating to the organization’s supposed ties to Scientology.

The suffering of those who have been misled by Narconon’s advertising is cause for outrage, but Narconon is also merely a symptom of larger problems in the addiction-care system. I’ve written previously on this blog about the lack of standardization in addiction care, and the tragic consequences it can have for underinformed addicts and their families. The sad fact is that Narconon is licensed by the state of California to adminster addiction treatment, a fact which is flaunted at great length on the website, which includes scans of many impressive-looking official documents. It would be very, very easy for someone who wasn’t aware of the many problems to be taken in by Narconon’s marketing, and sign themselves up for treatment that is not only ineffective, but potentially harmful.

The licensing of Narconon has been blamed on the understaffing and low budget of the California government offices responsible for vetting and approving treatment facilities, and it is likely that as our nation faces growing cuts to public services in the face of the recent budget crisis, such oversights will only grow more common. It is more vital now than ever before for people suffering from any illness to inform themselves on all their treatment options, and carefully investigate any facility before they pay for what may be fraudulent care. Snake oil salesmen thrive in times of uncertainty, and decades of misinformation have made people suffering from addiction prime targets.

Narconon is unusually harmful, even cruel, but there are many, many more centers out there that claim to treat addiction with regimens that are stunningly ineffective. I’ve written a great deal about various 12-step programs on this blog, and I am sad to see that Narconon displays many of the same traits that 12-step programs use to market themselves; a warning against all medications, an emphasis on permanent recovery and “cure”, and affiliation with a religion or “spiritual” approach. It just happens that Narconon is affiliated with the Scientologist religious model instead of the vaguely Judeo-Christian one that most 12-step programs are based on.

Snake oil salesmen of this type have been around as long as humanity, and the only way to weed them out is to combat their misinformation with proven medicine, sound science, and rigorous oversight. It has happened in other fields of medicine, and it will undoubtedly happen in the field of addiction, though it may take several years. I am confident that, if we continue to move ahead with research and treatment using medicine to treat the disease of addiction, that the patients who are being taken in by these scams now will be among the last to be fooled.