What Does Evidence-Based Treatment Tell Us— Podcast Episode 39!
Welcome to the LPP Podcast Episode 39!
In today’s episode of Sundays With Stories, Stanton and Zach discuss current events.
This week a New York Times article bemoaned the failure of addiction specialists to adopt a proven tool for treating drug addiction, “contingency management.” That is, paying meth, cocaine et al. users for abstinence.
That’s right: experienced, one might say addicted, “speed” (“crank”) users will desist drug use if you give them money — and not colossal sums at that. This has been Carl Hart’s research with meth, and the University of Vermont group’s under Warren Bickle with cocaine. The same benefits of providing alternative rewards have been shown in Bruce Alexander’s Rat Park and the Baltimore City Hospital group’s research with street drinkers.
What does this tell us? That drug and alcohol addiction is not a runaway train resistant to environmental factors and rewards. Which is useful to know.
However, Zach and Stanton question who is creating these rewards. There is a bit of science-gone-amok to the image of men in white coats divvying out money for drug and alcohol users, even those with the worst usage patterns, to be “good.” And what happens when the rewards, the gravy train, stops?
You tell us. But Harvard’s Global Anti-Tobacco Program offered a hint. While investigating the effectiveness of nicotine replacement therapy (NRT) for those who quit smoking, the program’s chief investigators found that, in the long run, those who quit on their own did as well as, or better than, those who rely on NRT. In fact, the most addicted smokers were the worst at keeping off the drug using NRT. This finding held true even though NRT was “proven effective in the laboratory.”
Zach and Stanton then speak of people managing their own contingencies. That is, their finding real-world reasons to quit or cut back their addictions. Most important of all (with a nod to Steve Slate et al.’s Freedom Model”) is people’s belief that they can control their own drug use and lives. This thinking belies NIDA Director Nora Volkow’s 2007 unwise piece “Addiction Is a Disease of Free Will” — which, per Stanton’s urging, Volkow seems to be abandoning.
What is she replacing this ill-conceived notion with? What Stanton and Zach practice in their Life Process Program: creating lives worth living and worlds people want to occupy. This is a tough task. But, once again, including a review of America’s ill-fated (drug deaths are ramping out of control) enthusiasm for medicine-assisted treatment for opioid addiction, there is no long-term alternative.
Finally, Zach reviews SMART Recovery’s belated shift to “abstinence from addiction” in place of its former “desist all use” basis — as the user chooses. They agree in their admiration for Tom Horvath/SMART Recovery’s remarkable success at creating an alternative to AA. At the same time, they embrace SMART’s long-awaited and necessary shift to Harm Reduction.
Stanton and Zach end their podcast by wondering how decades of addiction research and both positive and negative experiences with drugs have left even our “advanced guard” (i.e., policy reformists like the Ethan Nadelmann-founded DPA) so shorn of an appreciation for the interchange between people’s lived experience (their actual lives) and addiction.
Come join Stanton and Zach as they reveal a little secret. That is, the best science, policy, and treatment involve common sense.
At the same time, they say, free yourself from decades-old failed thinking.
The audio version of the podcast is here