The Failures of Our Addiction Treatment System

And, What We Can Do Better

“My name is Peter, and I am an addict.” I have recited these words at hundreds of A.A. and N.A. meetings that I was compelled to attend by the Massachusetts Medical Board. This was in response to a raid on my primary care office in 2005 by the State Police and the DEA for some unhelpful (illegal…) opioid prescriptions. I had written these ill-fated scrips when I was in the throes of an ugly addiction to prescription painkillers. I am now seventeen years into my recovery.

Many of these mandated A.A. meetings took place during my forced 90-day residence in Rehab. Over five years, what I was given for treatment included therapy, physician support meetings, about 400 drug tests, and a threat to withhold my medical license indefinitely. It was a brutal, negative regimen of “contingency management” with threats and punishment rather than rewards for not using drugs. The drug tests, all told, added up to twenty gallons of urine. Somehow, it all worked.

What is flatly unethical is that doctors weren’t allowed to take the only medications that are proven to save lives, such as methadone and buprenorphine (Suboxone). I discussed this in NPR’s ‘All Things Considered’. It is simply due to ignorance and stigma on the part of the medical boards, and the professional societies, that physicians are not allowed access to the most effective component of treatment.

They say it is “impairing” to physicians which has not been clearly demonstrated. Doctors are allowed to use alcohol, take opioids and benzos, freely consume meds such as muscle relaxants, gabapentin, and Benedryl – somehow these are O.K. and aren’t “impairing” toward the practice of medicine. It is only because addiction is heavily stigmatized that there is such a double standard and that lifesaving drugs are withheld. In reality, no one could identify my primary care patients who are on Suboxone; most of them are back at work, at home, healthy, and happily functioning again.

In truth, Rehab is generally useless, if not counterproductive

During the three months I was imprisoned in Rehab by the medical board, under threat of never getting my medical license back, I generally found it to be expensive, boring, mindless, cult-like, and unprofessional. This was in 2005 – though, I’m not sure if it has changed much in the last twenty years. When I was there, it was utterly impervious to new ideas, knowledge, or scientific evolution. The treatment was based almost solely on platitudes and anti-science nonsense. I go over, in granular, satiric detail, how silly and unhelpful Rehab was in my book, ‘Free Refills: A Doctor Confronts his Addiction’. The only parts of Rehab that I did find helpful were the friendships I developed, and the group therapy (neither of which were intrinsic to being at Rehab).

The sole professional qualification of many of the counselors at Rehab who treated us were that they were in recovery themselves. It seemed wholly unregulated. To treat the severe, deadly medical disease of addiction, we walked silently through shrubbery mazes and then repeated, chant-like, sayings such as “let go and let God”. I still don’t know what this means! Is it like a trust fall? In unison, we would recite The Lord’s Prayer (which is an awfully weird thing to be doing in a basement of a church in Virginia if you happen to be a Jewish Atheist from Boston). If I complained to anyone, about anything, they would respond with, “that’s just your disease talking.” This component of it was downright Orwellian. For all of the attempted brainwashing and pure controlling mindlessness that I was exposed to in Rehab, I could well have been among the Moonies or the Jehovah’s Witnesses. The only reliable outcome of Rehab that I witnessed was an addiction to nicotine.