Sunday, May 26, 2013

Are Psychosocial Interventions with Addicts Worthless?

It is often said that addicts require counseling in addition to maintenance drugs for the treatment of opioid dependence. This review of over 4000 patients cast doubt on that assertion. It would appear that opioid addicts simply require their drug supply. More evidence that ending drug prohibition would cause the problem of opioid addiction to cease to be a social problem.

Psychosocial combined with agonist maintenance treatments versus agonist maintenance treatments alone for treatment of opioid dependence. Amato L, Minozzi S, Davoli M, Vecchi S.
Cochrane Database Syst Rev. 2011 Oct 5;(10):CD004147. doi: 10.1002/14651858.CD004147.pub4

35 studies, 4319 participants, were included. These studies considered thirteen different psychosocial interventions. Comparing any psychosocial plus any maintenance pharmacological treatment to standard maintenance treatment, results do not show benefit for retention in treatment, 27 studies, 3124 participants, RR 1.03 (95% CI 0.98 to 1.07), abstinence by opiate during the treatment, 8 studies, 1002 participants, RR 1.12 (95% CI 0.92 to 1.37), compliance, three studies, MD 0.43 (95% CI -0.05 to 0.92), psychiatric symptoms, 3 studies, MD 0.02 (-0.28 to 0.31), depression, 3 studies, MD -1.70 (95% CI -3.91 to 0.51) and results at the end of follow up as number of participants still in treatment, 3 studies, 250 participants, RR 0.90 (95% CI 0.77 to 1.07) and participants abstinent by opioid, 3 studies, 181 participants, RR 1.15 (95% CI 0.98 to 1.36). Comparing the different psychosocial approaches, results are never statistically significant for all the comparisons and outcomes.


  1. I'm convinced that some addiction is due less to psychosocial factors and more to physiological factors........brain chemistry among them. The Lords On High doctors, the High Priests that sanctify drugs...oops! I meant, medications... don't think twice about prescribing all kinds of antidepressants without so much as checking to see if the patient is actually deficient in or produces an excess of any brain chemical. I spent a couple of hours last weekend perusing a number of journals looking into various meds. In almost every case that I looked into, the clinical trials were extremely small or non-existant in terms of testing for carcinogenicity, mutagenicity, teratogenicity, etc. In fact, a number of the literature simply stated "unknown". Yet, doctors keep prescribing these drugs without care as to whether or not they may actually do more harm than good.

    Now, on the psycho-social side of the aisle, these folks presume that, because they have gone to school and read about drug addiction that they know everything about each individual addict. Apparently, they think "talking" an addict out of using is a rather simplistic feat of genius on their parts. I get so angry when one of these smug bastards presumes to tell me why I do what I do. No one on this planet knows better than I. Most of these phucks have never once felt what any one addict feels on a regular basis. But damned if they're still not so sure that we can be "talked" out of our "habit".

    Give me the drug and shut the phuck up. IF...IF...IF my body allows me to, I'll taper down until I'm off. If not, I'm likely to be on maintenance for years.....if not the rest of my life. You don't walk away from a 30+ year addiction.


    1. Part of the problem is that there are no biochemical tests to diagnose mental illness. No brain scans are done to diagnose depression or addiction, just to name 2 examples. I read a very interesting paper on antidepressants, I believe it was called "The Emperor's New Drugs" by researchers from Connecticut who analyzed data from the clinical trials and found that antidepressants didn't outperform placebos. Now its one thing if you are prescribing a drug with some risks that truly improves your quality of life, but if they are mostly worthless for the majority of those who take them? Admittedly some people do benefit from SSRI's, but they are overused.

      Anyway onto addiction, I believe there are multiple pathways to becoming an addict. Some people may be born with an endorphin deficiency. Others find that opiates palliate their emotional pain stemming from trauma, often from childhood. For others drug use is an alternative lifestyle that rejects much of mainstream societal values.

      What I find frustrating is that the high priests call addiction a disease, but medical ethics are turned upside down when treating addicts. Normally when one drug doesn't work, another drug is tried. With methadone if it doesn't work heroin or morphine should be tried, but instead the patient is ejected from treatment.

      With addiction the doctor says, "make the following lifestyle changes or else treatment will be terminated." No other disease is approached that way. What if a doctor refused insulin because his patient refused to lose weight? What if a doctor stopped prescribing a bronchodilator or oxygen because it was enabling his patient's cigarette smoking?

      With therapy there must be a relationship between the therapist and the patient based on mutual trust and cooperation. This is impossible if the patient is punished for being honest about their drug use, or if the patient is mandated by the courts. Instead the therapist becomes a nanny, treating the patient like a child.

      There's this whole movement called evidence-based practice. US treatment officials should become more familiar, heroin and morphine has a large evidence base for reducing crime, improving the health of addicts, less homelessness and so on. Pure benefits at low cost.

    2. "Evidence-based practice"? No, we can't have that in these here United States. It's too much like right.