Prescription Based AODC

Background

As of today, Robert has spent one year studying the processes of addiction, recovery and relapse while trying to stay as detached as possible. His observations on AODC are based on subjective observation and a concentrated effort to read thirty books and forty articles on the topic while participating in a diverse number of settings. He spent time: talking with addicts, counselors, program directors, lawyers and treatment officers; observing drug classes organized to support California Penal Code 1000 (PC1000); observing drug courts; and attending meetings of Alcoholics Anonymous (AA), Cocaine Anonymous (CA), Narcotics Anonymous (NA), Nar-Anon the family support group for NA, Al-Anon the family support group for AA and CODA the support group for codependents. He made friends with people in California Proposition 36 alternative sentencing programs and he has taken classes in AODC.

Medication Anecdotes

In the late nineteenth century it was possible to buy medication to treat narcotic addiction. Many of those medications were based on alcohol.

In the late nineteenth century it was possible to buy medication that promised much and delivered little.

In the early twentieth century the patent medicine business was reformed. Regulations today require that every medication be tested for safety and effectiveness.

AODC Anecdotes

One treatment program sends alcoholics to work in concession stands selling beer.

One treatment program punishes dual-diagnostic clients for forgetting things.

One treatment program says they use Behavioral Therapy but they use essay writing assignments and group therapy as their primary treatment techniques.

One program bragged that they had a psychologist and a medical doctor who they pay to willingly sign any papers they give to them.

And many programs find themselves torn between continuing treatment and discharging the patient, not because the treatment is not completed but because there is an empty bed.

AODC Metrics

The U.S. Congress Office of Technology Assessment (OTA) published a classic report in 1983 in which it is noted that reported success rates varied from 7% to 73%

Miller and Hester (1986) reference several studies of treatment programs. One study done by Smart, Finley and Funston in 1977 found a 50% success rate for people who refused treatment and between a 25% and 50% success rate for people who enrolled in treatment. A study by Pittman and Tate (1972) reported a 29% success rate on abstinence. Wilson, White and Lange (1978) reported a 50% success rate. A study by Wilems, Letemendia and Arroyave reported a 41% success rate on abstinence after one year.

The data is not all gloom. Weisner, Merlens, Parthasarathy, Moore, Hunkeler, HU and Selby (2000) reported 95% success rates in the programs they studied.

Simpson, Joe, Fletcher, Hubbard and Anglin (1999) report a 77% success rate.

But in a study by Xie, McHugo, Fox and Drake (2005), only 23 out of 169 patients (13%) were still “in remission” nine years after treatment.

There are several problems with this data. First, as noted in the OTA report, there is no consistency in measurement or reporting. Some studies report success rates at the end of treatment, some studies report the success rates years after treatment. Second there is no consistency in the goal for treatment. Consider the controversy described by the OTA and by Marlatt (1983) regarding the controlled drinking study organized by Rand. Third, many people find recovery on their own without ever seeking treatment (Falcone, 2003). And fourth, the measure that is the most important seems to be the least reported. By that I mean the measure of what percentage of the people who receive treatment stay in remission.

If tomorrow there was a drug that could shrink cancer tumors by 95% then there would be great enthusiasm. But if after shrinking the tumor approximately 10% of the patients died then we would question that drug. And if out of the 90% who lived through the first year, 50% relapsed within five years then again we would question this drug. But today AODC researchers have a difficulty time doing longitudinal studies because so many of the successfully treated patients either die or relapse.

In the end, we do not know if any specific AODC treatment is beneficial or harmful. If Smart found 50% success in treatment and 50% success for those who refused treatment, then treatment is questionable. If the OTA found success rates as low as 7% and others find success rates for people who do not enter treatment to be 20 or 30%, then it seems that some treatments are detrimental.

Recommendation

Strategy

• Begin documenting the problem and enlisting people into the cause.
• Elaborate the goals for this effort and document specific proposals.
• Identify at least one treatment that meets the criteria for licensing under this proposal.
• Lobby the U. S. Congress to pass a three part legislation that will:
• Create a regulatory board responsible for certifying whether or not an AODC treatment is safe and effective.
• Set a deadline for all treatment programs that receive Federal funding to use only AODC treatments that have been certified by the U. S. program.
• Establish minimum guidelines for the licensing required to prescribe AODC treatment.
• Ensure that treatment programs are tested and certified by the regulatory body. Note that “grandfathering” in existing treatments is not advised.
• Ensure that the objectives for this program are met.

Our belief, however, is that we can succeed. In Luke 18:1-8 Jesus told a story about a woman who annoyed a judge until she got what she wanted. She was right and she was persistent. We intend to be persistent as well. And we hope to enlist support in a cause that you too see is just.

References