This morning, as I read the latest stories about opioid overdose deaths, I was struck by a common thread in most of the tragic stories. One report after another had phrases like ‘she was in and out of treatment for years’ or ‘he died tragically one month after leaving treatment.’
I often wonder, if we treated opioid dependence as if we were treating any other fatal illness, would the death rate be lower? What practice measures would result from such an approach?
First, we would remove the veil of low-expectation that keeps us from realizing the ineffectiveness of ‘residential treatment.’ Once the low expectations are gone, huge questions would come to light. Why does something so ineffective continue to be seen as the gold standard for treating a potentially fatal illness?
We know that opioid dependence is a chronic condition, marked by relapse. What should be our measure of ‘success,’ when treating opioid dependence? Is the treatment in a given individual a success, if that person dies within a year? Within 5 years? Does cost matter? Should we expect better results for $50,000 then we would for, say, $2,000?
Expectations for good results with addiction treatment have been lowered over the years by the absence of other options, the assumption, conscious or unconscious, that addiction is more of a choice than a disease, and by an indifference to the loss of people who often turn friends, family, and society against them. Instead of seeing a loved one destroyed by illness, people see those with addictions as foolish people, hurting themselves. By the time death by overdose occurs, those close to an addicted person see death as inevitable; even as a blessed relief in some cases.
For decades, the public perception of residential treatment has benefitted from the fact that nothing better was available. ‘Send him to treatment’ has become a phrase uttered without thinking; a suggestion that implies a great deal, yet offers almost nothing. Perceptions of such treatments have also benefitted from abdicating responsibility for their failures. When patient after patient does poorly, those providing such …