TAKE 3 W/ SLP, January 2023
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“Take 3 w/SLP” is Sober Linings Playbook’s monthly summary of stories we think deserve a closer look.
On tap this month:
1. Celebrity Rehab’s Dr. Drew Pinsky’s views on medication assisted addiction treatment at odds with the science
2. New study suggests pharmacists could play a key role in addiction treatment
3. “Goodbye to Dry”: SLP let’s Chatbot GPT have the last word on “Dry January
One. Say what, Dr. Drew?
Dr. Drew Pinsky (“Dr. Drew”) appeared as a guest on the Dec. 24, 2022 and the Jan. 20, 2023 episodes of the Dopey podcast. Wikipedia describes Pinsky as a media personality, an internist and an addiction medicine specialist, in that order.
From his appearances on Dopey, it’s clear that Pinsky has a passion for addiction medicine and a certain type of compassion for the patients with whom he works. He obviously has extensive experience and expertise. But there were a number of things about the comments he made on the podcast episodes that gave me pause.
As someone who works in (or at least adjacent to) the field of addiction treatment, I was surprised with the casual manner with which Pinsky uses the term “addict” to describe people struggling with substance use disorders. I use the term myself in certain contexts, but never in a professional setting. It seems out of step with the times for a doctor to use such a stigmatizing term in a public appearance as a representative of the medical profession.
I was also taken aback by Pinsky’s confidence about the “right” and “wrong” ways to treat addiction. Granted, I’m a lay person. But what little I know suggests there are a lot of unknowns when it comes to addiction. The causes, and the pathways to recovery, are complex and multifaceted. For that reason, I tend to put more trust in experts who have the humility to admit they don’t have all the answers and that there are things they just don’t understand. I was also struck by Dr. Drew’s comments about sometimes having to “kick people out” of treatment and by his opposition to the use of life-saving medications such as methadone and buprenorphine that have widely been found effective for treating opioid use disorders.
“Celebrity Rehab with Dr. Drew,” which many people see as an example of the best care available, for instance, used an approach that is not known to be effective for opioid addiction. More than 13 percent of its participants died after treatment, mainly of overdoses that could potentially have been prevented with evidence-based care.”
My purpose here is not to argue that Pinsky is wrong. People more expert than I have disputed his media-friendly “tough love” approach to addiction treatment and his disdain for medication assisted treatment (some probably fair, some not). See for example, Is Dr. Drew too dangerous for prime time?, Salon, Feb. 25, 2013.
What inspired me to mention Pinsky’s views on MAT was another podcast’s airing of a listener voicemail that offers a firsthand account of the benefits of medication assisted treatment and the shame that some people who benefit from it still experience. I thought it was worth sharing.
But before I get to that voicemail, what exactly did Dr. Drew say about MAT on the Dopey podcast? When Dave, the host of Dopey, mentioned his idea of interviewing people outside a methadone clinic, he was dismissive. According to Pinsky, “everyone is loaded and so messed up” at methadone clinics. It’s not clear whether Dr. Drew means methadone patients tend to still be using other drugs, or that people using methadone as directed are loaded and messed up. Or perhaps both. In any case, Dr. Drew paints with too broad a brush, and the image he creates is unfairly stigmatizing.
But what really got me riled up was Dr. Drew’s subsequent comments suggesting people on maintenance medications are not in recovery:
“Let’s be thankful that there are lots of options for people today to come into some version of sobriety…their version of stability. For me, I was only interested in seeing the miracles of recovery. People criticize full recovery these days because ‘oh my God, somebody could go out and use again and die.’ And yeah, they could. That could happen. But it’s a risk/benefit analysis. And to get the full benefit of a full recovery, you kind of have to be off everything. Or, way low down on your suboxone and methadone. Way low down. But for some people, that’s not possible. And we should celebrate that they are out of the hamster wheel of the active disease.”
There’s a lot to unpack in this short comment. First, Pinsky’s description of people using MAT being in “some version” of sobriety (i.e., not the right version) suggests they aren’t in actual or “full” recovery. This view stands in sharp contrast to more current definitions of recovery. The Substance Abuse and Mental Health Services Administration (SAMHSA), for example, defines recovery as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”
There is no mention of abstinence in the SAMHSA definition. Complete abstinence is a great goal with many benefits, but not everyone in recovery shares that goal. Nor is complete abstinence necessarily required to achieve health, wellness and a life worth living. Who is Dr. Drew to define someone else’s recovery?
Pinsky recognizes that without the use of medications there is a higher risk that someone in treatment might relapse and suffer an overdose. He seems comfortable with that risk. Others, however, make the reasonable point that no matter how you define recovery, people can’t recover if they die.
Finally, Pinsky claims that to get the benefit of a “full recovery,” a person has to be off everything, including buprenorphine and methadone. This flies in the face of experts who recommend long-term use for patients whose recovery is benefitting from medication.
According to a piece published by Harvard Medical School, “There is no evidence to support the claim that Suboxone (buprenorphine) should be taken for a short period of time as opposed to being maintained on it for the long term, just as a person would manage their diabetes with insulin for the long term. Ultimately, this comes down to patient preference.” (5 myths about using Suboxone to treat opiate addiction, Harvard Medical School, Oct. 7, 2021).
Now for the voicemail that inspired this piece. A young man named Ryan recently left a message for the hosts of the Recovery in the Middle Ages (RMA) podcast. Listen to the Jan. 4, 2023 episode if you’d like to hear it for yourself. Ryan is an RMA listener who has checked in with the hosts frequently over the last year-and-a-half or so. He spent time in residential treatment away from his home state about a year ago, and it sounds as though he has struggled off and on since returning home.
In his voicemail, Ryan mentions that he recognizes there is “a lot of stigma around” medication assisted treatment and because of that he “fought it [MAT] tooth and nail for a long time” because he thought he was strong enough to go without. He begins the call by saying that after a week on medication “it finally feels like I can breathe.” He continues to describe the benefits of MAT he has experienced:
“I have a lot more time. I have a lot more money. I have a lot more peace of mind and sanity. And while for me personally it [MAT] isn’t a long-term answer, it is definitely very helpful right now and it’s going to give me enough time to get my affairs in order, get my finances in order, and, most importantly, get my sanity in order. Sometimes in the last two weeks I forget that I’m on it. And when I wake up, I have this tremendous relief that I don’t have to go out and do crazy shit to use all day. So, at the very least man, it’s stabilizing my criminal behavior and stabilizing my life in general. It’s making it so that I can have just a little bit of peace right now. I feel a lot more happy. I feel a lot more sane. I just feel like I can fucking breathe man. I was feeling suicidal. There’s going to be a point in time where I want to get off this shit but I’m not going to rush it. And I’m not going to make it something I have to do right now. I’m just going to enjoy the peace I’m living in and try to get my fucking life in order. And when it’s time to come off, you know, I’ll do what I have to do to get off. For right now, things are a lot better.”
Good for Ryan for bucking the stigma and for doing others a service by sharing about how the medication has helped him gain the peace and clarity necessary to work on himself and his recovery.
On a somewhat related note, here’s a piece on a recent legal win against the stigma of MAT in the workplace:
US settlement signals protections for addiction medicine, AP, Jan. 19, 2023
Two. Speaking of MAT — New study suggests pharmacists may have potential to play key role in treatment of addiction
While it is widely acknowledged that medication assisted treatment has become the gold standard for treating opioid use disorders, it is also widely recognized that significant barriers limit access to medications like methadone and buprenorphine. This is particularly true for black and brown folks and for people who live in rural areas.
The November 2022 edition of SLP’s Take 3 highlighted some of the obstacles that make it difficult to make methadone more widely available. The December 2022 edition highlighted recent passage of the MAT Act which will make it easier to prescribe buprenorphine.
Last week, I came across an article about a study in Rhode Island suggesting that allowing pharmacists to dispense medications for opioid addiction shows promise in terms of effectiveness and in making those medications more available (Pharmacists Can Be Key to Helping Folks Kick Opioid Addiction, U.S. News and World Report, Jan. 13, 2023)
The study, co-authored by researchers from Brown University’s School of Medicine and the University of Rhode Island’s College of Pharmacy, examined the impact of a new law allowing pharmacists in the stat to prescribe buprenorphine to treat opioid use disorder. After one month, the pharmacy group had significantly higher rates of continued care than patients who had been randomly selected to receive care from a physician or a clinic.
“Pharmacists are an underutilized partner in the health care workforce, especially the behavioral health care workforce. There is a pharmacy within five miles of where 95% of Americans live,” said co-author Jeffrey Bratberg, professor of pharmacy at the University of Rhode Island.
“Treatment with medications can only work if it is available and accessible in the community,” added co author Dr. Josiah Rich, a professor of medicine at Brown University. SLP couldn’t agree more. Given that the addiction treatment options currently in place are only ever accessed by 10 percent (or fewer) of the people who could benefit from treatment, it’s high time we get creative and think about doing a better job of meeting people “where they’re at,” in the geographical sense.
For more:
Addiction Treatment Proponents Urge Rural Clinicians to Pitch in by Prescribing Medication, Hematology Advisor, Jan. 13, 2023
Pharmacists Can Be Key to Helping Folks Kick Opioid Addiction, U.S. News and World Report, Jan. 13, 2023
Offering addiction treatments in pharmacies could help combat the opioid crisis, NPR, Jan. 11, 2023
Study taps pharmacies as addiction treatment option during opioid crisis, WBUR, Jan. 11, 2023
Three. Goodbye to Dry? — Let’s see what ChatGBT has to say about “Dry January”
Sure, “Sober October” and “Try Dry in July” always seem to get some mentions in the media. But “Dry January” is the big one. As with previous Januarys, there was no shortage of coverage of the potential benefits and drawbacks. I include a small sampling at the end of this piece for anyone who has not yet had their fill.
As SLP begins its third year, I’m at a bit of a loss when it comes to saying anything new or interesting about Dry January. For that reason, I looked to another recent trend and turned the writing over to ChatGPT for an artificial intelligence take on the pros and cons of a month without the sauce.
Here’s how ChatGPT answered my question about whether Dry January can lead to lasting change:
Dry January can potentially lead to lasting change in an individual's relationship with alcohol. By abstaining from alcohol for a month, you may gain a better understanding of your relationship with alcohol and how it affects your life. This can help you make more informed decisions about your alcohol consumption in the future.
Research has shown that participating in Dry January can lead to long-term reductions in alcohol consumption. One study found that people who participated in Dry January were more likely to report reduced alcohol consumption and an increased intention to continue reducing their alcohol intake in the future. Another study found that people who participated in Dry January were more likely to report reduced alcohol-related problems, such as hangovers and unintended drunkenness, even six months after the challenge.
However, it's important to note that the effects of Dry January on an individual's relationship with alcohol will vary. Some people may find that participating in Dry January helps them make lasting changes to their alcohol consumption, while others may find it more challenging to maintain those changes over time. It can be helpful to set specific goals for your alcohol intake and to enlist the support of friends and loved ones in helping you achieve those goals.
Citations to go along with the research might have been nice, but not bad for AI.
A sampling of this year’s stories on Dry January:
Drinking Again? Maybe the Problem is Dry January., New York Times - Jan. 19, 2023
Dry January: The Good, The Bad, and The In-Between, Shatterproof, Jan. 11, 2023
Navigating romance during Dry January? Here are tips for sober dating., Washington Post, Jan. 6, 2023
Alcohol use is widely accepted in the US, but even moderate consumption is associated with many harmful effects, Yahoo!, Jan. 6, 2023
Take Dry January To the Next Level With Hydration Multiplier Mocktails From Liquid I.V., Spy, Jan. 5, 2023
People Are Already Tweeting About The Trials And Tribulations Of Dry January, And It's So Funny I Almost Spit Out My Mocktail, BuzzFeed, Jan. 4, 2023
Dry January: 'I'm a Doctor—Here's How Your Body Changes After a Month Without Alcohol', Newsweek, January 3, 2023
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That’s all for January. Until next month, stay tuned!