Physician Corner


From the Desk of the Medical Director

I have been told that the expression, “May you live in interesting times,” is a subtle curse.  I suppose that depends on how one defines interesting. There is certainly a lot of interest in opioid addiction these days as our Governor and others have called attention to a “heroin epidemic.”  While the words heroin and epidemic grab headlines, this did not catch any addiction professionals by surprise.  We know this is not something new.  This is still the ancient problem of opioid dependency, or more generally, of addiction.

But an important difference with opioid addiction in modern times is the use of Medication Assisted Therapies (MAT) in the treatment of opioid dependent patients.  These are better known by the medications used, suboxone and methadone. With attention to MAT comes the debate whether they are part of genuine recovery, or whether they are a crutch, or just a step toward recovery. As with many debates, defining one’s position is important, and defining recovery has been quite subjective.  For example, with other mental illnesses taking medication is often considered essential to recovery.

In addiction, the roots of thinking about recovery are found in AA where abstinence was the foundation and there was no equivalent to MAT.  Originally, many in AA considered taking antidepressants to disqualify one from being “in recovery”.  This is no longer so as we understand many people struggle simultaneously with mental illnesses such as depression and addiction.

This debate is most heated when participants focus on narrowly defined criteria, such as length of time not taking an opioid or a drink.  But if one considers the overall quality of life that a person experiences, it makes these medications seem trivial.  A more liberal viewpoint sees recovery as a process that begins with the desire or intention to change one’s life and therefore considers MAT part of recovery.  With this position, we can focus on ways to improve someone’s health, relationships and environment rather than dictating how they do so.  In addition to this being a more open position, it gives the patient an opportunity to define their recovery for themselves.

However, many patients seem initially to see prescription of these medications as a goal in itself.  Just as we realize there isn’t a one size fits all approach to recovery, we know the answer is not found in a medication.  Those who are ready to engage in recovery recognize these medications are simply one tool out of many tools needed for this task. Regardless of our position in this debate, we can all agree that recovery requires sustained work. And this sustained work takes place over the course of years, with many of us being involved in various phases of this process.  Because of this, it is important that we remain open to various paths our clients will take towards their recovery.

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Serenity House is accredited by the Commission on Accreditation of Rehabilitation Facilities.Serenity House and Grace House are licensed by the State of Vermont.Recovery House Inc. operates as a non-profit, 501(c)(3) organization.