Facilitating recovery from substance use disorder

We’ve come a long way in addressing substance use disorders, said John Kelly, PhD, at the 2019 Institute for Functional Medicine Annual International Conference in San Antonio, Texas.

In the last 50 years, laws passed have moved from more punitive to public health-oriented, Kelly said, increasing availability, accessibility, and affordability of treatment. The “war on drugs” was part of a national concerted effort to reduce supply but also demand that created treatment and public health-oriented federal agencies, such as the National Institute on Drug Abuse.

We have learned a lot as a result of these concreted efforts, Kelly said. For example, we are moving away from referring to substance use as a “moral issue” towards understanding it is a genetically influenced disease of the brain; from few treatment options to many evidence-based pharmacological and psychological treatment options; from a rapid detox to ongoing recovery management; from believing few people recover to understanding that most people recover, but it can take time; and from uncoordinated and segregated addiction care to health systems treating this as a topic public health problem.

Language matters when it comes shifting the paradigm, Kelly said. Our language and terminology both reflect and affect our approaches to addressing addiction. Certain terms and rhetoric may induce bias, increasing stigmatizing attitudes and discriminatory practices, he said. For example, people with eating-related disorders are referred to as “having an eating disorder,” but those with substance-related conditions are typically referred to as “drug abusers” and not “having a substance-use disorder.” “Drug abuser,” Kelly said, may elicit different attitudes toward the same individual.

How we talk and write about these conditions and individuals suffering them does matter, Kelly said. Avoid “dirty,” “clean,” and “abuser” language.

In shifting the treatment paradigm, there are multiple pathways to recovery. Practitioners must acknowledge the myriad ways in which individuals can recover. There are clinical pathways, provided by a clinicians or other medical professionals, which can include both medication and psychosocial interventions; non-clinical pathways, services not involving clinicians like Alcoholics Anonymous; and self-management pathways, recovery change processes that involve no formal services, sometimes referred to as “natural recovery,” Kelly said.

The clinical course of addiction and achievement of stable recovery can take time, Kelly said. The traditional addiction approach focuses on “putting out the fire,” but places less emphasis on or completely neglects preventing it from reigniting, recovery plan, recovery capital, and removing barriers. Treatment and recovery support services ideally should be available accessible, affordable, attractive, evidence-based, and diverse, he said.

There are several emerging and growing long-term support services that currently exist, including one model from the Massachusetts General Hospital in Boston. This model includes peer-based recovery support services, sober living environments, recovery community centers, recovery supports in educational settings, clinical models of long-term recovery management, and mutual help organizations.

 “If we want addiction to be de-stigmatized,” said Kelly, “we need a language that is unified and truly reflects the nature of what we’ve learned about addiction.”

Editor’s note: This article is part of Integrative Practitioner’s live coverage of the 2019 Institute for Functional Medicine Annual International Conference. For a full list of coverage, click here.