Facing the Root Causes of Addiction

Pharmaceutical interventions cannot replace psychotherapy in addiction treatment

Posted Apr 15, 2013

Recently, many articles have come across my desk about both herbal and pharmaceutical interventions that claim to help addicts recover. As the CEO of an elite treatment center, I read all these claims warily. Too often, therapies that claim efficacy are at best little more than stop-gap measures or at worst, snake oil. Two of these drugs have caught my attention.

Declinol is being touted as an “AA alternative.” It is designed to reduce alcohol cravings, thereby allowing the alcoholic to make better choices.  The formula is herbal and contains ingredients such as kudzu root, bupleurum, rehmannia, and licorice, items that have a long history of use in Chinese medicine.

While I do not have enough research on Declinol to know if it does what it says it does – reduce alcohol cravings – I can state unequivocally that the claims that it is an “AA” or treatment alternative are overreaching. Alcoholism is a terribly complex disorder with a great deal of impact on the body. Detox, for example, should never be undertaken without medical supervision as some of the complications of severe withdrawal from alcohol are life threatening and include death.

Additionally, Declinol, 12 step programs, and treatment have different aims. Declinol is an herbal drug that seeks to eliminate alcohol cravings. 12 step programs are mutual aid groups where addicts work together to provide one another with the support needed to reshape their lives. Quality treatment programs help an addict find and address the underlying causes of their addiction, so that they understand why they use and can change their lives so that using is no longer a desirable course of action. Simply “not craving” alcohol any longer does nothing to provide an individual with the support s/he needs to change behavior nor does it do anything to help the addict face the causes of his/her addiction. Without uncovering and dealing with the root causes of addiction, even without cravings, the triggers that cause an alcoholic to drink are too strong to ignore and s/he will drink again.

Another drug, buprenorphine, most commonly known by the brand name Suboxone, has been approved by the FDA to be administered subdermally for opioid maintenance. According to Elizabeth Mechcatie of Family Practice News (an online news publication for family physicians), “A four-rod subdermal implant that slowly releases buprenorphine over 6 months should be approved for maintenance treatment of opioid dependence, although more work is needed to determine optimal dosing strategies and how to address the potential risks of the treatment, the majority of a Food and Drug Administration advisory panel recommended.” This system of administering buprenorphine is being considered for use to prevent those on long-term buprenorphine maintenance programs from crushing and smoking or injecting the drug to get high.

This too raises concern for me. Though we use buprenorphine on a short-term basis at my treatment center to manage opioid withdrawal, the long-term use of the drug simply moves the addict from an illegal substance to a legal one. While there is certainly some benefit from this course of treatment in addicts who refuse other forms of treatment – we can help manage intake to prevent overdose, help decrease the amount of crime associated with dependence on illegal drugs, and ensure levels of purity that we cannot with street drugs – the long-term use of buprenorphine does nothing to address the reasons the addict began to use in the first place. Wouldn’t a better form of treatment be to help the addict learn why s/he began to need substances to deal with feelings and life circumstances and provide better tools for living rather than relegate the addict to life-long addiction to buprenorphine?

There is true hope for addicts to recover. Drugs like Declinol and buprenorphine may be useful tools for helping addicts separate from their drug of choice. But after that separation, real recovery comes from helping addicts to recognize the underlying causes of their addiction(s), face those issues, heal the old injuries, and transform their lives such that they can experience health, joy, and a bright future. …which by the way, we do at Cliffside Malibu every day.