Addiction has been described as a chronic problem that we’ve attempted to treat as an acute illness –a big reason for the revolving door of relapse.

Two divided groups of peopleHere’s an issue that came up in when I was reviewing the proposed Federal standards for Opioid Maintenance Treatment (OMT).

It struck me that there was a big difference with respect to OMT versus abstinence-based programs — besides the obvious one, I mean. In most states, addiction treatment is required to meet fairly rigorous requirements (and limitations) about the number and frequency of sessions, counselor to client ratio, length of a treatment episode, etc. If it’s not the states setting the limits, it’s the payers. Fair enough, we’ve adapted, right?

But for OMT, those limits are far looser. Take discharge planning, which ordinarily starts on Day 1 in treatment and gets updated regularly throughout. Not so in OMT. In an Opioid Maintenance Treatment program (also called “Medication Replacement Therapy” (MRT), especially for those battling an addiction to prescribed medicines,) the client can stay until he feels like terminating, and if that day never comes, so be it. He’s still considered a success. I can see the reasoning there –leaving OMT prematurely is apparently a predictor of relapse.

How come the expectations are so different for other treatment modes?

Somehow we’ve gotten the idea that abstinence-based treatment should produce powerful benefits that should last months or years, after treatment stops. By contrast, the benefits of OMT aren’t expected to last beyond involvement in OMT — which is why clients aren’t encouraged to leave.

Addiction has been described as a chronic problem that we’ve attempted to treat as an acute illness –a big reason for the revolving door of relapse. No disagreement there. Yet clinicians in many programs are required to spend a great deal of their time arguing for additional sessions or residential days, demonstrating that the client is making adequate progress to justify continued treatment.

Except in OMT. There, it seems to be about engaging the client and holding on to him for as long as humanly possible. Success, presumably, would be 100% retention in the program, indefinitely.

Services are often pretty minimal. An assessment, a physical, a treatment plan, a schedule of testing, maybe some referrals for other needs, some therapy sessions — that’s often it. Or even less. Wouldn’t you expect more for a population of chronic opioid addicts, many of whom have been struggling for decades?

I asked around in the OMT world, and was told adding requirements might discourage opioid addicts from enrolling, which is bad because of the hazards of staying out on the streets.

Makes sense. We sure don’t want to put up barriers to treatment. So I’m not arguing in favor of making it harder to access OMT.

I’m just wondering why we don’t apply the same standards to all forms of treatment?


4 Comments »

[…] McMillin touches on this in a thoughtful blog On Recovery SI. He points out that discharge planning starts early on in abstinence focussed […]

Pingback by Methadone's bad press - Recovery Review — August 22, 2014 @ 12:42 am

[…] A comparison of the expectations and standards for abstinence-based addiction treatment programs versus medication replacement or Opioid Maintenance Therapy (OMT.) (There's a double standard: #OMT versus #abstinence-based #addiction treatment.  […]

Pingback by Addiction Treatment: The Double Standard | Reco... — December 5, 2013 @ 12:06 pm

Thanks for the kind words, Lisa! We’d have no clue how to publish something in HuffPost, but anyone who’d like to re-blog it is welcome to do so. It’s an interesting question, and I definitely agree with you about “the system.” Your comments are always welcome!

Comment by Cecile — July 22, 2013 @ 1:40 pm

Wish you’d publish this in HuffPost. Or did you already and I missed it? As a simply educated woman with a ton of knowledge I sometimes see “the system” as more part of the problem than the solution, Insurance covers none of my work (life skills/recovery coaching), and rightfully so, however, my success rate with recovering addicts is phenomenal. And by “success” I am stating continued and unbroken sobriety AND integration back into life—engaged in life. I like to think I am helping set the ground work for a future where we teach life skills and personal/spiritual growth as part of the solution, if not, The Solution. I haven’t commented in awhile, but always appreciate your thought provoking posts. Thank you.

Comment by Lisa Neumann — July 22, 2013 @ 10:27 am

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