iStock_000003297469_MediumThe New York Times has an informative personal account from an insomnia sufferer that helps illustrate the benefits of cognitive-behavioral therapy (CBT) versus traditional sleep meds. I’ve been promoting this for about a year now based on promising early results.

Nonetheless, I have a sneaking suspicion that doctors will continue to rely on medication as the favored treatment. The modern healthcare system has reached the point where it almost can’t help but push pills for most problems. There are just too many incentives involved.

This is of special interest to persons with addictions, as insomnia is at the top of the list of common problems for both active addicts and the newly recovering, and sleeping meds can pose risks.

Let’s say you visit the local clinic or physician practice because you’re having trouble sleeping. The visit is probably timed to last no more than 15 minutes (most clinics keep close track). The doc listens to your complaint, asks a few questions, skims the medical record, gives you the once-over, maybe orders a test if the insurance company will pay for it. There isn’t much time for discussion, the quarter-hour is almost over. What’s the easiest way to send the patient on her way feeling that the visit was worth the trouble? Simple: Prescribe something.

It helps if the drug in question has been rated ‘effective’. But as the NYT article points out, that just means it works better than a placebo (sugar pill).

It doesn’t mean it’s guaranteed to work in your case– no medication is. A medication can be rated ‘effective’ while producing real improvement in only a minority of users. Where it does help, the improvement  could be for a limited time– research suggests that even the best sleeping meds are only effective for a month or two.  And there’s no guarantee you’ve been prescribed the med that will work best for you– some people do better on one medication than another, and a certain amount of trial and error may be involved.

Still, prescribing a medication makes very good sense psychologically. The patient is told that the med will work. That raises the expectation of success and takes advantage of the power of placebo. And told also that if (by some fluke) the symptoms of insomnia return, she’s to come back for another visit. No doubt resulting in another prescription.

Combining the medication with online CBT would probably work better. But that means the doctor must explain the process and answer questions. Pushing the outer boundaries of that quarter-hour visit. It’s easier just to trust in the meds and leave the rest to Fate.

One answer: Adjust the recommended protocols to include the behavioral treatment as well as the medication (or in some cases, instead of it.) As one practice manager told me, in a busy clinic, if something ain’t a requirement, it ain’t happening.

So let’s make it a requirement. No guarantee the patient will follow up with therapy, but it’s worth the effort.


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