The next drug? The addictions treatment dilemma

By Richard Schaub

Almost everyone is shocked by the answer to this question: at the beginning of the 20^th Century, what was the drug that was used for the treatment of morphine addiction?  The answer is heroin. 

We have come a long way in addictions treatment since then, but, in a way, we haven’t moved at all.  We are still looking for the next medically approved (and therefore legal) drug that will substitute for the problematic addictive drug that the patient is struggling with.  The daily headlines about opioid overdoses certainly demand an answer to this national crisis and giving the patient a safe replacement drug is a compassionate, practical, and quick response.  Unfortunately, the current replacement drug of choice, a narcotic agonist, is now being abused by patients and has a growing market for illegally-gained prescriptions and street sales. 

The recurrent theme in all of this is that a percentage of the population wants drugs to change the way they feel and will search out and repetitively use whatever appears to work for them. There is nothing wrong with this. It is perfectly natural and normal to want to feel better, and the pharmaceutical marketplace offers many legal drugs that will change the way you feel in addition to their healing medicinal properties. The addiction problem appears when we realize that drugs used legally to help with pain, sleeplessness, anxiety, and other issues can cause dependence and disturbing withdrawal symptoms.  A distinction used to exist between illegal drugs that were addictive and legal drugs that were addictive, but the line has blurred as legal drugs have become over-manufactured, over-prescribed, and abused and sold by independent drug entrepreneurs.

So then, what’s the missing ingredient in the current treatment picture of looking for the next drug?  A science of emotions, of feelings.  People use drugs to change an emotional unease they feel just being in this world.  This unease is articulated over and over in alcohol and drug rehabilitation programs.  Patients use phrases such as, “everything gets to me or I’m too thin-skinned or I don’t have a heat shield or the first time I drank was the first time I felt normal or I was just looking for something to feel right.”  Or, as one patient put it, “When they gave out the book on how to live, I didn’t get a copy.”

This sensitivity or vulnerability being expressed requires attention if the recovery is going to be successful long-term.  Self-help treatments such as Alcoholics Anonymous offer the power of the group and the realization that you are not alone in your struggle with being in this world.  Having accompanied patients to their first few 12-Step meetings, they are often shocked to hear another person describe the same sensitivity and vulnerability that they feel.  But the meetings themselves are not enough to solve the existential unease, which is why many people in recovery continue their search. 

If an important aspect of recovery is literally and figuratively trying to live in this world deprived of your emotional medicine, what can substitute for it?  The next drug is one answer, often supported by the theory that addiction is a brain disease that requires medicine of some kind.  Another, very different answer, is getting to the heart of what makes living in this world so difficult.  Everyone feels it, to one degree or another, but the existential unease seems to be more disturbing in the people who end up in trouble with drugs. 

A drug-free recovery answer is an integrative psychological and spiritual development that speaks to the unease.  Such development takes time, but it has lasting impact and offers a lifelong way of new living.  It also does not depend upon the idea of the next drug and avoids the possible abuse of that drug and/or the side-effects of that drug taken long-term.