Abert, Chris, 77–78
abstinence-only approach, 10, 36, 67, 161, 162, 190, 211, 217, 219, 230
comparison with harm reduction, 77–78
addiction: disease model, 22–23, 28–29, 63, 64, 66, 158, 167, 181. See also alcoholism; heroin addiction; opioid addiction
addiction counseling, 75, 94, 102, 106
addiction counselors, 93, 94–96, 97, 109, 121–22, 132–33
client-to-counselor ratio, 101
addiction medicine, 46–47, 130–31, 144, 149, 153–54, 159–60
inadequate training in, 147–54. See also medical education, addiction treatment training in
adverse childhood experiences, 1–2, 4
affiliative need, 81
Affordable Care Act, 51–52, 56, 163–64
African Americans, 32–33, 39–40
alcohol, detoxification from, 170
Alcoholics Anonymous (AA), 5, 6, 9–10, 55–87, 147
anti-MAT position, 12, 59, 70, 73–74, 229
combined with addiction treatment, 56–61, 66–67, 70–71, 74–77, 89
history, 62–65
mandatory participation, 118, 192
Nancy Reagan on, 38
proof of participation, 118
recovery concept, 75
spirituality/religiosity component, 63–65, 66–67, 75, 79–81
sponsors, 5, 6, 8, 60, 64, 75, 79–81, 82–83
“thirteenth step,” 77
alcoholism, 63, 64, 83–84. See also Alcoholics Anonymous (AA)
Alkermes, 196–97
Allen, George, 31–32
American Bar Association, 42
American Board of Preventive Medicine, 131
American Medical Association, 42, 47, 158
American Society of Addiction Medicine, 47, 67, 84–85, 178
Americans with Disabilities Act, 122, 187, 193–94
Anti-Drug Abuse Act, 39
Appalachia, 3
Azar, Alex, 50–51
behavioral treatment, 10–11
benzodiazepines, 107, 112, 208–9
Bill W. See Wilson, Bill
biopsychosocial model, of addiction, 3–4, 102
Black Panther Party, 32–33
Botticelli, Michael, 49
brain, 2, 3, 7. See also opioid receptors
Buchman, Frank, 63–64
buprenorphine prescribers, 50, 148, 219
patient quota limits, 46–48, 50, 114, 144, 145–46, 219
buprenorphine treatment, 11, 43–45, 72–73, 106, 108, 110, 196
accessibility, 14, 52, 93, 139–40
adverse reactions, 209
controlled substance classification, 45–46, 47
cost-effectiveness, 136–37
dose, 208
early discontinuation, 70
in foreign countries, 44, 205–15, 220
harm reduction approach, 111
health insurance requirements, 164
incarcerated persons’ use, 193–94, 196
long-term, 208
low-barrier, 111–12, 129, 231–32
misuse or diversion, 46, 48–49, 146–47, 160–61, 188–89, 208, 209
obstacles to use, 13
overdose and, 43–44, 106, 157, 208–9
for pain management, 44, 46–47, 145–46
psychosocial services in, 231
retention in, 106
short-term, 157
tapering-off policy, 174–75, 179
tolerance to, 189
transition to, 139–40
twelve-step programs and, 59–61, 67, 70, 82, 103
withdrawal from, 165. See also Subclocade; Suboxone; Subutex
Bush, George H. W., 40
case management / case managers, 22, 39, 52, 175, 176, 177, 199
chronic disease, 3–4, 102, 147, 207–8
chronic pain, 151
“clean,” definition, 88
client-directed addiction treatment, 105–6
Clinton, Bill, 41
cocaine use disorder, 154
Cochrane reviews, 11
coercive approach, in addiction treatment, 78–79, 81, 82
community resources, 13
Comprehensive Addiction and Recovery Act, 50
Congressional Black Caucus, 32
contingency management, 127–28
control, external locus of, 81
Controlled Substances Act, 37
cravings control, 10–11, 73, 76, 90, 91–92, 129, 134–35
criminal behavior / crime, drug use–related, 31–32, 33, 204, 221
mandatory sentencing laws, 23, 37, 38, 39–40
MAT-related decrease, 37, 128–29, 133, 140, 221
criminalization, 14, 20–21, 23, 29, 202, 205, 213, 223. See also decriminalization; drug courts
criminal justice system, 24, 39–41, 62, 91, 184–85, 218–19
drug dealers in, 182
MAT use in, 11, 30, 31, 183, 218–19
probation, 194–96. See also drug courts; incarceration
crystal meth, 134
culture, 13–14
DATA waivers, 46, 144–45, 146, 148, 153, 157, 159, 207, 220
training requirements, 151–52
Daytop, 28
decriminalization, 29, 203–5, 207, 219, 222, 227, 233, 235
Dederich, Charles, 28
deterrence theory, 205
detoxification, 23, 24, 67, 91, 93, 107, 182, 211, 217, 218
from alcohol, 170
partial, 139
from Vivitrol, 91, 92, 170, 171
Diagnostic and Statistical Manual of Mental Disorders (DSM), 18
Diana, Princess of Wales, 39
disease model, of addiction, 22–23, 28–29, 63, 64, 66, 158, 167, 181
Dole, Vincent P., 26–27, 42, 74–75
Drug Abuse Council, 22
Drug Addiction Treatment Act (DATA), 46, 50, 144. See also DATA waivers
attitude toward Vivitrol, 43
funding, 198
medical decision-making by, 186, 191–92, 198–99, 227
physicians’ participation, 177–78, 186, 190–91, 227
recommendations for, 197–200, 227
drug education, 29–30, 41, 46–47, 53, 197–98, 234
“Just Say No,” 38–39. See also medical education, addiction treatment training in
Drug Enforcement Agency (DEA), 21, 37, 42, 45–46, 50, 125
drug paraphernalia, 235
drug policy: demand-side approach, 3, 40, 41
failure, 52–54
Nixon administration, 29–38
Obama administration, 49–51, 52
punitive approach, 37, 38, 39–40, 52–54
supply-side approach, 3, 29, 36–37, 40, 53. See also funding, for addiction prevention and treatment
drug possession, 29, 37, 38, 202, 203, 204, 219, 227, 233
drug trafficking, 29, 36–37, 53, 182, 203, 210
Emanuel, Rahm, 41
empathy, 160
Employee Retirement Income Security Act, 168
European Monitoring Centre for Drugs and Drug Addiction, 202–3
European Union, 202–3
evidence-based treatment, 94, 95, 96, 102, 202–3
Family and Medical Leave Act, 104–5
Federal Bureau of Investigation (FBI), 37
Federal Bureau of Narcotics (FBN), 21, 22–23, 42
Federal Code of Regulations Part 2 (42 CFR 2), 154–58, 235
First Amendment, 192
Food and Drug Administration (FDA), 9, 10, 11, 37, 43, 44–45, 145
Ford, Gerald, 38
foster care, 4–5
France, drug policy, 44, 129, 130, 205–10, 227–28
physicians’ participation, 167, 206–8, 226
funding, for addiction prevention and treatment, 33, 35–36, 52, 96, 163
Bush administration, 40
Carter administration, 38
Clinton administration, 41
decline/inadequacy, 38, 39, 52
federal block grants, 101, 167
Nixon administration, 31, 32–33, 34–36, 51
Obama administration, 51
for twelve-step programs, 62
gabapentin, 177
Gottlieb, Scott, 51
Graham, Katharine, 32
group counseling, 96–99, 108, 118, 120–21, 173–74
harm reduction, 71, 77–78, 103, 108, 202, 215, 231
as norm, 234–35
safe legal drug injection sites, 77–78, 108, 220–21, 222–24, 235
Harrison Narcotics Tax Act, 20, 46, 145
Hatch, Orrin, 47–48
health care providers: attitudes toward MAT, 14. See also nurses; physician assistants; physicians; primary care physicians; psychiatrists
health insurance coverage, for addiction treatment, 56, 89, 90, 101, 120, 139, 179, 207–8, 211
addiction counselor credentialing and, 94
for drug courts, 199–200
inadequacies, 163–71
obstacles to, 163–68
physician reimbursement rates, 166–68
prior authorization requirement, 164
for Vivitrol, 90–91, 92. See also Medicaid
Health Insurance Portability and Accountability Act (HIPAA), 155, 157–58, 235
health services utilization, 12–14
hepatitis C, 10, 154, 226, 234
heroin, 3, 23, 30, 44, 53, 112, 134–35, 138
trafficking in, 36–37
heroin addiction, 6–10, 26, 31–32, 33, 77–78. See also buprenorphine treatment; methadone maintenance
heroin-assisted treatment, 26–27, 30, 202–3, 220–22
HIV/AIDS, 10, 39, 67, 77–78, 115, 154, 207, 208, 226
risk behaviors, 44, 128–29, 140, 201, 205, 210–11
homeless persons, 113–15, 231–32
hub-and-spoke model, of MAT, 110–15, 231
Humphreys, Keith, 51–52
Illinois Drug Abuse Program (IDAP), 27–29, 38
impulsivity, 2
incarceration, for drug-related crime, 53, 125, 204, 211, 213, 234
mandatory sentencing, 23, 37, 38, 39–40
negative effect on recovery, 179–83
individual counseling, 96, 97, 98, 103, 121–22, 133
injection drug use: disease transmission through, 10, 201, 205, 210–11
harm reduction approach, 77–78, 108
methadone maintenance for, 129, 140
safe legal injection sites, 202, 220–21, 222–24, 235
syringe exchange programs, 39, 181–82, 210–11, 234–35
Inside Rehab: The Surprising Truth about Addiction Treatment—and How to Get Help That Works (Fletcher), 98
Institute of Medicine, 230
intensive outpatient programs (IOPs), 96, 104–5
Internal Revenue Service (IRS), 168
Jaffe, Jerome H., 26–29
Lexington, KY, narcotic farm and, 24–26
national drug policy and, 33–38, 49
Johnson, Lyndon B., 31
“Just Say No” campaign, 38–39
Kunzelman, Justin, 77–78
Lawrence, Thomas, 222
Lexington, KY, narcotic farm, 24, 25–26
LifeRing, 84
Lortab. See hydrocodone
marijuana, 23, 37, 38, 41, 52, 105, 128, 204
Maslow’s hierarchy of needs, 76
MAT. See medication-assisted treatment
Medicaid, 51–52, 108, 113, 120, 146, 166–67, 199–200
Alternative Benefits Plan, 163–64
prior authorization requirement, 164–65
medical education, addiction treatment training in, 147–53, 160
Medication-Assisted Recovery Anonymous (MARA), 84, 85–87, 229
medication-assisted treatment (MAT), 10, 67, 102, 105
combined with behavioral or psychosocial treatment, 11, 18, 62
definition and terminology, 18, 192
effect on overdose risk, 107
federal ban, 20–21
federal recommendations, 106–7
hub-and-spoke model, 110–15, 231
long-term, 191
low-barrier, 105–6, 110–11, 215
as mainstream medicine, 225–26
physical dependence on, 72–73
recovery model, 71
retention rates, 16–17
short-term, 191
theoretical framework, 12–15
withholding of, 106. See also buprenorphine treatment; drug policy; methadone maintenance
medication-assisted treatment prescribers, stigmatization of, 83. See also buprenorphine prescribers
medications for opioid use disorder, 192
mental health counselors, 94–95
mental health disorders, 2, 102, 151, 154, 159, 235
Mental Health Parity and Addiction Equity Act, 163–64, 168
misuse and diversion, 36, 135–36
as pain medication, 123–26, 135–36
prescriptions for, 117–18, 123–125, 119, 130
Methadone Anonymous, 67–68, 84
methadone clinics, 116–41
ancillary services, 129
certification, 125
daily attendance, 119–20, 122, 123, 126–28, 129–31
high-barrier, 128
individualized approach, 130–31, 133
level one, 124
limited number and accessibility, 52, 131–32
low-barrier, 128–29
regulation, 35–36, 46, 52, 125–26, 137
waiting list, 35
methadone maintenance: combined with counseling, 120–22
compliance, 215
cost-effectiveness, 136–37
in criminal justice system, 30, 31
development, 26–29
dosage, 134–35
history, 26–29
international policies, 201, 205–6, 210–11, 212–16
legalization, 21–23
level one, 120
limited access, 52
low-barrier, 215
as mainstream maintenance, 228
misuse and diversion, 36
myths about, 140–41
Nixon administration policy, 29–38, 42
in nonwhite minorities, 134
regulations, 35–36
take-home doses, 122–23, 126–28, 129, 215, 228
tapering off from, 139–40
twelve-step programs’ opposition to, 67, 68–69, 82
withdrawal process, 139–40
morphine, 27
morphine maintenance clinics, 19–23
motivational interviewing, 96, 112
Musto, David, 23
naloxone, 44–45, 77–78, 107, 108, 234
naltrexone, 42, 43, 90–91, 93, 217, 218–19
naltrexone, extended-release, 11, 43, 90, 109, 110–11, 146–47, 196–97
health insurance coverage, 164, 166
induction process, 166
limited availability, 52, 139–40, 146–47. See also Vivitrol
Narcan. See naloxone
narcology hospitals, 211–12
Narcotics Anonymous (NA), 58, 62, 65, 67, 79, 118, 147, 192
alternatives, 67–68
MAT stigmatization by, 67–69, 83, 229
Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment, 68–69
National Academies of Sciences, Engineering, and Medicine, Medications for Opioid Use Disorder Save Lives statement, 11, 106–7
National Association of Drug Court Professionals, 197–98
National Institute for Justice, 205
National Institute of Mental Health, 29, 33–34, 35, 36, 38
National Institute on Drug Abuse, 3, 11, 43, 44, 45
National Institute on Drug Addiction, 49
National Research Council, Committee on Drug Addiction, 42
neonatal abstinence syndrome, 138
Netherlands, 220–22
Nixon, Richard M., 29–38
nurse practitioners, 50, 148, 219
nurses, opioid addiction in, 117–25
Obama, Barack, 40, 41, 49, 50, 51, 52, 198
Office of National Drug Control Policy, 40, 41
Oliver, John, 101
Opana, 146
opioid addiction: definitions and terminology, 1, 18, 53, 72
differentiated from opioid use, 72
differentiated from physical dependence, 72–73
iatrogenic, 2–3
misconceptions about, 158. See also heroin addiction
opioid addiction treatment, 99, 101, 102, 109, 180, 202
drug policy–related obstacles to, 52–54
individual level, 12–13
public’s knowledge about, 233–34
treatment plans, 99, 101, 102–4, 107, 109–10
waiting list, 35, 41. See also buprenorphine treatment; methadone maintenance; Suboxone
opioid addiction treatment centers, 88–115
decriminalization laws and, 205
high-barrier, 105
mandated twelve-step program participation, 81
patient’s goals, 230–31
person-centered care, 81–82, 230–31
spirituality component, 80–81
waiting lists, 92–93
opioid agonists. See buprenorphine; methadone
opioid antagonists, 42. See also naltrexone
opioid maintenance treatment: federal ban, 20–21, 23, 26
history, 19–23. See also buprenorphine treatment; drug policy; medication-assisted treatment (MAT); methadone maintenance
opioid receptors, 7, 9, 43, 44, 72–73, 129
opioids: increase in prescriptions for, 2–3
prices, 23
opioid use disorder (OUD), 18, 44, 110, 183, 184. See also opioid addiction
opium, 3
Organisation for Economic Co-operation and Development (OECD), 202
outpatient treatment: decriminalization laws and, 205
hub-and-spoke model, 110–15, 231
intensive outpatient programs (IOPs), 96, 104–5
limited number of clinics, 228
overdose, 3, 14, 108, 135–36, 139–40, 234
MAT-related decrease of, 10, 67, 73, 91, 107, 125–26, 157, 206, 208, 232
oxycodone, 2, 47, 50, 55–56, 138
pain management, with opioids, 2–3, 73, 123–26, 145–46
palliative care, 139–40
patient-centered care, 81–82, 99, 103–4, 112, 131, 132, 217–18
dimensions of, 230
lack of, 136
peer recovery coaches, 8–9
peer support groups, 53, 102, 147
drug courts’ attitude toward, 192–93
limitations, 10–11
MAT-supportive, 229–30
non-twelve-step, 83–87. See also Alcoholics Anonymous (AA); Methadone Anonymous; Narcotics Anonymous (NA)
peer support specialists, 95–96, 161
person-centered care. See patient-centered care
pharmacists, 214, 215–16, 219, 228, 233, 234–35
pharmacotherapy, 192
physical dependence, 72–73
physician assistants, 50, 148, 219
Physician Clinical Support System, 153
physician-patient relationship, 19–20, 158
physicians: drug court participation, 177–78, 186, 190–91, 227
lack of addiction medicine training, 147–54. See also primary care physicians
physicians, as MAT prescribers: bias toward addiction patients, 158–63
collaborative approach, 154–58, 235
in Europe, 206–10
insurance reimbursement rates, 166–68
privacy laws and, 154–58
Picker/Commonwealth Program for Patient-Centered Care, 230
polysubstance abuse, 154
Portugal, 201–2, 203–5, 219, 227
post-traumatic stress disorder (PTSD), 2, 5, 8, 154
pregnancy, 44–45, 125, 137–38, 226
prescription drug monitoring programs, 117
prescription opioid use, 2
history, 19–23
Price, Tom, 220
primary care physicians, as MAT prescribers, 13, 207, 213–17, 219, 227–28
addiction medicine education, 153–54, 226
as addiction treatment coordinators, 226
financial incentives, 207–8, 215–16
in foreign countries, 206–10, 219, 220
institutional resistance to, 160–63
need for increase in, 225–26
probation, MAT use during, 194–96
Probuphine, 188
psychoanalytic theory, of opioid addiction, 63
psychosocial treatment, 10–11
psychotherapy, 33–34
Reagan, Nancy, 38–39
reasoned action and planned behavior, 14
Reckitt & Colman (firm), 44
recovery, 49, 72, 74, 75, 76, 78
“reefer madness,” 23
“rehab.” See residential addiction treatment centers
relapse, 53–54, 67, 92, 105, 108, 202–3, 220–22
physicians’ attitudes toward, 158–59
prior authorization requirement and, 164, 165
as treatment planning issue, 103–4, 107
withdrawal symptom control–related, 139–40, 160–61
replacement therapy, 68
research, in opioid addiction treatment, 10, 11, 15–18, 95, 96–97, 100–101
residency programs, 148–53, 160
residential addiction treatment centers, 92, 93, 96, 99, 102–3, 104–5
combined with AA participation, 56–58
MAT-providing, 108–13
transition from, 103–4, 109–10
respiratory depression, 43–44
Rockefeller, Nelson, 37, 38, 40, 180
Rockefeller University, 26–27
Russia, drug policy, 201–2, 210–13
SAMHSA waiver. See DATA (Drug Addiction Treatment Act) waivers
Scott, Ric, 200
Secular Organizations for Sobriety (SOS), 84
self-efficacy, 14
Serenity Prayer, 57
sexual assault victims, 98–99
shame, 181
Shreveport, LA, morphine maintenance clinics, 19–23
SMART Recovery, 84
Smith, Bob, 65
societal factors, 13–14
socioecological model, of opioid addiction treatment, 12–14
Spain, drug policy, 220–22
Special Action Office for Drug Abuse Prevention, 35, 40
spiritual component, of addiction treatment, 102
spiritual support groups: court-mandated participation, 192–93. See also Alcoholics Anonymous (AA); Narcotics Anonymous (NA)
stigmatization: of addiction, 53, 232–33
by physicians, 158–63
of physicians, as MAT prescribers, 131
stigmatization, of MAT, 12, 76–77, 131, 133, 134, 216
within twelve-step groups, 13, 60–62, 67–70, 192–93, 229
Straight Inc., 39
Sublocade, 188
Suboxone, 7–10, 44–45, 59, 76–77, 91
twelve-step programs combined with, 73–74, 86–87
Substance Abuse and Mental Health Services Administration (SAMHSA), 11, 101, 106–7, 114, 125, 139–40, 143, 145
substance abuse disorder, 2. See also alcoholism; heroin addiction; opioid addiction
substance use disorder treatment centers, 92–93
Subutex, FDA approval, 44–45
suicide attempts, 92–93
SUPPORT for Patients and Communities Act, 51
Switzerland, drug policy, 220–22
syringe exchange programs, 39, 181–82, 210–11, 234–35
syringe sharing, as HIV/AIDS risk factor, 44
therapeutic alliance, 199, 218
therapeutic communities, 34–35, 36
tolerance, 6
threshold of, 73
Tournier, Robert, 65
Tuskegee Syphilis Study, 32
twelve-step programs, 13, 57, 62, 75, 81, 94, 98, 99
alternatives, 83–87
coercive approach, 78–79, 81, 82, 99–100
MAT combined with, 70–71, 73–74, 81, 84–85, 86–87
MAT stigmatization by, 13, 60–62, 67–70, 192–93, 229
online, 229
recovery concept, 70–74
spirituality/religiosity component, 38, 84, 86, 99–100. See also Alcoholics Anonymous (AA); Methadone Anonymous; Narcotics Anonymous (NA)
21st Century Cures Act, 51
Ukraine, drug policy, 212–13
United Kingdom, drug policy, 201–2, 205–6, 213–19
heroin-assisted treatment, 30, 220–21
methadone maintenance, 129, 221, 227–28
syringe exchange programs, 234–35
urine drug screens, 100–101, 111, 112, 126, 231
court-mandated, 175, 177, 187, 195–96, 199
US Department of Health, Education, and Welfare, 34, 168
US Department of Labor, 168
US Supreme Court decisions, 20–21, 29
US surgeon general, 11
Vancouver, Canada, safe injection site policy, 222–24
Veterans Health Administration, 98–99, 132
Vietnam War, 12
veterans of, 34
Vivitrol, 9, 43, 49, 92, 169–71, 179, 200
detoxification requirement, 91, 92, 170, 171
Volkow, Nora, 49
War on Drugs, 35–41
Webb v. United States, 20–21
White, William, 21
Wikler, Abraham, 25
Wilkinson, Bud, 29–30
Wilson, Bill (Bill W.), 62–65, 74–75
withdrawal symptoms, 26, 48, 138, 139, 161, 165, 189
withdrawal symptoms control, 10–11, 73, 76, 112, 129, 133–34, 160–61
as relapse cause, 160–61
Women for Sobriety, 84
World Health Organization (WHO), 11