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Doctors against medicalization

Posted May 21 2011 8:44am
“If the only tool you have is a hammer, you tend to see every problem as a nail.” — Abraham Maslow

An addiction physician says :

Over the past two years, I’ve witnessed a worrisome trend: the medicalization of addictions. Some of this makes no sense to me. Let me explain.

He describes the emerging norm of discharging patients with up to 7 medications, often including drugs that have potential for misuse, and finishes with this thought:

Message to substance providers: We have a problem. Although addiction experts may justify these “treatments” because education and solace is provided to the patients, I believe that this mocks the purpose of (the very important and necessary) addiction treatment. There is little, if any, harm reduction, because the clients are prescribed the same or other addictive compounds during and after rehab. The clients are also prescribed new drugs, particular in the latter case of the alcoholic woman, whose potential for drug-drug interactions and future adverse events cannot be accurately predicted.

The clients are receiving expensive inpatient care [$40,000+ per month] for services and treatment that could easily be managed in cheaper and less-acute-care outpatient settings, like intensive outpatient or partial hospital programs. And, most importantly, the clients are continuing to rely heavily on pills to combat their anxieties, mood changes and addiction.

Problem? Relying on pills got them to rehab in the first place. So what’s the point of attending and paying for — or charging a commercial insurance carrier, Medicare or Medicaid, or any other third-party payer — for an expensive retreat that leaves you in virtually the same mental place, or worse, than you started? Not that much.

I’m even more worried about what health care reform will mean for this. I fear primary care physicians are going to be the front lines, armed only with a prescription pad.

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