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We treat all sorts of illnesses with medications — why should substance use disorders be different?

Would anyone argue that people with schizophrenia shouldn't be medicated? Or that antidepressants should be banned? There are neurobiological factors that contribute to addiction, and drugs can help address these factors in a way that supports more effective recovery.

We need to start accepting that biological factors are a part of this picture

Would anyone argue that people with schizophrenia shouldn't be medicated? Or that antidepressants should be banned? (Shutterstock)

Many people are uncomfortable with the thought of treating substance use disorders with pills or vaccines. I imagine this has something to do with the notion that drugs shouldn't be treated with drugs, or with the belief that when you give medications to people with addictions, you're simply adding fuel to the fire. But here are the facts: there are neurobiological factors that contribute to addiction, and drugs can help address these factors in a way that supports more effective recovery.

Last month, CBC published a column that argued that "vaccines for addictions create the illusion that there's a quick fix for drug dependence." The writer of the column, Jowita Bydlowska, suggested that pills and vaccinations for substance use disorders are not really a solution for treating addictions.

That's because, she explained, addictions are "complex" and "confusing," and drugs "create the impression that anything other than abstinence will fix the problem." Bydlowska argued that if addiction to one thing is treated, it doesn't mean that a person's addictive tendencies or need for "fixes" will be treated people will still need to satisfy their cravings. She asked: "What about gambling? What about food? What about sex? The possibilities for dopamine rush are endless."

Comprehensive treatment programs

There are a few things that need to be cleared up here. For one, the cocaine vaccine is not being offered yet; human trials are only now beginning after years of animal testing. This vaccine, which seeks to eliminate the euphoric effects of cocaine, is far from being on pharmacy shelves.

As far as I can tell, no one is suggesting that this vaccine (or any drug) will be used in complete isolation to treat addictions. These medications, as well as with other treatments such as the 12-step program, cognitive behavioural therapy, or mindfulness therapies, are just one part of a full recovery program.

People with substance use disorders (i.e. addictions) are not addicted to "fun." By the time a person is in the throes of addiction, her body has often acclimatized to the drug that is, the drug gets her to a baseline state and without it, she suffers withdrawal. This is why it's so hard for people to quit: they need it to be normal.

Many people don't know that drug or alcohol withdrawal resulting from immediate abstinence can be fatal. Nor that, on average, seven Canadians die every day from opioid overdose, and the current most effective treatment for opioid addiction involves pharmaceutical intervention called Opioid Agonist Therapy (OAT). In Canada, there are three different medications approved for the treatment of alcohol use disorder.

Despite this, according to a report by Health Canada, many communities have limited access to OAT, and people continue to fight against the use of medications for substance use disorders. Whether due to stigma or misinformation, people continue to believe that addiction is a matter of personality, and not our biology.

Treating chronic mental illness

Just take a look at the comments below Bydlowska's article, and you'll find phrases like "destructive personal lifestyle choice" and "no such thing as addiction, just weak people.Not only is this inconsistent with modern research, but it's inconsistent with the way we treat other chronic mental illnesses.

Would anyone argue that people with schizophrenia shouldn't be medicated? Or that antidepressants should be banned? Or even that nicotine patches should stop being used by smokers trying to quit? Of course, these are all highly complex disorders with both social and environmental influences, but neurobiological effects are still a widely understood to contribute to the disease. Why should addictions be treated differently?

We need to stop inadvertently stigmatizing substance use disorders, blaming people and acting as if overcoming addictions is a matter of inner strength alone. This is not to say that brain chemicals should be the only things we consider in recovery, but we need to start accepting that biological factors are a part of this picture. Only then can we perhaps finally start treating addictions with the complexity that they deserve. We may not yet have a magical "drug vaccine," but it might not be such a bad thing if we did.

About the Author

Lauren Gorfinkel

Lauren Gorfinkel has worked in addictions research in Vancouver, B.C. and Hamilton, Ont. She is a vocal advocate for evidence-based treatment and improved public knowledge on substance use disorders.

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