Abstract
ABSTRACTBackground: People with severe substance use disorders require long-term rehabilitative care after the initial treatment. There is, however, a deficit in the availability of such care. This may be due both to inadequate medical coverage and insufficient use of community-based Twelve-Step programs in many treatment facilities. In order to address this deficit, rehabilitative care for severe substance use disorders could be promoted through collaboration between practitioners of medically assisted treatment, employing medications, and Twelve-Step-oriented practitioners. Objective: To describe the limitations and benefits in applying biomedical approaches and Twelve-Step resources in the rehabilitation of persons with severe substance use disorders; and to assess how the two approaches can be employed together to improve clinical outcome. Method: Empirical literature focusing on clinical and manpower issues is reviewed with regard (a) to limitations in available treatment options in ambulatory and residential addiction treatment facilities for persons with severe substance use disorders, (b) problems of long-term rehabilitation particular to opioid-dependent persons, associated with the limitations of pharmacologic approaches, (c) the relative effectiveness of biomedical and Twelve-Step approaches in the clinical context, and (d) the potential for enhanced use of these approaches, singly and in combination, to address perceived deficits. Results: The biomedical and Twelve-Step-oriented approaches are based on differing theoretical and empirically grounded models. Research-based opportunities are reviewed for improving addiction rehabilitation resources with enhanced collaboration between practitioners of these two potentially complementary practice models. This can involve medications for both acute and chronic treatment for substances for which such medications are available, and Twelve-Step-based support for abstinence and long-term rehabilitation. Clinical and Scientific Significance: Criteria for developing evidence-based approaches for combined treatment should be developed, and research for evidence-based treatment on this basis can be undertaken in order to develop improved clinical outcome.
Highlights
People with severe substance use disorders require long-term rehabilitative care after the initial treatment
The TwelveStep approach became embedded in the treatment community as part of the culture of recovery from alcoholism
The large portion of such facilities is compromised in terms of providing treatment with two of the most efficacious medications in the addiction rehabilitation field, ones that are key to addressing the prominent recent growth in prevalence of opioid use disorders
Summary
To cite this article: Marc Galanter (2018) Combining medically assisted treatment and TwelveStep programming: a perspective and review, The American Journal of Drug and Alcohol Abuse, 44:2, 151-159, DOI: 10.1080/00952990.2017.1306747 To link to this article: https://doi.org/10.1080/00952990.2017.1306747
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