Activity 1: Do treatment methods match etiology knowledge?

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Topic Progress:

Introduction

We begin this activity by returning to the HBO Series: Addictions to review the section on “Treatment”. Read through the materials and watch the associated videos in this section. For most of you, this will be a nice review, but it also will contextualize the other readings in this activity.

The primary aim of Activity 1 is to consider two peer-reviewed publications that demonstrate how theories are translated into action recommendations. The two papers represent opposing theories and approaches to the development of substance use disorder treatment. The first paper by Arria and McLellan (2012) argues that the advancements and knowledge in the etiology of addictions have not been followed through by changes to clinical practices, research strategies, or outcome evaluation. Simply put, Arria and McLellan state that “a significant mismatch remains between what this [western] culture has come to accept as the nature of the disease and how that same culture continues to treat the disease” (p. 1041).

This first paper was co-written by Dr. Thomas McLellan, who is one of the contributors to the HBO series on addictions (visited in Lesson 3). The biography on the HBO site identifies Dr. McLellan as a Professor of Psychology in Psychiatry at the University of Pennsylvania and co-founder and Chief Executive Officer of the Treatment Research Institute (TRI). TRI is a non-profit research institute in the U.S. dedicated to conveying the results of research to policymakers, treatment providers, prevention organizations, and the families of those affected by problematic substance use. Through TRI and his many other endeavors, Dr. McClellan’s work has promoted a better understanding of the factors that are responsible for treatment success, and he has fostered a greater understanding of addiction as a chronic illness that must be continually monitored and managed much like other chronically relapsing medical conditions, such as diabetes and hypertension. McLellan has published more than 400 articles (in scientific terms, this is a huge number) and book chapters on addiction research, and has served as Editor in Chief of the Journal of Substance Abuse Treatment (a world leading journal). In 2009, he became the Deputy Director of the Office of National Drug Control Policy under President Obama. Among McClellan’s many honors and awards are the Life Achievement Award of the American Society of Addiction Medicine in 2003 and the 2002 award for Distinguished Contribution in Addiction Medicine from the Swedish Medical Association. In 2003, he received the prestigious Okey Honorary Lecture Award from the British Medical Society, and in 2004 he was named Innovator of the Year by the Robert Wood Johnson Foundation.

While the Arria and McLellan article is written from a chronic illness medical perspective, the second paper by Cunningham and McCambridge (2011) provides a population health perspective. These authors caution about focusing on substance use disorders as a chronic relapsing disease; they argue that this stance overemphasises the biological aspect and minimizes the psychological, social, and environmental factors.

The second peer-review article is co-authored by Dr. John Cunningham, who is a Senior Scientist in the Social and Epidemiological Research Department. He is a Professor in the Department of Psychology at the Dalla Lana School of Public Health at the University of Toronto. He is the Canada Research Chair in Brief Interventions for Addictive Behaviours (also prestigious in academic terms). This paper considers recommendations for substance use disorder treatment based on a population health perspective.

Instructions

  1. Start by returning to the HBO Series: Addictions and review the section on “Treatment”. Most of you will have seen this material before, but this review also will help to contextualize the two readings in this activity.
  2. Read Arria, A. M., & McLellan, A. T. (2012). Evolution of concept—but not action—in addiction treatment. Substance Use Misuse,47, 1041–1048.
  3. Arria and McLellan (2012) argue that “the way addiction treatment is delivered and managed should be consonant with what is known about the onset, nature, course, and heterogeneity of other chronic illnesses, including addiction. Clinical interventions, including prevention, brief interventions, and formal treatment, should start earlier” (p. 4).
    1. What do you think of this recommendation?
    2. Considering your experience in practice, in practicums/preceptorships, or your lived experience, do you think a gap exists between what we now know about the etiology of substance use disorders and their treatment?
    3. How do you think the system of care you are working in fares? Is treatment consonant, or not, with current knowledge on the etiology of substance use disorders?
  4. Read Cunningham, J.A., & McCambridge, J. (2011). Is alcohol dependence best viewed as a chronic relapsing disorder? Addiction, 107, 6–12.
  5. Cunningham and McCambridge (2011) argue that “the majority of people with alcohol dependence do not behave as though they have a chronic relapsing disorder” (p. 6) and that furthermore this perspective undermines broader public health strategies aimed at prevention and early interventions in the general population.
    1. What do you think of this perspective?
    2. Considering your experience in practice, in practicums/preceptorships, or your lived experience do you think your region/province has an adequate population health strategy?
    3. How do you think the system of care you are working in fares? Are substance use resources consonant, or not, with a recognition of a continuum of substance use severity in the general population? For example, are a preponderance of resources focused on those people with severe dependence and concurrent mental health issues; or is there a balance of intervention approaches for those with mild and moderately severe substance use disorders?