Several recent articles have alerted us one again that the “other” pandemic — substance use disorder — is still very active, and just like the COVID-19 pandemic, substance use disorder will be best solved through science and medicine.

There may be an assumption that going through “treatment” will solve the problem. The reality, like the disease itself, treatments vary and may not provide or address the individual’s particular symptoms. A great book on this is “Inside Rehab” by Anne Fletcher. I recommend it highly. 

If we are ever going to get on top of this here are some ideas.

1. Stop all the focus on substances; they are a symptom, not the problem. The actual problem is a neurologically based disease mostly genetic in origin. Focus on the disease, not just one obvious symptom.

2. Every person entering treatment should have an individual comprehensive cognitive screening. Evidence shows us that a person entering treatment needs six to eight weeks just to clear from use; until then they may not hear much of what the treatment has to offer.

3. Treatment needs to focus on the disease via education and cognitive behavioral approaches. Continued focus on the person as the problem doesn’t work.

4. Medication-assisted treatment can be a helpful tool for most. It is not a substitute for other substances, which is a belief stated in some articles.

5. Stop ignoring the nicotine issue. Most programs do nothing about it. It’s a powerful trigger to return to other substances along with the obvious health issues. A person leaving treatment still using nicotine is still in the active disease process.

6: Investigate transcranial magnetic stimulation, or TMS, and bring substance use disorder into the 21st century. It’s very successful in treating depression and OCD, and trials are underway in substance use disorder. They’re worth it.


Robert Creamer


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