You Can't Be in Recovery If You Are on Medication: A Concept Worth Retiring

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Notes

¹ The reader is reminded the diagnosis of a “substance use disorder” is a relatively new diagnosis that is based upon a consensus-based taxonomy (American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th Ed, 1994; 5th Ed., 2014; American Psychiatric Association: Washington, DC) and is the outcome of an ongoing diagnostic process. In order that any diagnosis be useful for treatment planning it should “offer,” minimally, three critical, necessary types of information: etiology, process and prognosis…which are not always known. Second, a diagnosis, when demystified, is simply the outcome of an information gathering process to be used for decision-making. Third, the underpinnings for diagnostic criteria can be theory-driven, empirically-based, individual and/or systemic stake holder-bound, based upon “principles of faith,” etc. All-too-often the resources of the person to be diagnosed (types, levels, qualities, etc.) and the needs or agendas of the classifier (individuals as well as systems) are not adequately considered or noted. Lastly, whereas all diagnoses are taxonomy categories or labels, all labels are not diagnoses. Editor's note.

² The reader is asked to consider that the term “recovery” is an overloaded container concept, catch-all-code, in the substance use-misuse intervention field, which is bounded by culture, time, place, stakeholder values, agendas, interests, and influences. Although there is no consensually agreed upon definition by a range of involved deliverers of care and services for its targeted populations, recent definitions include the United States: (1) Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship. Sobriety refers to abstinence from alcohol and all other non-prescribed drugs. The Betty Ford Institute Consensus Panel, Journal of Substance Abuse Treatment 33 (2007) 221–228; and (2) the UK Drug Policy Commission: “Recovery is a process, characterized by voluntarily maintained control over substance use, leading towards health and well-being and participation in the responsibilities and benefits of society’ The UK Drug Policy Commission, Recovery Consensus Group Policy Report, July 2008; www.ukpc.org.uk, “Recovery” is most often associated with abstinence. Its dimensions, and the necessary internal and external, micro and macro level conditions for its achievement and sustainment, and the person's necessary enabling resources as well as interfering flaws and limitations, have yet to be delineated in treatment ideologies such as harm reduction, quality-of-life, and conflict resolution. Editor's note.

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George E. Woody

George E. Woody, MD, USA, graduated from Amherst College in 1960, Temple University School of Medicine in 1964, interned at Bryn Mawr Hospital, was a general medical officer in the Navy from 1965 to 1997, and completed a residency in Psychiatry at Temple in 1970. His first paper was published in 1971 and consisted of case reports of undergraduate students who had taken hallucinogenic drugs and had visual disturbances while driving. He worked at a Community Mental Health Center in 1970–1971, then as a staff physician in a newly formed substance abuse treatment program at the Philadelphia VA Medical Center led by Charles O'Brien, and later became Chief of the program. He is currently Professor in the Department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania and Principal Investigator of the Delaware Valley Node of the NIDA Clinical Trials Network. He was a member of the DSM-IV Work Group on Substance Use Disorders and the FDA Drug Abuse Advisory Committee, has co-edited Treatment Improvement Protocols on methadone maintenance, and has lectured nationally and internationally. He was awarded a Doctor Sui Causa from Pavlov State Medical University in St. Petersburg, Russia, and an award in honor of Dr. Alexei Alexeevich Likhachev, founder of the Pharmacology Department of the Women's Medical Institute of St. Petersburg, Russia, later renamed Pavlov State Medical University, was a recipient of the Scott Mackler award by the University of Pennsylvania for contributions to substance abuse teaching, and was received the McGovern award for contributions to teaching and research on substance use disorders. He has authored or co-authored over 250 publications and participated in studies of psychotherapy and counseling for methadone patients, buprenorphine for opioid-addicted adults and adolescents, addiction treatment as HIV risk reduction, and oral and extended release naltrexone for opioid and amphetamine dependence.