Prescribing medication for Ontario adults to reduce high risk drinking

Most prescribers are unfamiliar with medications that can help and how to prescribe them. I am just learning.

I was disappointed that the article chose to dismiss and attempt to discredit the 12-step program. The author seemed to think that, because  the program only helps 5-10% of alcoholics (which the article states without any citations), then the program has no benefit. Well, helping 5-10%  of people (which may be an underestimate of the percentage of people who are helped) to achieve sobriety should not be ignored. Whereas prescribing medication, to reduce cravings and reduce drinking, may help to reduce risk and reduce harm, it will not itself achieve sobriety for the patient. The patient still needs a sobriety program as well as the medication. Harm reduction is not a sobriety program. Harm reduction may help with the physical and mental health but sobriety is needed for emotional and spiritual health. Being dry is not being sober.

The article states that "a vow for members to surrender their lives and will to the care of God (is necessary)”. That concept is outdated and has not been true for decades. So, the article is misleading. Participants in a 12-step program are encouraged to find a 'higher power' to help to guide them to sobriety, which does not have to be a deity. And many participants use the program to achieve sobriety without ever finding a 'higher power'. 'Surrendering' is a component of Acceptance and Commitment Therapy, which has been an accepted therapy for some time now. Surrendering is a means of letting go old coping mechanisms and opening up to new ideas that help to achieve health.

So, I think that it is possible for medication, harm reduction and 12-step programs to co-exist and it is up to the patient to decide which path is the best for them.

David M.

CathE posted:

Pills can help people control risky drinking, so why aren't doctors prescribing them?

A recent study found that fewer than 1% of Ontario adults with an alcohol use disorder is ever prescribed a drug that can help them drink less, and less often.

This article in the National Post highlights the issue of access to medication for alcohol use disorder and cites 2017 research by Dr. Sheryl Spithoff and colleagues.

Comment and share your thoughts on why there is limited use of these medications in Ontario.

A big component of these not being prescribed in Ontario is that until last summer, they were available by exceptional access program application and approval only. They are now available on LU code for those who have coverage under Ontario Drug Benefits. This removes a large barrier in prescribing.

This is a great discussion. I have to be honest. I think the hard core division over "abstinence base 12 step" and "harm reduction" is where the real harm lies. People need to be able to make informed choice, free of discrimination if they are on a harm reduction pathway. Many times those on methadone/suboxone are barred from treatment because they are not considered "clean" (if the treatment environment is 12 step and the only game in town).  They are "othered" and shunned by other people in recovery, if they are not following the "preferred" wellness pathway. 

I think treatment choice/philosophy must be respectful of each other and must find ways to co-exist.

I am close to twenty years in recovery from a long hard battle with alcohol and drug addiction (Multi-drug).  I am abstinence based but not 12 step.  I have been through rehab three times (Homewood) and then a stint at Stonehenge before I could find my way.  My alcoholism was so engrained that I was prescribed Antabuse.  That helped me. I could not embrace the 12 step program for many reasons. Almost all of them due to my childhood trauma, on-going sexual abuse and sexual exploitation.  I was self medicating the trauma (and negotiating rapid cycling bi-polar). I could not sit in a room with people. I did not trust people. I had social anxiety. I certainly couldn't believe in a "God" or a higher power because I was too pissed at the world and the unequivocal and irrevocable harm that was so deeply entrenched.  

Then sadly, as I found my wellness and worked through my trauma, and mental health issues so I could come to a place of not needing to use substances to just be able to breath without nightmares, triggers, panic attacks and horrendous daytime flashbacks - my beautiful 25 year old son died of an accidental opioid overdose (Dec 23 2001). He was struggling with his mental health for years, and fell into alcoholism. I could not find him help because the only choice was 12 step and it didn't "fit" him.  Plus he was physically addicted to opioids and really needed some harm reduction options.  Back then there were not as many harm reduction options. I think he would have been alive today if he might have been able to be on some medically assisted treatment until he was able to get to a place where he might be able to embrace abstinence. 

I don't think there should be a score card of what is the "right" treatment pathway.  All treatment pathways must co-exist and allow people informed choice.  That informed choice will probably change and evolve as people deal with "hidden" trauma, mental health and any other reason.  "We" as a society and the system needs to be flexible enough to adapt to what people need when they need it.

Thanks so much for sharing your story, Betty-Lou. I agree with your idea that there is no 'right' treatment' and that treatment needs to be patient-centred.  It is heartwarming to hear your story of your journey to sobriety, which is a common story of several episodes of relapse and recovery and the need to address and heal childhood trauma. You also highlight the shortcomings of most studies of recovery and that is that the follow-up of study participants is short and usually only goes as far as the first relapse, by which the outcome of the treatment modality is judged. One year follow-up is just not long enough. There seems to be a dearth of information about the long-term recovery rate after several relapses and several visits to rehab and after trying different modalities of recovery before finding the 'right' one. And, the study results of treatment are also tend to be judged by avoidance of relapse, whereas an important indicator of success needs to be the quality of life after treatment.

Thanks again for sharing.

David M.

Thank you David. I so agree with you and your thoughts regarding the shortcomings of most studies regarding recovery.  If I think about the first year of my recovery...I would still have considered myself in the "infant" stage.  (Very vulnerable).  Then I had three more relapses before securing the collective foundation I needed to have a chance to hold it all in place.  I think recovery is more about "growing" into one's "new life" and that takes so much time to build the skills/wisdom to sustain that new role (while still mitigating the damage from it all).  I really do wish studies could follow people long term to get the bigger picture.  I think we might find that the actual treatment only plays a small part in comparison to the all the dynamics that evolve us to our wellness.

Hi Betty-Lou,

Yes, your story about the length of your journey to sobriety is quite typical. I was speaking with someone this morning, who told me that she has been clean and sober for 5 year. When I asked her how long it took to reach sobriety, the answer was, "25years!" - with many lapses and relapses. She did use a 12-step program and told me that she had attended 'secular 12-step', which does not use the concept of a deity or higher power. So, alternatives are out there.

Thanks again.

David M.

You're welcome, Cathe.

David M.