How Questioning Medication-First Addiction Treatment Made Me a Heretic
Questioning addiction treatment orthodoxies shouldn’t lead to academic exile
I am an experimental psychologist, and my goal throughout my career has been and still is to find the truth and to teach my students to do the same. How do we do that in science? We disprove our own and others’ faulty claims and methodically arrive at truth. Or at least that’s the way it’s supposed to work.
My own research is in the area of addiction. I want to eradicate it—a big goal, especially as vast amounts of money and manpower have been invested in addressing addiction without actually reducing the problem. So, there is much work to be done.
The scientist in me wants to “build a better mousetrap”—to find the best ways to reduce dependence on substances. I particularly want to investigate the effectiveness of non-pharmacological treatments, methods such as intentionally increasing the patient’s interpersonal connections. However, whenever I question the status quo, which involves using medication as the (almost) universally recommended, “evidence-based” treatment for addiction, I am accused of endangering people, stigmatizing addicts, and bringing up questions that have already been answered.
But those questions have not been answered. In fact, the questions haven’t even really been asked yet because the “evidence” base is comprised of studies comparing one medication to another, rather than comparing medication to non-pharmacological interventions.
Unfortunately, when it comes to treating addiction, there is an ironclad orthodoxy. Research funding for additional treatment almost always requires medication to be provided to patients. Treatment guidelines call a failure to medicate unethical. And trying to publish articles questioning medical intervention for addiction has been nearly impossible for me and my colleagues.
Seeking effective treatment alternatives threatens several multibillion-dollar industries—from Big Pharma to the prison system, from lab testing to treatment centers. Those protecting these industries are far better positioned to lobby and to curry favor with funders, publishers, and guideline gatekeepers. Is that what is happening or is their ideology just so strong that they truly can’t fathom any alternative being viable, let alone superior?
I would like to see head-to-head comparisons of treatments. Let the chips fall where they may. Let the most effective treatments win. But because I dare to question the pharmacological bias, I feel as if I am left (or being sent) outside the camp.
 | A guest post by
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My own anecdotal stories of trying to have various forms of a lit review outlining some of the drawbacks of addiction treatment medications is what drove me to write this paper. I also have a colleague who does the "controversial research" on tapering buprenorphine for women who are pregnant and want to be tapered. It is controversial because it goes against current ACOG guidance (which has a very shaky scientific underpinning), but it is remarkably successful at preventing neonatal abstinence syndrome (NAS). He eventually has gotten his research published in lower tier medical journals, but was pulled from presenting it at ACOG after having been accepted. That was not because the science was bad, but because it differed with the current guidance. Others at the University of Tennessee had done similar research finding the same effect. The primary driver of that research finally retired because of the exhausting treadmill of trying to power through the gatekeeping.
I have also been looking into funding more deeply. I frequently try to find grants to support the investigation of alternatives or additions to medication for my own research. I would love to see scientifically sound studies comparing various treatment modalities to determine effectiveness. That is nearly impossible without funding programs that test abstinence as a goal. Currently, SAMHSA's State Opioid Response (SOR) Grants explicitly mandate that grant recipients must ensure patients have access to all three FDA-approved forms of MOUD: methadone, buprenorphine, and injectable naltrexone. Section 501 of the Public Health Service Act (42 U.S.C. § 290aa) gives SAMHSA the legal authority to do this. The latitude in this law would allow SAMHSA to fund the study of abstinence promoting research, but it currently doesn't. Why?
I appreciate Clements’ interesting piece, but I would like to see more evidence. Are there anecdotes of scholars like this being excluded from grants and publications? Is there systemic evidence of this bias?
Then we have the question of how to help address this problem. Ironically, one solution is precisely the opposite of what HxA urges: We need more scholar-activists. Clements is a social justice activist (“I want to eradicate” addiction). This is in no way incompatible with her being a scientist. It seems the solution is that we need more activists in the field who want to cure addiction, rather than people who view it as simply a job where one acquires grants from pharmaceutical companies.
The other solution is a little known aspect of the Shils Report at the University of Chicago, which says that scholars should be judged by the quality of their research rather than the quantity of money they generate from grants. This wouldn’t solve all the problems of groupthink, but it would help address the corrupting influence of corporate grants.