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Is treatment synonymous with therapy?

Confusing the two terms is very common (even by addiction professionals) and has serious implications.

In modern medicine, the term health means more than just physical health. It also means much more than fighting or not having the disease.


The human being has at least four different dimensions, including biological, psychological, social, and spiritual. The human mind and the term mental health involves all these dimensions and not just ideas. Therefore, when talking about mental health (or mental health treatment) all these dimensions must be covered. Likewise, when talking about treatment, it is important to cover all these dimensions, as opposed to talking about therapies, which can only include some of them.


Common mistakes are calling any mental health medication treatment rather than therapy or pharmacotherapy. A common serious mistake is to call "Buprenorphine treatment" or "Methadone treatment" instead of .... therapy or ..... pharmacotherapy.


The term "drug-assisted treatment" is misunderstood if it is not clarified that Methadone and/or Buprenorphine or other drugs are the therapies that, when combined with other sociological, neuropsychological, and social therapies, facilitate treatment and are not by themselves the treatment.


What are the implications of this error?


The implications can be serious: giving these medicines without evaluating or treating the other comorbidities and other psychological, social, and spiritual dimensions will greatly reduce the long-term effectiveness of these therapies in generating new life skills and in retaining the patient the same. enough time in it for it to be cost-effective.

To achieve this in the case of active addictions, it is necessary to establish treatment programs with at least three professionals from different disciplines (Bio: Psychiatrist / Addiction Physician; Psychologist / Neuro-Psychologist of addictions; Social Worker / Addiction Counselor. Professionals trained in addictions know how to form a team to complement their different therapies by stages following scientific manuals in what is known as treatment or treatment program. Evidence-based therapies are an individual, group, family, and drug therapies united by the team. in a program for the benefit of patients.


In active addictions, the lifestyle of the patients deteriorates and in addition, the rule rather than the exception is that they have several concurrent mental illnesses that are usually not diagnosed or treated. This confusion of terms using the word treatment as a synonym for therapy reduces the offer of treatments based on scientific evidence and also reduces their cost/effectiveness. The payment system such as "health plans" and "capitation" put enormous barriers to physicians and pressure them to offer therapies instead of combining them in interdisciplinary treatments. This results in an increase in the costs associated with addictions and low long-term effectiveness.


Example:

The term "Office-based treatment with Buprenorphine" is the best example where pharmacotherapy is easily confused with treatment. Again: drug therapy in mental health and addictions is a therapy and not a treatment; which is something much more comprehensive and complete. Thus I see the unfortunate situation that both in PR and the USA there are "dispensaries" of Methadone and Buprenorphine where there are no (or they are very scarce/incomplete or fragmented) interdisciplinary teams or programs or other therapies or other services but are hardly dedicated to the mere distribution of those drugs. Yet some advertise and receive public funding as "treatment programs." In the case of opioids we see the unfortunate low long-term cost-effectiveness related to this lack of accessibility to complete interdisciplinary treatment in the next study:


Johns Hopkins University Study on Mixing Opioids with Buprenorphine

(Reference: Non-Buprenorphine opioid utilization among patients using Buprenorphine; Matthew Daubresse J, ADDICTION 2017)

A study done by John Hopkins University in USA found that just three months after starting Buprenorphine therapy, only 1/3 of patients continue to use it and 2/3 use other opioids again

1. Poor compliance: only 1/3 are still using Bupre at 3 months; 20% at 6 months and less than 10% a year When leaving Buprenorphine (Bupre) , they return to using opioids as before.

2. Mix with other opioids: More than 1/3; 43% used prescriptions for other opioids with Bupre and 2/3 67% used them when discontinuing Bupre. (The minority who continue to use Bupre are decreasing their use throughout the year from 10% approaching 0 per year)


Family support and psychotherapy combined by an interdisciplinary team are known from studies to be factors that improve compliance and prognosis of practically all mental illnesses including addictions. The treatment goes beyond fighting the disease to developing wellness skills and a healthier lifestyle. Developing problem-solving and self-help skills is also important in long-term rehabilitation. Patients are trained to develop support and self-help networks in the different stages of treatment and maintenance.


Other Ref. Principles of Drug Addiction Treatments: A Guide based on NIDA Research

2. Economic Benefits of Drug Treatment: A critical review of the evidence for policymakers Feb 2005, Steven Belenco, et al University of Pennsylvania


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