A Courageous Statement from Dr. Volkow
by Tom Horvath, PhD
There is no more important person to the addiction treatment and recovery field than Nora D. Volkow, MD. Dr. Volkow is the Director of the National Institute on Drug Abuse (NIDA). In the US government’s fiscal year 2021 NIDA spent about $1.4 billion, primarily on research. By comparison, the budget for the National Institute on Alcohol Abuse and Alcoholism is only about $500 million. A substantial portion (if not the majority) of the world’s addiction research is funded under Volkow.
The Statement from Dr. Volkow:
Consequently, when Volkow speaks, people listen. Maybe more so than ever now: “Making Addiction Treatment More Realistic And Pragmatic: The Perfect Should Not Be The Enemy Of The Good”
https://www.healthaffairs.org/do/10.1377/forefront.20211221.691862/full/
I suspect this statement has been in preparation for months (given the potential controversy), but it was published January 3, 2022, the first business day of the New Year. Volkow presents the rationale for and evidence behind supporting progress for individuals with addictive problems, rather than insisting on abstinence as the only legitimate goal of treatment or change efforts.
The main points of Dr. Volkow’s statement include:
“Last year saw drug overdose deaths in the U.S. surpass an unthinkable milestone: 100,000 deaths in a year. This is the highest number of drug overdoses in our country’s history, and the numbers are climbing every month…
Only 11 percent of people with opioid use disorder receive one of the three safe and effective medications that could help them quit and stay in recovery…
The magnitude of this crisis demands out-of-the-box thinking and willingness to jettison old, unhelpful, and unsupported assumptions …. [including] the traditional view that abstinence is the sole aim and only valid outcome of addiction treatment…
While not using any drugs or alcohol poses the fewest health risks and is often necessary for sustained recovery, different people may need different options…
Reduced number of heavy drinking days is already recognized as a meaningful clinical outcome in research and medication development for alcohol addiction…
A return to substance use after a period of abstinence may also, in some cases, lead to less frequent use than before treatment…
Realistically and pragmatically addressing addiction requires that we not let the perfect be the enemy of the good. Right now, we need all the good we can get…
Other harm-reduction modalities being studied include personal drug-testing equipment like fentanyl test strips, as well as overdose prevention centers…”
This statement is also noteworthy for mentioning autoimmune diseases and infectious diseases, but not mentioning addiction as a disease. For those who have been listening for awhile, Dr. Volkow is singing a new song!
Many would say that this statement is long overdue. The central ideas in it have been discussed for decades. Stable alcohol moderation following alcohol dependence has been recognized as a reality since at least the 1960s. Stanton Peele’s work, which remains even more courageous than Volkow’s statement, has been ongoing since the 1970s. However, the reality of social change is that there is a leading edge (the rapid adopters), followed later by the majority, and finally followed, if ever, by the slow adopters.
Has the majority arrived at idea that when addressing addictive problems we should focus on progress (which can include abstinence) rather insisting on abstinence? Given Volkow’s statement, perhaps anyone not supporting her well-reasoned position is now a slow adopter. Perhaps the addiction treatment and recovery field and the public are finally ready to believe that it is time to make “Addiction Treatment More Realistic And Pragmatic.”
If you remain a slow adopter, you might consider a long-standing AA slogan: “progress, not perfection.”
If you or a loved one would like to explore harm reduction and alternative approaches to recovery, our outpatient services might be the perfect fit.