The Gold Standard for Addiction Treatment
Mark S. Gold, M.D., is a legend in the world of addiction. Dr. Gold was one of the main forces in establishing and building the McKnight Brain Institute at the University of Florida in Gainesville. The Institute was funded with a Department of Defense matching grant and opened its doors in 1998. Today, the McKnight Brain Institute has over 250 faculty members spanning 12 academic departments and is considered a top-five university in neuroscience and neuromedicine research.
Dr. Gold specialized in psychiatric research and translational addiction research, meaning translating from animal studies of addiction to arrive at predictive analytics for humans, with an emphasis on comorbidities between addiction and other mental health disorders. Dr. Gold developed an early addiction medicine training program and has been called “the father of medicine-assisted therapy,” or MAT. Dr. Gold is the editor of a highly regarded textbook on eating addiction called Food and Addiction: A Comprehensive Handbook.
Dr. Gold recently wrote a long treatise for Psychology Today entitled, “Key Addiction Points You Need to Know,” that offers a plain-language overview of the vast field of research and treatment in addiction recovery. Dr. Gold is particularly concerned about the opioid epidemic, which has claimed over a million lives in the 21st century. Dr. Gold is not thrilled with the current rescue and release manner of treating opioid addiction: “This approach has created a revolving door of overdose-rescue-treatment-overdose.”
Does that mean less emphasis on naloxone? Far from it. Dr. Gold would like to see overdose victims sent home with Narcan, as most overdose deaths happen at home or away from a medical facility:
Most overdoses occur in people with a history of overdoses. This means carrying naloxone and remaining vigilant is important for family and friends.
Dr. Gold says that medicine-assisted therapy only works if patients take their medicine, but most patients drop out of treatment and stop taking medication, with the same rate of lethal overdose before and after treatment. Rather than giving up, Dr. Gold wants to see treatment options expanded, with more residential beds and greater telehealth options.
One of those treatment options is methadone, and Dr. Gold cites a study tracking 17,568 survivors in Massachusetts who overdosed between 2012 and 2014. The study looked specifically at whether any of three drugs used to treat recovering addicts – methadone, buprenorphine, and naltrexone — impacted future overdose deaths. The study found:
After surviving the overdose, there was a 59 percent reduction in mortality for individuals who were taking methadone compared to those who were not taking medication. For individuals who were receiving buprenorphine, there was a 38 percent reduction in mortality. The data indicated no association with a change in mortality for patients receiving naltrexone compared to patients not receiving medication.
Dr. Gold is particularly sensitive when discussing issues of comorbidities which are often not taken into consideration in medicine-only addiction treatment. “Treatment of opioid use disorder usually means treating multiple medical and psychiatric problems and substance use disorder co-addictions,” writes Dr. Gold. Medication needs to be combined with counseling and lifestyle changes, says Dr. Gold, lamenting, “many programs have devolved into medication-only drug delivery vehicles.”
Regarding the crossover between mental health and addiction, Dr. Gold writes:
Some people use drugs because they have a psychiatric illness like depression. For others, the drug itself causes chemical changes, making susceptible individuals depressed and hopeless. Fentanyl may have even more severe effects compared with other opioids in producing anhedonia (inability to experience pleasure), depression, despair, and suicidal thinking.
An important lesson from Dr. Gold’s research and his overview for Psychology Today is the need to intervene as early as possible to head off substance use disorders. For adolescents whose brains are still developing, addiction can lead to a lifetime of struggle against substance use disorders. The earlier one enters into treatment and the longer one stays in treatment, the better the chances for recovery.
In the most eloquent section of his review, Dr. Gold notes that opioid addiction takes time:
The evolving concept of pre-addiction, modeled on pre-diabetes, focuses on identifying and treating problematic users. This means doing something now rather than waiting for overdoses or hitting bottom.
And there you have the Gold standard for addiction treatment.
Written by Steve O’Keefe. First published August 1, 2024.
Sources:
“Key Addiction Points You Need to Know,” Psychology Today, July 25, 2024.
“Methadone and Buprenorphine Decrease Mortality After Nonfatal Overdose,” Boston Medical Center, June 18, 2018.
Image courtesy Openclipart, used under Public Domain license.