(Illustration courtesy of Pixabay)

What is an addiction? Is it any use of drugs? Obviously not. Probably every person on the planet has used a “drug” of some sort for the relief of illness or pain, be it a hand-picked herbal remedy or a mass-produced, scientifically-tested and quality-controlled pharmaceutical.

Besides, not every addictive substance is a “drug”. Alcohol is highly addictive. Alcohol also eliminates the argument that addiction is when you use a substance for pleasure instead of medical need.

If you use a substance repeatedly, is that addiction? No. Most medicines are used more than once, though usually for a limited time.

Maybe the length of time a substance is used equals addiction? No. Insulin for the treatment of diabetes, once begun, is usually a lifelong requirement. People with diabetes need insulin, but they are not “addicted” to it any more than we all are addicted to breathing air.

No, addiction is the continued and compulsive use of a substance despite its negative effects on your health and life.

So why do so many people insist that using medication-maintenance treatment (MMT) – such as buprenorphine (Suboxone) or methadone – to control opioid addiction or antidepressants to control mental illness-induced drug addiction is merely trading one addiction for another?

The answer seems to be a misunderstanding of the science of addiction, the abstinence-only argument, or an ulterior agenda.

Drug court judges and politicians have been targeted by those that oppose the use of MMT, including the manufacturer of the alternative medication-assisted treatment (MAT) Vivitrol. A once-monthly time-released version of the opioid antagonist naltrexone, Vivitrol is not an opioid and can’t get you high. In fact, it actually prevents you from getting high (on opioids, anyway; a person with an opioid addiction who still wants to get high can use other drugs such as methamphetamine; that is trading one addiction for another).

Buprenorphine and methadone are themselves opioids and it is possible to abuse them – possible, but very difficult, and precautions are built-in. To begin with, both are weaker opioids than oxycodone or hydrocodone, so a heroin or OxyContin addict will probably not get high on them but escape the severe withdrawal pains that make quitting and holding down a job so difficult.

The much-maligned methadone overcomes abuse worries by so strictly regulating the drug that users must come to their doctors’ offices or clinics every day for a single 24-hour maintenance dose.

Buprenorphine uses a different approach. It most often is prescribed as Suboxone, a formulation that includes the opioid antagonist naloxone (Narcan), the same drug that is used to reverse opioid overdoses. If abused, the one drug largely will cancel out the other. (Tamper-resistant long-term versions of buprenorphine are available or in development.)

Antidepressants also are maligned. Prominent addiction journalist Maia Szalavitz wrote about how her recovery from cocaine and heroin addiction was aided by taking Zoloft and was mocked (by someone extolling the virtues of imbibing alcohol, even to excess): “she has simply swapped one addiction for another addiction, at least equally powerful”. This also is the viewpoint of the Church of Scientology (as espoused by actor Tom Cruise to Matt Lauer) and many 12 Step programs.

Szalavitz calls bollocks, not just on the denigration of antidepressants (“at least half of people with opioid addictions also have a mental illness or personality disorder”) but the idea of MMT as swapping “one addiction for another”. “Suboxone or even heroin maintenance aren’t the same as active addicts; they have a different relationship to the drug,” Szalavitz writes. Addicts are obsessed with getting and using the object of their addiction, even though it makes their lives worse: “It destroys joy and erodes human connection”.

Not that MAT, MMT or antidepressants are effective for all – Szalavitz has adjusted her medications, and says “The wrong drug for the wrong person can absolutely be worse than doing nothing” – but the 12-step absolute abhorrence for any psychiatric meds doesn’t help. All options need to be on the table.