Detox and Marshmallows: Dealing with Addiction

On Monday, NPR's Morning Edition ran two pieces back-to-back that while ostensibly not intended to be related, nonetheless struck me as providing important insights into opioid misuse and abuse.  

The first story (read and/or listen here) was about the potential perils of Do-It-Yourself detoxification from drugs of addiction. While there's plenty in this story for the schadenfreude crowd ("he says his stomach cramps felt like 'having Freddy Krueger inside you trying to rip his way out.'"), I was struck by the comments of a doctor interviewed for the story:

So can detoxing on your own be the solution? In most cases, the answer is no. 

In fact, a growing movement within the field of addiction medicine is challenging the entire notion of detox and the assumption that when people cleanse themselves of chemicals, they're on the road to recovery. 

"That's a really pernicious myth, and it has erroneous implications," says Dr. Frederic Baurer, president of the Pennsylvania Society of Addiction Medicine.

"Detox" does not equal "treatment."  Treatment may, of necessity, start with detox, but without counseling and the potential use of other medications, recovery is rare.  In fact, the relapse rate from detox alone is upwards of 90%.  We have to do more than just detox if we want long term results for injured workers suffering from addiction.  

The second story (read and/or listen here) was about marshmallows.  More accurately, it was about a child psychology experiment involving marshmallows.  In the the 1960s, a Stanford psychologist named Walter Mischel designed this experiment to study children's self-control.  Kids ages 3 to 5 have a marshmallow placed before them. Then researchers give the child the following instructions: You can eat the marshmallow now, but if you can wait for me to return, you'll get two marshmallows.

More than half of kids dig in.  And among those who don't gobble up the treat but instead exercise self-control, there appears to be a correlation to superior future academic performance and achievement.  (The story is interesting because new research deploys the experiment outside of western culture for the first time and the results are interesting, if not concerning).

The objective of the experiment is to study a psychological phenomenon called "delayed gratification."  Can one put off immediate gratification in return for greater, albeit delayed, reward?  Even among 3 to 5 year olds, the delay creates physical and emotional distress.  They whine, they squirm in their seats, their heart rates go up, they feel real stress.

Am I comparing a 4 year old who eats the first marshmallow to an opioid addict who can't go a day without a fix?  Absolutely not.  Addiction is a disease and it requires treatment.  It's not a simple failure of willpower.

Rather, I'm comparing the 4 year old who eats the first marshmallow to some insurers, employers, government regulators and politicians who want a simple, cheap, fast, pop-the-balloon solution for an injured worker who has been on opioids for 10 years.  Relying on detox alone is like gobbling up that first treat.  Instead, we need to squirm, face hard choices, make investments in sound treatment, and exercise patience.  

We could use a little more delayed gratification in the fight against opioid misuse and abuse.

Michael
On Twitter @PRIUM1