WASHINGTON — The Trump administration has gone nine months without a permanent drug czar. But within hours of the announcement that Rep. Tom Marino (R-Pa.) had withdrawn his name from consideration on Tuesday, the D.C. rumor mill was up and running.

Potential candidates, according to administration officials, Capitol Hill staffers, and others in the world of drug and addiction treatment policy, include a who’s-who of players in the current battle against the opioid crisis.

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  • Whomever the job of Drug Czar falls to, there needs to become more awareness as to effective treatment of “opioid addiction.” Even if one follows the argument that people can accidentally get addicted to opioids while under medical treatment for a condition that doesn’t require opioids, the situation is still most about helping those that want to stop to stop.

    Much of the thinking on opioid addiction, and addiction in general, seems to come from the highly flawed 12 Step model of Alcoholics Anonymous that is increasingly under fire as a religious cult. The 12 Step model is based on the premise that people are “powerless” over their drug of choice, and that the only way to function (as sick as they are and always will be for the rest of their life) is to “turn their will and their life over to a Higher Power” and their 12 Step support group.

    The core of this thinking is much more like that of a religious cult than of a self-help group for “addiction.” What the best research indicates is that “opioid addicts” have the best outcomes with a combination of medication that helps control cravings, such as methadone or suboxone, and talk therapy. 12 Step rehab has abysmal success rate, lower even than AA’s success rate for alcohol, which is about 5-10%. And again like a religious cult, AA and 12 Step blame the majority for not doing well in their “spiritual” program rather than taking a look at how their program is truly ineffective in what it offers.

    In addition, there are self-help groups that are not religious cults, such as HAMS, SMART, LifeRing, Women for Sobriety.

    Once lawmakers see that drug use is a choice, even if it is a choice often influenced by stress and more serious psychological problems, there might finally start to be real improvement in the opioid epidemic.

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