Legal and Ethical Consideration in Alcohol and Drug Treatment
Recovery support services may be provided by clinically trained professionals as an adjunct to their clinical (assessment and counseling) activities, or they may be delivered by people in recovery who are not clinically trained but who are trained and supervised to provide such support services.
Alcohol has been administered to subjects with alcohol dependence to treat withdrawal, and nicotine has been used as a therapeutic agent to decrease smoking. These studies have not generated enough controversy in the US to halt the research, however; alcohol and nicotine are legal drugs in the US, and, in general, accepted by society. Opioid agonist treatment is a related example. Although not exactly the agent of addiction, opioid agonists (methadone and buprenorphine) are among the most efficacious treatments for opioid (i.e., heroin and/or prescription-opioid) dependence. These agonists are also legal medications, which facilitates their study, although many people remain “against” these treatments. Heroin addiction is highly stigmatized in the US. Although heroin was developed as a cough suppressant by Bayer Pharmaceuticals in the 1890s and was prescribed as a treatment for opioid dependence in the early 1900s, its use was restricted by the Harrison Narcotic Act in 1914, and by 1919, doctors risked prosecution for prescribing it to people with addiction. Nonetheless, diacetylmorphine has been used as a therapeutic agent on a limited basis in Britain since the early 1960s, and the first reported controlled clinical trial of diacetylmorphine prescription was conducted there.
As such, changes in one part of the system can and do produce changes in other parts of the system, and these changes can contribute to either problems or solutions.
Kaufmann, P., and Kaufman, E. From multiple family therapy to couples therapy. In: Kaufman, E., and Kaufmann, P., eds. Family Therapy of Drug and Alcohol Abuse. 2d ed. Boston: Allyn and Bacon, 1992a. pp. 85–93.
McCrady, B.S., and Epstein, E.E. Theoretical bases of family approaches to substance abuse treatment. In: Rotgers, F., and Keller, D.S., eds. Treating Substance Abuse: Theory and Technique. New York: Guilford Press, 1996. pp. 117–142.