A "whole person" approach is required to address the opioid epidemic

WASHINGTON, D.C. — The chief executive officer of the American Psychological Association told a congressional panel that solving the opioid epidemic requires a "whole person" approach that includes nonpharmacological pain treatment as well as ensuring that people have the employment, education, and housing supports they need for long-term recovery.

12/21/20222 min read

In prepared remarks (PDF, 199KB) to the House Committee on Oversight and Reform, APA CEO Arthur C. Evans Jr., PhD, said, "Research suggests that the most successful treatment of opioid use disorder includes psychosocial therapies in combination with pharmaceuticals." "Contingency management, cognitive behavioral therapy, and multidimensional family therapy are the three modalities of treatment having the strongest evidence base for use in treating opioid use disorders."

Positive reinforcement is used in contingency management therapy to induce drug abstinence. Patients who receive cognitive behavioral therapy are better able to notice, avoid, or cope with situations where they are more prone to use drugs. Multidimensional family therapy tackles a variety of personal and family factors on drug use patterns, and was developed for teenagers with drug use problems.

Evans stated that APA "strongly supports the use of medication-assisted therapy drugs in treating opioid use disorder, and we support policies to ensure that the full range of such drug therapies are available to patients and their providers" in support of the Comprehensive Addiction Resources Emergency (CARE) Act, H.R. 2569.

"However, keep in mind that the term'medication-assisted treatment' refers to the use of pharmaceuticals to help with treatment. … We will not be successful in treating opioid use disorders solely by providing medication without the full range of psychosocial treatments and supports that people need to initiate and sustain recovery, just as we do not treat diabetes solely by providing patients with a packet of insulin and syringes."

Evans, who has 30 years of experience working in the fields of substance abuse and mental health disorders, cited studies showing that psychological support programs, such as those that focus on providing stable housing and family therapy, as well as those that address employment issues, "can help people with substance use disorders stick to an effective treatment plan."

"For instance, research has shown that programs like Homes First, which assists homeless people with substance use disorders in finding stable housing without first requiring them to demonstrate abstinence, are an excellent gateway into treatment," he said. Other research has found that integrating family members and other concerned individuals in opioid use disorder therapy can enhance outcomes, particularly for youngsters.

Evans stated that the United States' health-care system has begun to shift away from the indiscriminate use of opioids for pain relief, and that opioid prescription rates are starting to decline. "There is still much space for improvement in our management of acute and chronic pain," he noted. Psychologists have been at the vanguard of the shift away from treating pain as a purely physiological illness and toward seeing pain as a biopsychosocial phenomenon combining biological, psychological, and social components of one's health and functioning."

The CARE Act would authorize $100 billion in funding directly to states, U.S. territories, counties and cities, tribal nations, and other qualified public/nonprofit entities over ten years to address the opioid crisis, modeled after the Ryan White CARE Act, which was enacted in 1990 to combat the HIV/AIDS epidemic. With few exclusions, organizations receiving funds would be required to provide behavioral therapy in addition to medication-assisted therapies.