There aren’t too many of them yet, and the ones we have are only effective in some cases, but a flurry of anti-craving medications has proven to significantly lower cravings among a wide number of substance-abusing patients. We have buprenorphine and methadone for heroin addiction; Antabuse, naltrexone, acamprosate, and baclofen for alcoholism; and buproprion (Zyban) and varencline (Chantix) for nicotine addiction. But despite promising results, treatment professionals have proven remarkably unwilling to make use of them at times. As Alison Knopf charges in a blistering article in Addiction Professional: “Nowhere else in medicine are the people who treat a condition so suspicious of the very medications designed to help the condition in which they specialize.” Dr. Charles O’Brien, one the nation’s most respected addiction professionals and a Professor of Psychiatry at the University of Pennsylvania, is incensed that anti-craving medications are not more widely used. “It’s unethical not to use medications,” he says. “This is a subject that I feel very strongly about.” O’Brien told Addiction Professional he no longer cares who he offends on the subject. “If you’re discouraging people from taking medications, you are behaving in an unethical way; you are depriving your patients of a way to turn themselves around. Just because you don’t like it doesn’t mean you have to keep your patients away from it.”

Acamprosate, a drug used to treat alcoholism, is a good case in point. A dozen European studies examining thousands of alcohol test subjects found that the drug increased the number of days that most subjects were able to remain abstinent. Like blood pressure medication, the one pill didn’t work for everybody, and caused unpleasant side effects in some. But many European alcoholics swore by it, and the safety record was good. But when a German drug maker decided to market the drug in the U.S., fierce advocates for drug-free addiction therapy came out in force, even though the drug was ultimately approved for use.

Twelve Step programs deserve a significant share of the blame. Throughout its history, A.A. has been notoriously slow to acknowledge medical advances. To date, the prestigious Betty Ford Center only allows buprenorphine to treat heroin abusers, though it is equally effective in treating a wide variety of opiod abusers as well. Many 12-step stalwarts also believe that taking anti-craving drugs are a matter of substituting one addicting drug for another. Hazelden, however, made an abrupt about-face a few years ago, and now offers naltrexone or acamprosate to incoming alcoholics. And the Association for Addiction Professionals is decidely “pro-medication,” a spokesperson said. She claims the “disconnect” at treatment centers is due to “a lack of education about the connection between biology and addiction.” And that is putting it about as politely as possible. As more medications come on the scene, we can expect this picture to continue changing. But we don’t discount the ferocity of the rear-guard action that some people in the treatment and recovery industry are prepared to mount on the subject of fighting fire with fire.