The ground breaking article from the NY Times, “Rethinking Addiction’s Roots, and Its Treatment” finally gets it right. After years, if not decades, of blaming the victims of drug addiction, this refreshing and important article makes the bold statement that addiction is disease. By saying addiction is much the same as diabetes or a thyroid condition, new possibilities are opened up for the treatment of addiction. This change in attitude allows medical professionals to develop sound, medically based treatment modalities and just as importantly, opens the door for insurance policies to pay for treatment.
The past history of addiction treatment put a heavy focus on psychiatry and paid little, if any attention to the possibility of the underlying physical or genetic causes of addiction. Even when patients had a long term, multi generational history of addiction in their families, specialists treated this as offhand information and continued to emphasize psychotherapy as the primary method of treatment. “In the past, the specialty was very much targeted toward psychiatrists,” said Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse. “It’s a gap in our training program.” She called the lack of substance-abuse education among general practitioners “a very serious problem.”
As pointed out in the Times article, new treatments are being developed. One very encouraging step is the first accredited residency program in addiction medicine started by 10 prominent medical institutions including St. Luke’s-Roosevelt Hospital in New York, the University of Maryland Medical System, the University at Buffalo School of Medicine, the University of Cincinnati College of Medicine, the University of Minnesota Medical School, the University of Florida College of Medicine, the John A. Burns School of Medicine at the University of Hawaii, the University of Wisconsin School of Medicine and Public Health, Marworth and Boston University Medical Center. Designed for doctors who have completed medical school, they will be able to spend a one year residency studying the relationship between addiction and brain chemistry.
“This is a first step toward bringing recognition, respectability and rigor to addiction medicine,” said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa.
The new program will treat patients with addictions to alcohol, drugs, prescription medicines and nicotine. Starting July 1, 2011 with 20 students at the various institutions, the doctors will study brain chemistry and the important role of heredity.
The change in the thinking about addiction has been a gradual process that has taken place over the last two decades. The catalyst was when researchers using high-resonance imaging began to notice actual physical changes occurring in the brains of addicts. Once this was understood, many forward looking professionals began to realize that the treatment of addiction required an ongoing medical program. Much like the way diabetes treatment requires continuing medication and regular medical care, addiction specialists have begun to develop treatment programs for the long term care of the addict. It is now realized that there is more to successfully treating addiction than 28 days in a detox and will power.
One of the most successful treatments for opiate addiction has been long term methadone maintenance. While many of the traditionalists in addiction treatment complain that methadone just replaces one addiction with another, advocates point out that methadone has enabled many of its users to lead productive lives while preventing the use of illegal drugs or the abuse of prescription drugs. Long term methadone treatment has also enabled patients to avoid many of the destructive and often fatal consequences of drug addiction including further exposure to aids and the risk of death due to overdose.
Another promising new treatment for opiate addiction is Buprenorphine which is marketed under the name Suboxone. Buprenorphine is used to ease patients withdrawal symptoms from opiate detoxification. Buprenorphine binds more strongly to receptors in the brain than do other opioids, making it more difficult for opioids (or opiates) to react when buprenorphine is in the system. This makes the drug useful for long term use in the treatment of addiction as an alternative to methadone.
Many other promising new drugs are being developed to treat a range of addictions including opiates, alcohol, cocaine, methamphetamine and nicotine. As the focus evolves towards a fuller understanding that addiction is a physical disease and not a reflection on the personality of the addict, new hope is to be found among medical professionals and addicts alike. As stated in the NY Times article by Derek Anderson, 53, who credits Suboxone and the medical doctor who diagnosed his addiction with helping him kick his 35-year heroin habit. “I used to go to detoxes and go back and forth and back and forth,” he said. But the Suboxone “got me to where I don’t have the dependency every day, consuming you, swallowing you like a fish in water. I’m able to work now, I’m able to take care of my daughter, I’m able to pay rent — all the things I couldn’t do when I was using.”
Guest article written by Wolff Bachner