For years Twelve-step programs and a medication-free approach have dominated the recovery industry. But now doctors and scientists and the leader of the National Institute on Drug Abuse are pushing for broad recognition of addiction as a disease and more medical approaches to therapy.
In the last couple of years, the addiction society officially declared addiction a “brain disorder.” Due to this declaration a specialty substance-abuse training program for doctors has been ushered into medical schools. The federal government has announced the creation of new resources to help guide patients, families and doctors toward science-based addiction treatment, and more drugs to treat addiction are entering the pipeline.
About 21 million Americans have a substance-abuse disorder for which they need specialty treatment, according to 2010 statistics from the government-funded National Survey on Drug Use and Health. Deaths from drug overdoses now exceed traffic fatalities. Much of the reason for the disconnect is rooted in the recovery movement’s history: Addicts, shunned by the medical establishment, received their help from those outside of it, a trend that continues to this day. Yet, decades of basic laboratory science has revealed that addiction is a serious medical problem involving profound brain alterations. Alcohol, opiates, cocaine and other substances increase levels of the dopamine in the reward pathway of the brain. With repeated use, baseline dopamine levels fail to compensate and a drug becomes less pleasurable, requiring larger and larger doses.
Even when people are weaned from a drug, their brains don’t return to normal. So they remain vulnerable to its draw, suffering mood swings and profound urges to use again. Such discoveries are filling science journals at an alarming rate, adding weight to the position taken by National Institute on Drug Abuse— that addiction is a chronic disorder that will require multiple rounds of therapy to reduce the risk of relapse and to lengthen drug-free abstinence.
Several drugs to treat addictions have been approved in recent years, adding to the modest collection already in limited use, such as methadone for heroin addiction, Antabuse for alcoholism and a handful of others. New medications are important for two reasons. First, recovery from addiction is hard and patients need every tool that medicine can offer them. But there is another potential benefit: The growing availability of medical treatments will encourage doctors to treat their patients’ drug problems, just as they would a patient’s out-of-control blood sugar with Diabetes or high cholesterol and Hypertension.
One of the most important new developments has been the emergence of long-acting drugs to reduce cravings that persist even in people who are highly committed to abstinence. Freeing addicts from summoning the willpower to take their medications each day, as well as the temptation to sell them on the street eases their inclination in the challenging first months of recovery.
The medication naltrexone, a pill to treat alcohol dependence, was reformulated into a monthly injection called Vivitrol in 2006. In studies, 36% of the opioid-addicted patients on Vivitrol were able to stay in a treatment program for the full six months, compared with 23% of the patients receiving a placebo injection. That is a significant improvement for addiction, experts said.
