Treatment for addicts is starting to change
A call for change is afoot in the difficult and often heartbreaking world of addiction treatment.
For decades, 12-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, a top addiction society officially declared addiction a “brain disorder.” 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.
In June, Gil Kerlikowske, director of the Office of National Drug Control Policy and President Obama’s top advisor on drug policy, declared in a speech at the Betty Ford Center in Rancho Mirage that addiction “is not a moral failing on the part of the individual. It’s a chronic disease of the brain that can be treated.”
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.
Nine out of 10 people addicted to drugs other than nicotine receive no treatment, and most of those who do get it are put through unproven programs run by people without medical training, according to a 500-plus-page report released by Columbia University in June. Solid data on effectiveness of the most popular recovery approach - 12-step programs - are lacking, the report said.
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.
“Drug abuse treatment developed outside mainstream medicine,” said Dr. Walter Ling, a leading addiction specialist at UCLA. “We’re still suffering from that.”
And yet decades of basic laboratory science has revealed that addiction is a bone fide medical problem involving profound brain alterations. Alcohol, opiates, cocaine and other substances increase levels of the chemical dopamine in the reward pathway of the brain. With repeated use, baseline dopamine levels wane to compensate and a drug becomes less pleasurable, requiring ever-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 a prodigious rate, adding weight to the position taken by National Institute on Drug Abuse chief Dr. Nora Volkow - that addiction is a chronic disorder that will require multiple rounds of therapy to reduce the risk of relapse and to lengthen drug-free intervals.
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.
There are currently only three medications approved by the U.S. Food and Drug Adminstration for the treatment of alcohol abuse and alcohol dependence.
None of these medications are prescribed to people who are still drinking alcohol. They are only prescribed to those who have already stopped drinking and are trying to maintain alcohol abstinence.
There are no medications on the market that are prescribed for people who are still drinking alcohol that will cause them to stop drinking.
Disulfiram
Also known a Antabuse, Disulfirm was the first drug approved for treating alcohol dependence. The basic premise is simple, if a person drinks while taking this drug they become ill. Akin to behavioral training, over time the mind begins to associate drinking with being sick, which helps a person stay abstinent.
A person’s normal metabolism breaks down alcohol in the liver then converts it. Disulfiram blocks that process, making a person highly sensitive to negative effects. Within 10 minutes of drinking the individual begins experiencing hangover like symptoms that can last several hours. These symptoms include headache, nausea, and confusion.
The effects of Disulfiram as an alcoholism medical treatment are cumulative. The longer a person takes it, the stronger it becomes. Even if they stop taking the drug it can still affect them for up to two weeks. Therefore, it’s vital that the patient stop drinking before starting this protocol or they can become very, very ill.
In a 1986 study of drugs to help alcoholism, those who took Antabuse, compared to other relapse patients who did not get the medication, drank less frequently.
Naltrexone
Naltrexone is sold under the brand names Revia and Depade. An extended-release form of naltrexone is marketed under the trade name Vivitrol. It works by blocking in the brain the “high” that people experience when they drink alcohol or take opioids like heroin and cocaine.
Acamprosate
Acamprosate (also known as Campral) was approved by the FDA in 2004 after many years of use in Europe. This particular alcoholism medical treatment is intended to restore balance in the brain and decrease the emotional distress of withdrawal. Compared to the other two drugs to help alcoholism discussed in this article, this one also lessens tensions, sleep disorders and other symptoms that may occur when a person stops drinking.
This medication gets taken three dimes daily, and works best when combined with some type of recovery therapy.
To Volkow’s mind, the 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 or High cholesterol.
“You are killing two birds with one stone - giving tools to improve outcomes for the patient and giving tools to the physician, increasing the likelihood they will incorporate substance abuse disorders into their practice,” she said.
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 burden in the challenging first months of recovery, Ling said.