The medication naltrexone, a pill to treat alcohol dependence, was reformulated into a monthly injection called Vivitrol in 2006 and was approved for opioid addiction in 2010. 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.

Titan Pharmaceuticals of South San Francisco plans to seek Food and Drug Administration approval of an implant that would provide continuous delivery of the drug buprenorphine - known as Suboxone in its pill form - for six months to people attempting recovery from dependence on heroin or prescription painkillers.

In advanced studies led by UCLA’s Ling, nearly 66% of patients who had the implant inserted under the skin in the upper arm stuck with treatment, compared with only 31% of those who received a placebo implant. They had higher rates of clean urine tests and lower rates of withdrawal symptoms and cravings.

The National Institute on Drug Abuse is also putting considerable effort into developing vaccines to fight addiction to nicotine, cocaine, heroin and methamphetamine, Volkow said. The aim is to trigger an immune response to a drug of abuse so it can’t reach the brain and elicit a “high,” causing cravings for the drug to erode over time.

The move to treat addiction as a disease may receive a boost from the Affordable Care Act, which mandates treatment for substance abuse disorders and is likely to push services away from nonmedical treatment centers toward mainstream medicine, a Medicare official wrote last year in the journal Health Affairs.

But many U.S. drug treatment centers shun medications, or offer them only sparingly.

A 2011 survey of 345 directors of drug treatment centers in the Journal of Addiction Medicine found little interest in medications: Among programs with access to a medical doctor, fewer than half had adopted all available addiction treatments. Despite the availability of three prescription drugs approved to treat alcoholism, only 24% said they offered them.

Medications don’t address the lifestyle, relationship and spiritual problems that lie at the heart of addiction, said John Schwarzlose, president and chief executive of the Betty Ford Center, one of the oldest and most highly regarded inpatient treatment facilities.

“That’s why the Betty Ford Center has the 12-step program as the core philosophy,” said Schwarzlose, who added that doctors at his center prescribe addiction medications on a case-by-case basis.

Volkow said she wasn’t proposing that behavioral, psychosocial and spiritual approaches be kicked out of treatment programs - only that the best that science can offer be thrown at this highly intractable problem.

“Addiction is a very aggressive disease,” she said. “We need to treat it aggressively. We do that for other diseases.”

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Los Angeles Times