So what is addiction treatment? why can’t most drug addicts just quit on their own? How effective is addiction treatment, when is it necessary, and is addiction treatment worth the cost? why isn’t more treatment available? what can we all do to help? There are about five federal government agencies now tripping over each other trying to get a clearer grip on these issues. we’ve got the National Institute on Drug use (NIDA) and the National Institute of Alcoholism and Alcohol use (NIAAA), both of which are part of the National Institutes of Health (NIH); we’ve got the Substance use and Mental Health Administration (SAMHSA), which is part of the US Department of Health and Human Services (HHS); we’ve got the white House Office of National Drug Control Policy (ONDCP); we’ve got the Bureau of Alcohol, Tobacco, Firearms and explosives (ATF); and the Drug enforcement Administration (DeA). Some of these agencies focus on research, including research on treatment approaches, some focus on providing information and policy, and some are concerned specifically with law enforcement. As far as policy and law enforcement, among my favorite things to pick on is the “war on drugs” because, as I’ve said, it is not a war on drugs; it’s a war on people. Throwing somebody in jail for simply using drugs does little to nothing to change individual behavior and serves no socially useful purpose. even in some jails and prisons drug use is widespread, and the cost in dollars and human terms of incarcerating people for drug use is absolutely preposterous. Addiction is a complex illness. It persists in the face of extremely negative consequences. If somebody burns his hand on a hot stove he generally learns from his experience and doesn’t go close to that stove again. even my basset hound won’t go near the stove because a while back he burned his nose jumping up there. But an active addict will keep putting his hand in the flame or his nose on the stove. His thinking has become so distorted that he rationalizes “this time I won’t burn myself.” Addiction is a brain disease that has direct impacts on thinking. The thought processes of someone who is addicted can be bizarre, as evidenced by his or her continuing to put his or her hands in a hot flame, thinking that “this time it’s going to be different.” If every time you drink you wind up in trouble, end up in jail, bleed from your stomach, and yet keep doing it again and again, that’s a special type of twisted thinking. Two impressive examples of the cognitive warping that takes place in active addiction that I’m familiar with involve a man with a gambling addiction who moved to Las Vegas to quit gambling, and a woman addicted to cocaine for more than ten years who switched to crystal meth to stop using cocaine. But distortions in thinking related to addiction are not exclusive to addicts. Society still commonly sees addiction as a disorder of willpower and personal choice, so addicts tend to be viewed and judged differently than people who struggle with other chronic illnesses. Because addiction is a chronic disease, relapse is possible even after long periods of abstinence. Sometimes professionals, as well as lay people, challenge me on this point, saying that I don’t “cure” anybody because addicts in recovery often relapse and end up coming back to treatment. But then, so do patients with congestive heart failure. Those patients are on heart medications and do well for a few months or a few years, but then have to come back to the hospital for a “tune-up” due to a relapse—a recurrence of their heart failure. Heart failure is an excellent example of how chronic illness works. Asthmatics frequently go through cycles of remissions and exacerbations (or relapses) of their symptoms, and have to come back periodically for breathing treatments, but we don’t pass negative judgment on them or consider giving up on them. Asthma is a chronic illness. Most people, including many medical and behavioral health professionals, have an understanding that chronic conditions are managed rather than cured. But for some reason they think that if somebody with addiction relapses and needs to return to treatment again, it’s a treatment failure. It is not a failure. It is the natural course of the disease as it often manifests in those who suffer from it just like heart disease, diabetes, and asthma. Treating alcoholism and addiction involves management of a chronic disease. Successful recovery from addiction means a stop to using drugs including alcohol and maintenance of a drug-free lifestyle, while regaining/achieving productive functioning with regard to family, relationships, work, and in society generally. Some people think that recovery is just about not using, and, of course, to a certain extent it is about not using, but I could handcuff patients to the wall and they won’t use, but that doesn’t mean they would be in recovery. So recovery is more than just not using; it involves being a contributing member of one’s community, and making progress toward internal states of acceptance—not only of the need for ongoing abstinence, but also of people and situations that one has no control over—and peace of mind, otherwise known as serenity. This only comes with time and practice working a program of recovery by engaging in recovery-supportive activities. In contrast, in very early recovery, many people are effectively “white-knuckling” it, holding on to their abstinence for dear life. It is in the days, weeks, and few months immediately after the cessation of using, whether the person went through professional treatment or not, that he or she is especially vulnerable to relapse. It may come as a surprise to a lot of people, but addiction treatment is as effective as treatment for other chronic medical conditions. In other words, addiction treatment has basically the same outcomes—the same rates of success and relapse—as treatment for asthma, diabetes, congestive heart failure, high blood pressure, low-back pain, and other chronic medical conditions. effective treatment for addiction varies depending on severity, the types of drugs involved, and the characteristics of the patient. The best treatment programs provide a combination of therapies and other biopsychosocial services. Since 1999, the National Institute on Drug use, part of the National Institutes of Health, has maintained the following thirteen principles of effective treatment for drug addiction:
- No single treatment is appropriate for all individuals.
- Treatment needs to be readily available.
- effective treatment attends to multiple needs of the individual, not just his or her drug use.
- An individual’s treatment and services plan must be assessed continually and modified as necessary to ensure that the plan meets the person’s changing needs.
- Remaining in treatment for an adequate period of time is critical for treatment effectiveness.
- Individual or group counseling and other behavioral therapies are critical components of effective treatment for addiction.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- Addicted or drug-abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
- Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
- Treatment does not need to be voluntary to be effective.
- Possible drug use during treatment must be monitored continuously.
- Treatment programs should provide assessment for HIV/ AIDS, hepatitis B and C, tuberculosis and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
- Recovery from drug addiction can be a long-term process and frequently requires multiple episodes of treatment.
There are many types of behaviorally oriented therapies, and for addiction therapists or students in addiction counseling programs, these are a primary focus of treatment. This is what we refer to as “talk therapy.” Talk therapy can take a variety of forms and orientations, including, but not limited to individual and group counseling, family therapy, educational lectures, cognitive-behavioral therapy (where the specific focus is on helping people to identify and change their thought processes and problematic behaviors), and psychotherapy. A point of clarification: Most of the time, counseling and therapy essentially refer to the same thing. However, there are some distinctions between counseling and “psychotherapy,” with which it is helpful to be familiar. In the context of behavioral health (which includes addiction), “counseling” generally means a relatively brief treatment process that focuses on specific behavior. It often targets a particular symptom or problematic situation and offers suggestions and advice for dealing with it. Psychotherapy is typically (though not necessarily) a longer-term treatment that is oriented more toward gaining insight into mental and emotional challenges by focusing on the person’s thought processes and way of being in the world rather than on specific problems. In clinical practice there is frequent overlap between counseling and psychotherapy. A therapist may provide counseling for specific situations and a counselor may function in a psychotherapeutic manner. As a generalization however, psychotherapy requires more skill than simple counseling, and is conducted by professionals trained to practice psychotherapy, such as psychiatrists, trained counselors, social workers, and psychologists. While a psychotherapist is qualified to provide counseling, a counselor may or may not possess the necessary training and skills to provide psychotherapy. These differences notwithstanding, for simplicity, I will use the terms “counseling” and “therapy” interchangeably. Addiction treatment can involve the following levels of care: medical detoxification, inpatient rehabilitation, non-intensive outpatient treatment, intensive outpatient treatment, short-term residential treatment, and long-term residential treatment. All of these levels of care include various forms of talk therapy/counseling, addiction- and recovery-specific education, drug screening/testing to verify abstinence, and medication. Medications in addiction treatment can be those prescribed for detoxification and co-occurring psychiatric conditions, as well as agonist maintenance therapy and antagonist maintenance therapy. An agonist is a molecule that combines with a receptor on a cell to trigger a physiological reaction. I liken the process to turning on an appliance through electricity. when you plug a blender into an electrical outlet, the plug is the agonist and the outlet is the receptor. The brain contains receptors. when certain drugs and medications fill those receptors, they trigger specific reactions. Agonist therapy includes medications like methadone and Suboxone (though technically, Suboxone is a partial opioid agonist—more about that later) that are designed to substitute for opiates/opioids, whether illicit or legally prescribed, on which people have become dependent (this will be discussed at length in Chapter Five). This notwithstanding, these medications have their own addictive potential and their use should be carefully structured and supervised. There is also antagonist treatment. An antagonist is the opposite of an agonist. It is a medication that acts against and blocks the mind- and mood-altering effects of specific substances. Agonists and antagonists are key players in the chemistry of the nervous system. An example of a medication antagonist is naltrexone. This is used to block the effects of opiates and alcohol. I will also discuss these medications at length in Chapter Five. In addiction treatment we see a lot of people who have psychiatric issues along with their addiction. There is a lot of depression and no small amount of bipolar symptomology among people with addiction. Addiction treatment providers also see a lot of anxiety disorders. Sometimes alcohol and other drugs are the primary cause of these psychiatric symptoms. In many others, the addiction contributes to and exacerbates co-occurring mental health problems that began prior to the initiation of substance use. Moreover, the existence of psychiatric issues also commonly complicates and exacerbates one’s active addiction. When the field of addiction treatment was young, “sequential treatment” was typical. Unfortunately, what used to happen was that psychiatrists, psychologists, and therapists often refused to work with patients who were actively using alcohol or other drugs. At the same time, a lot of people in addiction treatment were uncomfortable working with addicts who also had psychiatric issues. As a result, nobody wanted to work with these patients with co-occurring addiction and psychiatric issues and they often fell between the cracks of the treatment and service delivery system. we have since learned that integrated and concurrent treatment in which patients’ addiction, mental health, and medical needs are addressed simultaneously is the most effective approach. Behavioral therapies offer strategies for dealing with cravings, teach patients ways to enhance their coping capacity and prevent relapse, and help them deal with relapse should it occur. Addicts often suffer severe cravings. And unless they receive some form of treatment to help them learn how to manage cravings and withstand them, many addicts feel as though they have no option but to use. In treatment they learn and can practice other options. The desire to use is normal and may pop up from time to time, but there are a range of behavioral strategies that addicts in recovery can draw on instead of using. Perhaps the most fundamental of these is instilling and reinforcing in patients the knowledge that cravings will pass because they come in bursts and spurts. even though, for the person experiencing an intense desire to use, cravings can feel like they will last forever, they are always temporary. It is critical to teach this information because addicted people are not aware of it. The solution to cravings is to develop ways to ride them out. This often involves distraction, such as listening to music, going for a walk, going to a movie, or calling friends. This is one of the many areas where participation in mutual-aid/support programs, twelve- step programs in particular, can be extremely valuable. when people in twelve-step recovery are struggling, they can call their sponsor. They can go to a meeting; they can talk with members of their support group who have been through very similar experiences. Why can’t addicts quit on their own? In the beginning, many addicts believe they can and from time to time they try to stop. For most addicts, discontinuing using means going through detoxification, the process of substances leaving the body and brain. Depending upon the substance and how long and how much someone used, the withdrawal symptoms people experience during detox can be agonizingly painful to potentially lethal. For example, opiate withdrawal from opiates/opioids like heroin, Vicodin, and OxyContin causes a withdrawal syndrome that is horribly painful, but it’s not dangerous (opioid overdose is dangerous but opioid withdrawal usually is not). However, withdrawal from sedative-hypnotics such as xanax and Valium, and from alcohol, is extremely dangerous because people can die from DTs (delirium tremens) and seizures. It’s important to not confuse how addicting specific substances are with the severity of the withdrawal syndrome associated with them. These are entirely different areas. For example, stimulants like cocaine and crystal meth are very addictive, but their withdrawal syndrome is minimal compared to opiates, sedative-hypnotics, and alcohol. To give you an idea of why, think of the neurons in your brain as little springs—alcohol and the sedatives keep the springs down, because they’re depressants. If you let a spring up really quickly, it bounces all over the room, but if you let it up slowly, you can control it. when people suddenly stop drinking, their neurons are firing like crazy (the springs are bouncing uncontrollably), and that can result in physiological instability, up to and including seizures. But even when addicts are able to stop using—whether they detox on their own or through a medically supervised detoxification regime where medications are administered to make them safe and somewhat less uncomfortable—without treatment and/or working a program of recovery, the vast majority fail to achieve long-term abstinence. Detox is merely ridding the body of the physical presence of substances. It is not addiction treatment, though many addicts go through detox as a prerequisite to treatment. A lot of people go through detox and then refuse to attend treatment. Medical detoxification is only the first step. A lot of addicted people come in, especially to a medical facility, and say, “I’m here to get detoxed,” or “I want to get detoxed.” Once they’ve been detoxed I say, “I now want to set you up to go see a counselor or therapist to go over addiction treatment.” Their response will sometimes be, “No, I’m not interested in that; I only came to be detoxed.” Addicts come in all stripes. we have patients at our clinic who come in for detox and we never see them again. And there are those who come back six months or a year later for detox again. They won’t meet with a counselor, won’t get any kind of treatment, and don’t establish any real abstinence, nevermind recovery. And we don’t see them again until the next time they need detox. I always tell people that even when addicts can stop using, the problem is they don’t stay stopped. They stop for a day or two, or a week; they stop for two weeks, or even a month. And then they go right back to using again. what defines success in addiction treatment? For people who complete a treatment program, one basic definition of successful treatment is no substance use and no criminality for a minimum of two years. Positive outcomes are correlated with adequate lengths of treatment. Success depends in part on whether patients remain in treatment long enough to experience and integrate its full benefits. As a generalization, the longer people remain in treatment, the better their chances of remaining abstinent and achieving recovery. And whether a person stays in treatment depends on multiple factors related to both the individual and the program. Important individual factors include personal motivation to change, family dynamics, social supports, medical insurance, and other financial resources, as well as outside pressure to stay in treatment. Such factors include the criminal justice system and the Child Protective Services system, where the options are often either addiction treatment or incarceration, or potential loss of the custody of one’s children. Other external motivating factors are the person’s partner/spouse/family and his or her employer. All of these variables can play a role in whether the person enters and remains in treatment long enough to complete it or not. These individual variables assume many different configurations, consistent with the diversity of addiction treatment patients. This diversity ranges from (for example) the previously high-functioning Beverly Hills attorney who is abusing alcohol to the schizophrenic high school dropout who is shooting heroin and living under the freeway overpass. The Beverly Hills attorney is the head of his law firm, is married and has two kids, went to Harvard, and makes a million dollars a year in his law practice. One day, he comes home and an intervention is waiting for him. His wife, his law partner, and his kids are all sitting there with a trained interventionist, and they all say in various ways, “Listen, we love you, but we don’t love your drinking.” You know how the rest of it goes: “If you keep drinking we’re going to leave, we’re going to turn you over to the state bar, you’re going to lose your law license, we’re going to remove you from the law firm, and all these bad things are going to happen unless you go into a treatment program.” Then there’s a heroin addict with an eighth-grade education who has schizophrenia, who contracted HIV from intravenous drug use, has no job skills, and is hearing voices. How do you compare these two situations? Obviously, there are many significant differences between these two people. There are also treatment program factors related to retention. It is essential for counselors to establish positive therapeutic relationships with clients as early in treatment as possible, and ensure that a treatment plan is developed and followed in collaboration with each client. Clients also need information and psychoeducation regarding what to expect both structurally and experientially during treatment. Medical, psychiatric, and case management services should be available concurrent with psychosocial addiction treatment, and transitions to step-down continuing care or aftercare need to be agreed upon well in advance and be as seamless as circumstances allow. Something that comes as a surprise to a lot of people is that individuals who enter treatment under legal pressure have outcomes that are just as successful as those who enter treatment voluntarily. That seems counterintuitive, doesn’t it? we tend to think that somebody “forced” into treatment because the court has given him or her the choice of treatment or jail would rebel against the process. Of course some people do rebel against the structure and process of addiction treatment—but that happens regardless of whether their motivation is primarily internal or external. Interestingly, once many people who are mandated to enter treatment are exposed to recovery, positive things happen, and a lot of people begin to turn their lives around. I tell patients that “I don’t care all that much about the reason why you’re here. I don’t care if you’re here because your wife or your husband or your parents sent you, or if it’s the court or Child Protective Services that made you come, as long as you’re here. If you want to do it for your wife or whomever, do it for her, just as long as you’re here, and then we’ll see what happens after that.” Here’s a critical point for aspiring addiction treatment professionals to consider: not everybody wants to stop using. That’s something you need to learn right now so your expectations can be set realistically, and you don’t burn out from the frustration and disappointment of not succeeding with all of them. Often, it’s much more than denial that we have to deal with. while many people don’t stop because they are in denial and contend that they “don’t have a problem,” there are people who simply don’t want to stop using alcohol and other drugs and are not yet ready to stop, despite the adverse consequences they have experienced to that point. In order for addiction treatment to be effective, addicts usually have to get to the point where the pain of using and everything that goes along with it significantly outweighs the pleasure and/or relief that using brings. we used to talk about the need for people struggling with addiction to “hit bottom,” but at a minimum, addicts need to get to a place where they are confronted unavoidably with the reality that the negative consequences of using far exceed the perceived benefits. Ambivalence is common, even if technically, a person is not being “forced” into treatment. A skilled counselor can tip the scales of this ambivalence by helping the patient to specifically identify the “good” things that he or she gets from using, as well as what using has cost, continues to cost, and is likely to cost him or her in the future. As this list is formulated and processed, it usually becomes clear that the costs of using are greater than its benefits, that the advantages can no longer compete with the disadvantages. This helps people come to the realization that they really don’t wish to continue living the way they have been, and they become willing to enter treatment. Over the last decade or so, drug courts have evolved as an innovation wherein both drug use/addiction and criminal acts can be addressed in an integrated way. The most effective models incorporate criminal justice considerations with drug treatment that includes screening, placement, counseling, testing, monitoring, and supervision, and often include attendance at twelve-step meetings. Treatment should also include assessment and counseling for high-risk infections such as hepatitis C and HIV. Intravenous drug users, in particular, are going to be at considerable risk for these viruses. I’ve rarely met an IV addict who didn’t have hepatitis C. Many of the patients you will work with in addiction treatment are going to have HIV, they’re going to have hepatitis C, they’re going to be pregnant (with complications), and they’re going to have a range of medical problems from their using. we’ll cover these commonly seen medical comorbidities later. Sometimes it isn’t possible to motivate clients externally to seek treatment. I recall one patient many years ago who had AIDS and was addicted to crystal meth. The only reason he periodically came to the hospital was because he was running out of money and running out of drugs. He had abscesses all over his body from injecting drugs and by the time I saw him, he had wasted away to about ninety pounds. He needed antibiotics and medical stabilization, as well as to get some food and hydration in him. Rather than let him die, we’d admit him to the hospital for a few days. One day I said to him, “why don’t you give this up?” He said, “Doc, I don’t have much to live for. I’m going to die in a year or two anyway, if I live that long. At this point, the only enjoyment I get in life is shooting up crystal meth.” I didn’t have an answer that would satisfy him. I told him that his life would get better if he didn’t use, even if he only had a year or two. I never saw him again and I guess he died. In this field you see people who, for whatever reason, don’t want to stop using. I had another case where a woman brought her husband in for treatment. They had been married for a long time and their marriage had reached that critical moment where she said, “Look, either you follow the doctor’s advice and get into treatment, or I’m leaving you. I don’t care how many years we’ve been married, I’ve had enough. It’s either me or the booze.” He said goodbye to his wife, right there on the spot in my office. It’s not possible to force help on someone who absolutely doesn’t want to be helped. There are times when, faced with that choice of treatment or incarceration, people will actually choose to go to jail. For some people, especially if they have a history of incarceration, the idea of going to jail is more comfortable and (believe it or not) less scary than entering treatment. You can put somebody in a psychiatric hospital against his or her will on what we call a seventy-two-hour hold, sometimes called a psychiatric hold, but that’s only if the person is acutely suicidal, an imminent danger to other people, or gravely mentally disabled. In this situation, there is a judicial hearing within seventy-two hours. But no one can be hospitalized against his or her will simply for using drugs, even if continuing to use puts his or her life at risk. Sometimes this is very difficult to explain to family members. One of the ways to tell that someone is unmotivated to enter treatment or to complete it and achieve recovery (regardless of what he or she may say) is when the family, the doctors, and the therapists seem to be working harder on behalf of the patient than the patient is. everyone else is pulling their hair out while the patient is drunk and stoned and often doesn’t care one bit. This is an example of codependency. Officially, codependency is defined as “a psychological condition or a relationship in which a person is controlled or manipulated by another who is affected with a pathological condition (as an addiction to alcohol or heroin).”2 More broadly, codependency is a psychological condition wherein a person’s view of him- or herself and self-esteem is dependent upon the welfare of others, most often the primary partner and/or family. Someone who is codependent defines him- or herself only in relationship to others, rather than as an independent individual. Codependents are much more concerned with the needs of others than their own needs. As as result, people who are codependent are overly responsible and controlling. They take responsibility for the feelings of others and can only be happy when those they are in codependent relationships with are happy. Codependent caretaking of the addict by family, friends, or others enables him or her to avoid taking responsibility for his or her behavior and actually helps keep that person in active addiction. Codependents often have the best possible intent: with their pleading, they convince the addict to begrudgingly enter treatment; they may call all over town to find a treatment program, transport the addict there, make arrangements to pay for treatment, and after two days, the addict wants to leave treatment because “he had a fight with his roommate” or “didn’t like the way that counselor talked to him” or “doesn’t like the food.” So he calls his mother or whoever is likely to be the easiest to manipulate, who then agrees to allow him to come home and picks him up, thus saving him from the “horrors” of treatment and potential recovery. Amazingly, it’s not that unusual for addicts, whether adolescents or adults, to get money for their drugs from their parents. Often the parents have not been told what their child needs the money for. But at a certain point, it’s evident and people are just kidding themselves. Allowing children to continue to live at home rent-free while they use whatever money they can get for drugs is another common way that parents practice codependency. Somewhere along the line, the parent comes to you, the addiction treatment professional, and says, “I want you to fix him, to cure him.” This is not to assign blame, but to clarify that active addiction generally has the unwitting assistance of people close to the addict. Their reactions to the addiction and its related problems enable it to continue. How do twelve-step programs fit with addiction treatment? Many people who could benefit from addiction treatment have neither health insurance that covers it nor the resources to pay for what are often expensive services. Most addiction treatment programs require patients to have health insurance with the appropriate coverage or the ability to self-pay for treatment. Although many communities have some publicly funded or subsidized addiction treatment that is accessible to people without financial resources or health insurance, these programs are often limited in size and types of services they offer (for example, they may provide detox only), have narrow eligibility criteria, and may have long waiting lists for admission. It is an extremely positive development that the new federal healthcare law, the Affordable Care Act, mandates some coverage for addiction treatment, but how long it will take to become widely operational and how much positive difference it will make in terms of facilitating access to addiction treatment remains to be seen. AA, NA, and the other twelve-step addiction recovery programs are free. As I noted earlier, as necessary as professional treatment is for many people, many others achieve and maintain recovery through twelve-step programs alone. Sometimes patients will ask me, “I go to twelve-step meetings, so why do I have to come to your treatment program? Or, alternatively they may ask, “I’m attending your treatment program, so why do I have to go to twelve-step meetings?” I try to explain to them that twelve-step programs provide invaluable opportunities for mutual identification and support. They are self-help fellowships run by the members themselves, wherein members share their “experience, strength, and hope” with one another. Frequently, the most effective approach is a combination of professional treatment and twelve-step program participation. I tell my patients (quite truthfully) that it’s really therapeutic for them to associate with people who have the same disease they do and have been through similar kinds of experiences. As such, people in twelve-step programs can understand, relate to, and support one another in ways that few others can. But it’s not professional treatment; it’s not professional counseling, and people involved in twelve-step programs alone are not learning about addiction as a brain disease, and do not have access to medications that might help them maintain abstinence or assist them with psychiatric or medical problems. without professional treatment, needs that can be critical to the recovery process frequently remain unaddressed. Twelve-step program involvement and professional addiction treatment complement each other and work hand in hand. How can family and friends make a difference? Family and friends can play a critical role in the recovery process by participating in professional treatment in the form of family therapy with the addicted person and/or attending one of the twelve-step programs for the family members and significant others of those struggling with addiction, such as Al-Anon or Nar-Anon. One of the valuable things that significant others of addicted persons learn in these programs is that they do not have any control over the behavior of other people; they have no control over whether the addicted person uses alcohol or other drugs. They learn what they can and cannot realistically do to help the addicted person and themselves in dealing with this problem. These groups provide information, mutual aid, support, and important opportunities to connect with people who share very similar experiences. Addiction is a state in which an organism engages in compulsive drug-taking. The behavior of drug use is neurochemically self-reinforcing, which leads to a loss of control in limiting intake. The hallmark of addiction is this compulsive out-of-control drug-seeking, combined with obsessive thinking, drug craving, and physical dependence. Remember, people can be dependent on a substance/medication and not be addicted to it. Dependence is a state in which an organism functions normally only in the presence of a drug and manifests as a physical disturbance (withdrawal) when the drug is removed. Someone who has cancer can be dependent on opioids for pain management, but he or she may not demonstrate the obsessive-thinking, drug-craving, and compulsive drug- seeking and drug-taking that define addiction. Is addiction treatment worth the cost? The short answer is yes, and that’s one of the reasons this book exists. It is also why the government allocates resources to conduct research on the disease of addiction and how it can be most effectively treated. Addiction treatment is cost- effective in reducing alcohol and other drug use and its associated health and social costs. According to the National Institute on Drug use, every dollar invested in addiction treatment programs yields a return of between four and seven dollars in reduced drug-related crime, criminal justice costs, and theft. when savings related to healthcare are factored in, total savings can exceed costs by a ratio of twelve to one. Major savings to the individual and to society also come from improvements in workplace productivity.3 It’s much cheaper to help people stop smoking now than it is to treat their lung cancer later. In the same way, it’s much cheaper to help people stop using alcohol and other drugs than it is to pay for them to be hospitalized for an overdose, after a car accident from driving while impaired, or for a liver transplant. The bottom line is that addiction treatment works. If the same principles are applied to the disease of addiction that are used to treat any other progressive chronic illness, we find that addicted persons respond to their prescribed treatment just as those who struggle with any other chronic illness do. Recap: The most important points to remember are:
- Alcohol and other drug use is not the same thing as addiction.
- Addiction is a chronic brain disease that is amenable to treatment.
- Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) are valuable mutual-aid/support programs, but they are not the only support groups available for people with addiction, and they do not constitute treatment.
- If you apply the same principles to the disease of addiction that you would use to treat any chronic illness, you will find the disease of addiction will respond to treatment just as any other chronic disease would.
- Addiction treatment works.
2 By permission. From Merriam-Webster’s Collegiate® Dictionary, 11th edition, ©2013 Merriam-webster. Inc. (www.Merriam-webster.com). 3National Institute on Drug use, “Understanding Drug use and Addiction: what Science Says” (2007), http://www.druguse.gov/publications/teaching-packets/understanding-drug-use-addiction/section-iv/6- cost-effectiveness-drug-treatment (accessed January 2, 2013). This blog post is an excerpt from The therapist’s Guide to Addiction Medicine – A Handbook for Addiction Counselors and Therapists – by Barry Solof, MD, FASAM; Published by Central Recovery Press (CRP).