The Roots of Addiction
The debate over alcoholism is certainly nothing new. The see-saw of whether or not it is within the patients head versus a physical disease is forever up and down. Can willpower, spirituality, or therapy truly help an alcoholic, or does it require ongoing medical treatment, the same as epilepsy or diabetes?
More so, we are seeing various medical establishments supporting addiction as a physical diagnosis. Recently, about ten medical institutions have created residency programs that are accredited and focus on addiction medicine. Doctors who complete medical school and have completed their primary residency will now have the option to spend a year observing the relationship between brain chemistry and addiction.
David Withers who is responsible for overseeing the new program at the Marworth Alcohol and Chemical Dependency Treatment Center said that this is the beginning steps towards recognizing addiction medicine.
The goal of the program is to take addiction medicine and establish it so that it is seen as a standard just as oncology, pediatrics, dermatology and other specialty areas. The program which started on July 1st is made up of twenty students from all different institutions. The residents will work on the treatment of patients that have a range of different addictions with alcohol, prescription drugs, illegal drugs, nicotine, and more. They will also study the role of heredity as well as the brain chemistry that is involved with these addictions.
Nora Volkow, who is a neuroscientist at the National Institute of Drug Abuse, points out that in the past, this specialty was focused on psychiatrists. She refers to this as being a gap in the training program. The severe lack of the education on substance abuse treatment among general practitioners is an issue that is very serious, Volkow believes.
The various institutions that are offering this one year residency include the University of Maryland Medical System, St. Luke’s-Roosevelt Hospital in New York, the University of Cincinnati College of Medicine, and others. Although some of these schools had already offered addiction treatment programs, they were not accredited until now. Courtesy of the American Board of Addiction Medicine (ABAM), this new accreditation has been made available. Founded in 2007, the goal of ABAM was to promote addiction medical treatment.
The board is also aiming to get accredited by the Accreditation Council for Graduate Medical Education. This will require many steps and among them, having the program established within at least twenty institutions. This type of recognition would mean that this specialty of addiction would serve as a primary residency. Meaning, a doctor right out of school can enter such a program. One of the chairmen at ABAM, Richard Blondell, expects up to 15 institutions within the year to be accredited.
The point of view of addiction as a medical disease versus a psychological disease started fifteen years or so ago. This was discovered using high resonance imaging and with this, it was shown that addiction to drugs actually causes physical changes within one’s brain.
Doctor Daniel Alford, who is in charge of the program at Boston University Medical Center, states that when managing individuals who have an addiction, it is very much like managing those who have chronic diseases such as hypertension, asthma, or diabetes. He points out that while it is difficult to completely cure people, the problem is able to be managed. Certain therapies and pharmaceuticals can be used so that the person can function.
Alongside with addiction being a physical illness, there is a belief that treatment must be up kept in order to avoid a relapse. Just as a diabetes patient cannot be cured with several weeks of insulin management, it is also not realistic for an addiction to be gone after say, several days of detoxification at a facility. Doctor Alford points out that it is no surprise that when an addict stops treatment, they will relapse. He says that this doesn’t mean the treatment didn’t work, but it does mean that the treatment should have continued. The physical changes within ones brain may be responsible for example, of why a smoker can have a craving thirty years down the road, after they have long quit the habit.
Doctor Volkow partially blames the slow taking of the idea that addiction is a chronic illness on doctors failing to understand brain function. While a heart disease is fairly simple to understand because it is muscle, the brain is full of complexities.
The increasing interest in medicines for addiction includes several pharmaceuticals that are new, one being Suboxone. It has proved to not only assist in easing the symptoms of withdrawals, but blocks cravings as well. Several other drugs used to treat alcoholism and opioid dependence have also shown promise.
While these treatments assist, only a handful of specialists rely solely on these pharmaceuticals. Petros Levounis, who is head of the residency program at the Addiction Institute of New York points out that the more that is learned about addiction, the more it is realized that one style doesn’t suit everyone.
Many criticize not only pharmaceutical treatments, but the idea of the 12-step program or even psychiatry and feel they are not adequate when it comes to curing the physical roots of the disease. Doctor Alford points out that this is because many addicts do not have a psychiatric problem. He also points out that there is certainly a role for addiction physiatrists, however.
Within these new programs, although each one has established their own curriculum, the underlining competencies remain the same. Overall, residents will learn to recognize substance abuse, diagnose it, take part in interventions, while also providing options for treatment including medications. These doctors will need to understand not only the legal implications of substance abuse, but the practical implications as well.
A resident as the Boston University Medical Centre, Christine Pace, who is a graduate from Harvard Medical School, is the first to be part of their program. Interested in addiction ever since she was a teen, she recollects overhearing the discouragement of addicts about doctors who had failed to help them. Working at a methadone clinic as an in-house doctor in Boston, she was distraught to hear that this common complaint has not been changed. She has seen physicians pushing addiction to the side, referring it to social work.
Derek Anderson, one of Dr. Pace’s patients who has used Suboxone as part of treatment, alongside a general practitioner, have helped his heroin habit that lasted for 35 years. He recalls going in and out of detox, but points out that the Suboxone has actually gotten him somewhere. He no longer needs to depend on drugs and can work and take care of his daughter. He is now able to do these things that he was not able to do when he was using.
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