Approaching Addiction as a Chronic Brain Disease

How to treat addiction comprehensively.

Posted Aug 03, 2009

My name is Harold Urschel III, MD. I am an addiction psychiatrist practicing in Dallas, Texas. In this blog, I will to bring to bear all of the power of science and new research results to attack our nation's biggest health problems - alcohol and drug dependence. I don't know if you are aware that Alcoholism is the third leading cause of death in the US today!! Let me give you some of my thoughts on how to successfully approach treating this life-threatening illness.

In chronic, multi-factorial medical conditions such as cardiovascular disease, the standard of care involves front-line physiological interventions through surgery or medication, followed by environmental and behavioral modifications. Hypertension and high cholesterol are often controlled by medication, but modifying dietary habits and exercise are necessary steps as well. Addiction treatment in the US today is unique in that the majority of interventions are behavioral and psychosocial. Recent awareness about the neurochemical mechanisms of the brain, the effect of addiction on the brain and the discovery of medications that can positively impact that process are dramatically changing addiction treatment approaches. Consequently, using these new addiction treatment paradigms with a combination of behavioral and medical approaches can prove quite powerful.

Behavioral treatments and other psychosocial interventions (such as AA or other 12-step programs) are essential in helping people recovering from substance dependence and learn new, effective coping skills to deal with stress in order to stop their drug and alcohol abuse. These new healthy coping skills enable them to function without alcohol or drugs, to handle cravings, to avoid alcohol/drugs and situations that could lead to drug use, and to handle a relapse should it occur. Behavioral approaches such as individual, group or family counseling, contingency management, and cognitive-behavioral therapies, also help patients improve their interpersonal relationships and their ability to function at work and in the community.

Simultaneously, new anti-addition medication treatments - many of which have only been developed in the last few years - can be used to counter the brain injury from past drug use, to relieve withdrawal symptoms, and to help overcome drug cravings. However, medical approaches - sometimes referred to disparagingly as "treating drug addiction with drugs" - have historically been considered suspect by the addiction community, some of whom exhibit what I term "pharmacologic Calvinism."

One of the positive trends that is helping increase acceptance of a medical approach to alcohol and drug addiction is the growing awareness that substance dependence is not a moral failure, nor a sin, but rather a chronic medical disease with many similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. It was only within the last 20 years that researchers began to realize substance dependence is a "brain disease" - a medical condition with a neurobiological basis that causes lasting changes in the brain -- changes that don't go away, sometimes for months or years, even after recovering patients stop using.

To this end, I have worked hard with many creative and very bright people to create a variety of treatment resources geared specifically towards patients and their families. These resources are to help educate and support them through this process. The two primary tools that I have helped to create are my new book Healing the Addicted Brain,, and a patient friendly website, An excerpt from the book's first chapter can give you a better understanding of what I am trying to accomplish here in this blog with the help of Psychology Today:

From Healing the Addicted Brain, Chapter 1 - "It's A Disease!"

Everything you know about addiction treatment is wrong.

I can safely make this statement to most laypeople-plus an alarmingly large number of health professionals-without fear of being contradicted. Why? Because most people know very little about addiction, and what they do know (or think they know) boils down to this: addicts can quit if they really want to; all they have to do is commit wholeheartedly to their treatment, which consists largely of "talking therapy" - individual or group psychotherapy, or 12-step programs like Alcoholics Anonymous.

That's the sum total of most people's knowledge of addiction treatment. But it's dead wrong. And it's the main reason that the success rate for addiction treatment is currently only 20-30 percent. This means that 70-80 percent of the participants in any given addiction treatment program will not be successful. No wonder people think that alcohol or drug addiction treatment doesn't work!

Fortunately, recent scientific research has discovered new avenues of treatment by showing conclusively that addiction is a chronic physical disease that attacks the brain, damaging key parts of the cerebral cortex and limbic system. This brain damage cannot be reversed by talking therapies; only select new medications and continued sobriety can do that. But when used together, these new medicines and talking therapies can literally work wonders...

As I discuss in Healing the Addicted Brain, I believe maintaining an open mind about the latest, scientifically-proven, medical approaches and a willingness to consider a combination of both approaches, when indicated, will empower us as intelligent addiction treatment professionals to be maximally effective in treating our patients. In short I believe that you need to treat alcohol and addiction comprehensively in order to get the best treatment outcomes.

In the next few weeks I will continue to share more of my thoughts about what is a comprehensive approach to treating alcohol and drug addiction effectively. In the meantime, feel free to learn more about the latest scientific findings and how they can help to create a successful recovery program by looking at the book, its' website and the elessons on the EnterHealth website. My goal here in this blog is to share as much as I can, as quickly as I can with you, so that you or someone you care about can get effective treatment for alcohol and drug addiction.

Harold Urschel III, MD

About the Author

Harold C. Urschel III, MD

Addiction psychiatrist Harold Urschel brings science-based addiction treatments to the general public.

More Posts