The Anatomy of Addiction
The Book Brigade talks to psychiatrist and addiction expert Akikur Mohammad, MD.
Posted Jun 30, 2016
Science has a lot to say about the true causes, the best preventive measures, and most successful treatments for addiction.
What is the single biggest myth about addiction?
There are many myths of addiction. It's difficult to pick the single biggest one, but it would probably be "addiction is a problem of willpower and abstinence, which is why medications don't work." This is clearly not true. Addiction is a disease of the brain and using willpower to treat it is no more effective than using willpower to treat cancer or diabetes. Drugs are often used to positively treat and manage addiction.
How can addiction treatment be more effective for those among them who have serious mental illness?
Addiction combined with mental illness is called a "dual diagnosis" or "co-occurring disorder," and it is quite common. It's difficult to say which comes first, because every person is different, but for treatment to be effective, it's important to tackle both conditions at the same time. Many addiction facilities do not treat co-occurring disorders because they don't have staff experienced in mental illness, and a psychiatrist is required for diagnosis and treatment. Treating only the addiction or the mental illness alone, and not both simultaneously, will not lead to success.
What is important to know about the treatment of drug addiction with drugs?
Medication-assisted treatment for addiction is finally getting the recognition it deserves, and scientific evidence supports the efficacy of using such drugs as Suboxone, which is a combination of buprenorphine and naloxone, and methadone to successfully manage the cravings of addiction. A person with asthma might use an inhaler, and a diabetic might use insulin to treat the illnesses. Because addiction is a brain disease, it is much more complex; it involves both mental and physical dependence. Suboxone can help people addicted to heroin or opioids stop using and get quality of life back so they can work and return to normal family life. Without it, they are likely to continue using because addictive drugs have such a powerful grip on the brain.
What is the best way to think about relapse?
The National Institute on Drug Abuse defines addiction as "a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences. It is considered a brain disease because drugs change the brain; they change its structure and how it works." Relapse is part of the definition of addiction, because addiction can't be cured, although it can be treated and managed. Relapse can happen with cancer or diabetes, too. It is often viewed as a setback but not a failure. After a relapse, it's important to get back on track and continue medication or therapy protocols that have been successful.
What do you think about medical marijuana?
There hasn't been any recorded death from a marijuana overdose, and there is no evidence that decriminalizing or legalizing marijuana increases its use. But I do support regulating marijuana, because there are no standards for dosages or packaging. Today's marijuana is much stronger than it was decades ago, and it is now available in edible forms, which can be unknowingly consumed by children or other adults. Eating marijuana produces especially strong effects, which have sent some people to the emergency room with panic attacks. Because marijuana is a Schedule I drug, research has been limited, but if that changes, better research and evidence will provide a more thorough understanding of its efficacy.
How has heroin use changed and what can be done about it?
For more than a decade, opioid painkillers were overprescribed and a lot of people got hooked on them. When the government cracked down on opioids and made them harder for doctors to prescribe, patients got them from family or friends. And when that supply ran out, they bought them on the street. Because street prices are expensive, many people have turned to heroin, because it's cheaper and easier to get. Essentially, we traded a painkiller epidemic for a heroin epidemic. It's difficult to regulate or impede the flow of illegal heroin coming into the country, so now it’s a matter of education and treatment. Medication-assisted treatment is needed today, and fortunately it is becoming more widely accepted as the best treatment option, but there is still a long way to go.
Is there anything to be learned from the way other countries deal with addiction?
Portugal, Ecuador, and other countries have decriminalized some drugs in favor of harm reduction and treatment policies instead of incarceration. In Switzerland, the government promotes needle exchanges, counseling, safe injection rooms, and even housing for addicts who are willing to get sober. This trend is increasing around the world, and it has been shown to reduce the flow of drugs coming into the countries and the spread of HIV. Several states in the U.S., including Colorado and Washington, have decriminalized marijuana. Seattle has a program called Law Enforcement Assisted Diversion in which police officers work with a case manager to find treatment and counseling for addicts instead of sending them to jail. Such new approaches are proving effective so far.
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