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Dear M.D.,
In the Oct. 4, 2000 edition
of the Journal of the American Medical Association,
researchers ( (McLellan, Lewis, O'Brien, Kleber, et
al) said that "while many physicians believe there
are no effective interventions for addiction, the research
says otherwise." This is especially true when outcomes
are compared with those for type 2 diabetes, hypertension
and asthma; diseases that are "well studied, have
effective treatments, although not yet curable."
The JAMA article noted that addiction
has a strong genetic component: studies of twins reveal
rates of genetic predisposition to drug dependency similar
to those for those same three chronic illnesses and
are also alike, in that personal responsibility also
plays a strong role in developing the disease and for
the likelihood for success in treatment.
Obesity, stress level and inactivity
are all behavior-related risk factors for hypertension,
for instance. While 40 to 60 percent of drug-dependent
individuals resume drug use within a year of treatment,
the article points out that less than 30 percent of
diabetics, asthmatics and hypertensive patients adhere
to the dietary or behavioral recommendations that would
improve their health and prevent recurrence.
In addition to education and counseling,
a number of medications have been developed in recent
years that have been proven effective in treating addiction,
e.g., naltrexone, nicotine patches, buprenorphine.,
amongst others.
Similarities in heritability, course
and response to treatment raise the question of why
medical treatments are not seen as appropriate or effective
when applied to alcohol and drug dependence. Part of
the problem, the article notes, is that addiction --
a chronic disorder with long-term biological changes
-- is often treated as an acute condition, with detoxification
and short-term counseling. Further, few medical schools
adequately train physicians about addiction.
The biggest factor contributing to addiction
treatment's image problem among physicians is simply
that the outcome bar is set artificially high... whether
the patient has been continuously abstinent after leaving
treatment. The authors ask us to "imagine the same
strategy applied to the treatment of hypertension: How
effective would treatment for hypertension be considered
if patients received short-term counseling, had their
medication limited or eliminated by insurance cost-constraints,
and were considered failures if they didn't keep their
blood pressure under control from the point of discharge
on?"
Relapse among patients with diabetes,
hypertension and asthma following cessation of treatment
has long been considered evidence of its effectiveness
and the need to continue medical monitoring, while relapse
to drug or alcohol use has been considered evidence
of treatment failure.
While the advocacy role of the recovery
community is important, the medical profession lacks
leadership when it comes to addiction issues. The addiction
field includes thousands of researchers and treatment
professionals, most of whom are not in personal recovery.
Practicing physicians must take advantage of their findings
and stop treating alcohol and other drug addiction as
a moral failing; They must learn to adapt the care and
medical monitoring strategies that they currently use
in the treatment of other chronic illnesses to the treatment
of drug dependence...unless they do, our nation's addiction
problem will never end.
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