Dear Readers,

This is Part III of my response to bewildered-Englewood's letter asking, if addiction is truly a disease, why do most health providers and insurers persist in raising barriers to treating its victims? In previous columns, I discussed this paradox by describing factors which contribute to the wide gap between scientific facts, which specifically identify addiction as a brain disease, and false perceptions by the public about the illness. This week, still borrowing freely from an article by Dr. Alan Leshner Director of the National Institute of Drug Abuse (NIDA), I will address some health problems caused by addictive illnesses. Also, I'll discuss what I think really matters in addiction and where clinical and policy efforts should be concentrated.
Addiction to alcohol and other drugs has tremendous implications for the health of the general public. Directly or indirectly, it is a major cause of violent deaths and injuries and is now recognized as a major cause of the spread of many serious infectious diseases, particularly AIDS, hepatitis, and tuberculosis. The problem is complex and pervasive, yet present funding of the so-called "drug war" still concentrates on punitive measures with too little committed to public health strategies such as sufficient financing for education, prevention, treatment and research.
In order to properly treat an addict, the treatment provider must be aware of what matters in addiction. Too often, the untrained provider may be overly concerned over whether the patient has been using a physically or psychologically addictive drug, with the issue revolving around whether or not dramatic physical withdrawal symptoms occur when the individual stops taking the drug...the assumption being, the more dramatic the physical withdrawal symptoms, the more dangerous the drug. This is simply not true.
Clinically it doesn't matter much what physical withdrawal symptoms occur except for alcohol withdrawal which can result in death if improperly treated. Heroin withdrawal may cause the addict to wish he could die, but it doesn't kill. Cocaine and methamphetamine, like
many of the most addictive and dangerous drugs, do not pro sever physical withdrawal symptoms. What really matters is what we now know is the essence of addiction: compulsive drug seeking and use, even in the face of serious health and social consequences. These are the characteristics toward which treatment should be directed, for they are the basic reasons for the huge health and social problems caused by those who are addicted to alcohol and other drugs.
Virtually all drugs of abuse have common effects, either directly or indirectly, on a single pathway: a reward system dep within the brain. Activation of this system appears to be a common element that causes users to continue taking drugs. This is not unique to any one drug...all addictive substances effect this circuit.
Acute drug use modifies many brain functions; prolonged use results in changes which persist long after the individual stops using. The addicted brain is distinctly different from the non-addicted brain...manifested, amongst others, by changes in brain metabolic activity and responsiveness to the environment. Addiction is tied to changes in brain structure and function making it, fundamentally, a brain disease. A "switch" in the brain seems to be thrown as a result of prolonged drug use. Initially usage is a voluntary behavior but when the "switch: is thrown, the individual moves into the state of addiction, characterized by compulsive drug seeking and use.
Next week I will conclude this review of Dr. Leshner's paper with a short discussion as to why understanding and treating addiction as a brain disease is a vital factor if we are to have any hope of winning the so-called "drug war."