Dear Bewildered of Englewood and Readers,

Last week, in my continuing review of an article by Dr. Alan Leshner, Director of the National Institute of Drug Abuse, I discussed how prolonged exposure to alcohol and other drugs can cause some fundamental changes in brain function and structure which will move an individual into a state of addiction. In this final segment, I hope to convince readers of this column and (dare I hope?) some of our political leaders in Congress that addiction is a brain disease, the treatment of which should be the keystone of any strategy designed to “win” the so-called “war” on drugs.
The major goal of treatment must be either reverse or compensate for the previously described negative brain changes. This can be accomplished through either medications and or behavioral treatments which, when provided by trained professionals, are known to be successful in altering addiction and other psycho-biological illnesses. Presently, most federal anti-addiction money is used in support of punitive programs, leaving the leftovers for the provision of and development of new treatment and prevention programs.

Addiction is not just a brain disease, it is a disease for which the social content in which it developed is also very important. For example, it was relatively easy to treat the thousands of returning Vietnam vets who had become addicted to heroin in contrast the street addicts in the U.S. They had become addicted in a setting entirely different from the one to which they returned. Exposure to conditioned cues can be a major factor in causing recurrent drug relapses even after successful treatment.

Thus, looking at addiction as an illness with critical biological, behavioral, and social context elements, treatment strategies must include all of them...hardly within the capabilities of a “provider” who is not credentialed to treat addictive illnesses.

Addiction is rarely an acute illness...for most people, it is a chronic, relapsing disorder. Total abstinence for the rest of one’s life is a relatively rate outcome from a single treatment episode. Relapses are more the norm, so addiction must be approached more like other chronic diseases such as diabetes and chronic hypertension. All must have close follow-up care..in the case of addiction, the 12 Step support groups (e.g.) AA and NA) are excellent adjuncts to professional management of illness for which, as yet, there is no cure.

Addiction as a chronic, relapsing brain disease is a totally new concept for much of the general public, for most policy makers and, sadly, for many health professionals. Inadequate
understanding of the true nature of addictive illnesses has caused serious defects in our public health policies relating to the problem. One example cited by Dr. Lesher is how lack of knowledge affects criminal justice strategies: if we know that a criminal is drug addicted, i.e., has a brain disease, them jailing them without providing treatment is futile. If left untreated, recidivism rates can be dramatically reduced. It is simply counterproductive not to treat addicts while they are in prison.

Schizophrenics have an abnormal brain state. We used to put them in prison like asylums but we now know they require medical treatments. Once society recognizes that an addict is also someone who mind (read: brain) is an altered state, it may begin to understand the basic reason for the lack of success of current policy strategies which, for the most part, ignore the need for treatment and focus solely on the social or criminal justice aspects of addiction. Dr. Lesner’s article concluded, “If the brain is the core of the problem, attending to the brain needs to be a core part of the solution”...Obviously, I agree.

(For those readers who would like a copy of original paper, send a stamped, self addressed envelope to me C/O The Van Ost Institute. 150 East Palisades Avenue. Englewood)