Pharmacological (Anti-Addiction Medication therapy) Approaches to Addiction. In chronic, multi-faceted medical conditions, such as cardiovascular disease, the standard of care involves front-line physiological (medications and fluids) interventions through surgery or medication, followed by environmental and behavioral modifications. Hypertension (high blood pressure) and high cholesterol are often controlled by medication, but modifying dietary habits, new exercise programs, and specific lifestyle modifications are necessary steps as well to enhance successful treatment. Drug and alcohol Addiction treatment is unique in that the majority of interventions are behavioral and psychosocial. Recent awareness and understanding gleaned from scientific research about the neurochemical mechanisms of the brain, the effect of addiction on the brain and the discovery of anti-addiction medications that can impact that process are changing our previous drug and alcohol addiction treatment approaches. Just like in other chronic medical illnesses, the field of addiction treatment is an area where in combination with behavioral approaches, certain anti-addiction medications can prove quite powerfully effective. New scientific research makes it increasingly clear that addiction is not a weakness or a moral failing, but rather a chronic medical disease with many similarities to other chronic diseases, such as diabetes, hypertension, and asthma. It is a chronic physical brain disease, with damaging changes to that vital organ that can be documented via MRIs and other imaging tools; changes that firmly, inevitably alter both thoughts and behavior. The pictures that follow show some of the physical damage that excessive alcohol consumption can cause within the brain. The top image shows a normal brain; the lower three are views of the brain of a 38-year-old who drank heavily on weekends for 17 years. The images of the alcohol-damaged brain show obvious physical injury, plus a marked decrease in overall activity. (In non-technical terms, you can think of the damaged brain as a big chunk of polar ice that's half-melted and full of crevasses.)
Image of A Normal Brain
Alcohol Damaged Brain
(Seen from the bottom, front and side)
These images say it all. Abusing alcohol and addictive drugs can physically transform and damage the brain, just as excess cholesterol transforms and damages the linings of the arteries. In short, addiction is a chronic physical disease! And this means it's simply not enough to talk to people with drug/ alcohol addictions and urge them to change their behavior. Most of the addicts can't, no matter how much they want to, until their bodies have repaired the physical damage to their brains caused be the addiction. And this recovery process can take six to eight months, which is a lot of time - time during which addicted people are physiologically programmed to relapse into old destructive habits, no matter how much they want to remain sober. Behavioral treatments and other psychosocial interventions are essential to helping people recovering from substance dependence. These addiction treatments help stop alcohol and drug use and enable them to function without illegal drugs, to handle cravings, to avoid situations that could lead to drug use, and to handle a relapse should it occur.
- Behavioral approaches to addiction treatment, such as individual counseling, group or family counseling, contingency management (getting rewards for sober behavior), and cognitive-behavioral therapies also help addiction patients improve their personal relationships and their ability to function at work and in the community.
- On the other hand pharmacological (anti-addiction medications) treatments, many of which have only been developed in the last few years, can be used to counter the effects of the alcohol/drug on the brain and behavior, to relieve withdrawal symptoms, or to help overcome drug cravings.
However, pharmacological approaches, sometimes referred to disparagingly as "treating drug addiction with drugs," have historically been considered suspect by the "recovering" addiction community, some of whom are adamant in their refusal to consider any medications in the treatment of this life-threatening chronic medical illness. In order to obtain maximum effectiveness of the addiction treatment, individuals must maintain an open mind about the use of medications to treat addiction and a willingness to consider a combination of both approaches customized for each patient will allow cutting-edge tool sets to be used in addiction recovery. It was only within the last 20 years that researchers began to realize substance addiction is a "brain disease,". Addiction is a medical condition with a neurobiological basis that causes lasting changes in the brain, changes that don't go away, sometimes for many months, after recovering patients stop using. Additionally, an increasing understanding of the neurobiological (brain) mechanisms that maintain substance dependence (addiction) has led physicians to be smarter when customizing patients pharmacological medications with psychosocial treatments. Let's take a look at the latest pharmacological treatments for addiction and available evidence of their effectiveness. Thanks to the latest scientific research, there are now anti-addiction medications that provide a key component of genuinely effective drug and alcohol treatment. Several newly-approved anti-addiction medications and treatments help rebalance the brain's biochemistry in ways that make it impossible for people with addictions to experience a "high," no matter how much of the addictive substance they ingest, inject or inhale. Just one of these medications, a form of naltrexone known as Vivitrol, was found to reduce the median number of "drinking days" per month from 15.2 to 0.2.
Why are these new anti-addiction medicines so helpful? It has to do with the way the brain is "wired." Your brain is an extremely complex network made up of billions of cells that give birth to thoughts, ideas, sensations, emotions and drives. To ensure survival, your brain is programmed to pay special attention to certain things, such as immediate threats, hunger, thirst, the need to bond, and sexual attraction. It is hardwired to protect you and ensure the survival of the human race - making it difficult for you to resist when, for example, it tells you to find something to eat because your body's fuel supply is low. To make certain that you do the many things that help you survive and thrive, your brain contains numerous "reward pathways," neural networks that reinforce helpful actions and behaviors. When you engage in "surviving and thriving" behaviors and actions, the neural pathways are filled with dopamine and other "reward" brain chemicals that make you feel good. Unfortunately, addictive substances powerfully stimulate some of these same reward pathways and "rewrite" your brain's programming. When this happens, the natural drive to survive and thrive is co-opted by an even stronger drive for the false rewards offered by addiction. Harmful behaviors and actions are vigorously rewarded by the release of dopamine and other "reward" substances, and you can't stop seeking that reward. The pleasure of doing things that are good for you is replaced by a single overriding mission: get your hands on the addictive substance and use it. Essentially, drug and alcohol addiction "hijacks" the brain. So complete is this hijacking that you can even lose your normally powerful drive to protect yourself. I once saw a beefy man on crutches drive this point home at a group counseling session. Wayne had been in and out of treatment for alcoholism for 20 years when he stood up and told the group that he knew drinking was bad for him. Everyone had been telling him so for years; his ex-wife, his friends, his doctors. He knew it was killing him but that didn't stop him. "It doesn't matter how many times you tell me it's bad for me," he insisted, "or how many pictures you show me of rotted brains and drunks who smashed their cars into telephone poles and died horrible deaths. You could give me a one thousand page list of names of men who lost their families and wound up in the gutter because they drank. You could even show me my name at the top of that list, but it wouldn't matter. I can't stop." We've long known that this hijacking of the brain takes place in the pre-frontal cortex, an area situated at the front of the brain where planning, abstract thinking and the regulation of impulse behavior, drives and compulsive repetitive behaviors occur. And now, thanks to new addiction research, we know that it also occurs in the limbic region, an area deep inside the brain that is responsible for powerful, primal drives such as hunger, thirst, the need to bond and the need for sexual contact. Until recently, there's been no way to reach the limbic system and correct the damage. But new anti-addiction medicines can do so. They can actually correct the imbalances in dopamine and other neurotransmitters and repair physical damage caused by the addictive substances, in both the limbic region and the cortex. Once this damage has been repaired, a person with addictions is in a much better position to focus on the cognitive and behavioral changes used in "talking therapy" and achieve permanent sobriety.
Drug/ alcohol addiction damages both the cortex, at the right of the diagram, and the limbic region, at the center. "Talking therapy," the traditional mainstay of addiction treatment therapies, helps attack problems involving the cortex, but cannot reach the limbic region deep inside the brain. Fortunately, new anti-addiction medicines can do so, repairing brain damage and "freeing up" the addicted brain so it can concentrate on cortex-based "talking therapy." The combination of anti-addition medication and "talking therapy" produces significantly better results than "talking therapy" alone. Now that we understand that addiction is a chronic disease, and now that we have medications to help correct the brain damage it causes, we have a whole new way of thinking about addiction and addiction treatment. With the judicious use of new medicines, those with drug/ alcohol addictions can focus on and benefit from their group and individual therapy, and can stick to their 12-step programs much more effectively.
So, by applying this state-of-the-art scientific knowledge to everything that you have learned through the behavioral components of recovery programs, you get the new era of addiction treatment. This exciting concept is similiar to the history of other chronic medical illnesses (diabetes, hypertension, asthma). Once the scientists studying those life-threatening illnesses, invented a break-through medication, such as Insulin, Lasix, or Theophylline, all of a sudden these previously hopelessly, "untreatable" illnesses became "conquerable".
Today we almost can't imagine treating diabetes without insulin or high blood pressure or asthma without at least one, if not two, of a large "stable" of cutting edge medications now available. It is almost malpractice these days if a physician treats a patient with one of those illnesses with only behavioral or lifestyle change and management rather than these plus the latest scientifically developed medications.
Now, people suffering from addiction not only have a chance at sobriety. You have an excellent chance of beating this formerly "unbeatable" illness. Before you get too excited, you must remember that just like patients with diabetes, asthma, or hypertension, a successful treatment program for alcohol/drug addiction is not easy; yet at least now it is doable as long as you work hard at it and apply the appropriate medical principles.
Call (800-388-4601) and speak with an Enterhealth admissions specialist today.
