In the past, society viewed drug addiction as a moral flaw. Popular "treatments" involved imprisonment,
sentencing to asylums, and church-guided prayer. Not surprisingly, these methods were generally ineffective.
Today we understand that addiction is a brain disease characterized by fundamental and long-lasting changes in the brain. Modern treatments are based on scientific research. Treatment is tailored to the individual, and typically involves a combination of drug and behavioral therapy. Today's methods are very effective, with 40-70% of patients remaining drug-free.
Victorian-era treatments for alcoholism were often both ineffective and inhumane.
For some addictive drugs, suddenly stopping use can cause painful withdrawal symptoms.
In the past, the resulting suffering was considered a necessary part of rehabilitation.
It was the punishment for having the moral flaw of being an addict.
Today we understand that while detoxification is the necessary first step to recovery from drug addiction, there is no reason for the patient to suffer. In fact, allowing painful withdrawal decreases an addict's chances of recovery. To avoid withdrawal symptoms, today's doctors often give patients medication that makes them feel similar to being on the addictive drug and gradually reduce their dose over time. This stabilizes the person's brain long enough to get through the detoxification process. Examples of this type of treatment include methadone and LAAM for opiate withdrawal; nicotine replacement therapies (patch, gum) and bupropion for nicotine withdrawal; and benzodiazepine and anti-seizure drugs for barbiturate withdrawal.
"The idea that if we can detox [an addict], they're cured, is nonsense."
Dr. Glen Hanson
Counseling, support groups and other forms of therapy are crucial to preventing relapse.
In order to stay off drugs, addicts must learn new ways of thinking and behaving.
Cognitive and behavior therapy can include such things as learning to:
. talk openly about personal experiences
. manage problems without turning to drugs
. identify and correct problematic behavior
. identify and correct harmful patterns of thinking
. recognize drug cravings
. identify and manage high-risk situations
. establish motivation to change
. improve personal relationships
. develop refusal skills
. manage time more efficiently
Bupropion, the drug in the anti-depressants "Zyban" and "Wellbutrin", can also help people quit smoking. This drug inhibits the uptake of dopamine and is taken just before quitting to "prime" the brain and reduce withdrawal.
The brain changes that characterize addiction can persist long after an addict stops using. As a result, addicts can easily relapse, and often do. Using drugs to treat cravings and prevent relapse buys crucial time for behavioral and cognitive therapies to begin working.
The classic example of a maintenance-based drug treatment is methadone. Taken once a day, methadone suppresses heroin withdrawal for about 24 hours. Itself a narcotic, users of methadone experience a "high" and withdrawal symptoms, but both are much milder than those resulting from heroin. As a result, it is possible to maintain an addict on methadone without severe health effects. But patients often require continuous treatment, sometimes over many years.
Some politicians oppose the use of Methadone but research shows it saves lives.
Naltrexone alcohol and opiates
Blocks opiate receptors, preventing dopamine release. Because the addict no longer receives pleasure from the drug, cravings diminish.
5-10 minutes after drinking alcohol, the patient experiences severe nausea, vomiting and headache for 30 minutes to several hours. Fortunately, most people don't need to 'test' this to experience the deterrent effect of the drug.
Methadone and LAAM (Levo-alpha-acetylmethadol) opiates
Work on the same receptor as heroin, but with much more gradual "ups" and "downs" and longer-lasting effects. These drugs reduce cravings and block the effects of opiates.
Decreases the irritability characteristic of early recovery and decreases the pleasurable effects of alcohol. It most likely works by stabilizing the activity of the neurotransmitters GABA and glutamate in the brain.
A combination of two drugs that reduces craving and blocks the effects of opiates. Unlike methadone, it has mild withdrawal effects.
Treating addicts who end up in the criminal justice system adds another layer of complexity to the issue.
How should law enforcement deal with administering drug addiction treatment? Innovative approaches
such as drug court may prove to be the answer.
Drug courts deal with offenders charged with less-serious crimes such as possession or being under the influence of drugs. In lieu of serving a jail sentence, offenders must plead guilty to the charge, agree to take part in treatment, get regular drug tests, and report to the judge for at least one year. If they fail to complete any of the requirements they may be incarcerated. But if they complete the requirements, the charges against them are dropped and they graduate from the program.
Developing improved treatments for addiction is becoming easier thanks to the discovery of addiction susceptibility genes. Each new addiction gene identified becomes a potential 'drug target'. The more we understand about the mechanism of addiction, the more effectively we will be able to treat it. Learning how to reverse or stabilize signals or pathways in the brain may help us to restore proper brain function in drug addicts.
Researchers are working hard to find effective treatments for cocaine and amphetamine addiction. There are a few drugs in clinical trials, but none are approved for treatment.
Dr. Kelly Lundberg
How drug courts work and why they have been so successful.
Old drug treatment methods were a shotgun approach. Doctors were willing to try anything to get their patients
to kick the habit, even things that would seem pretty crazy today. For example, in the 1950s and 1960s drugs
like LSD were used experimentally in an attempt to treat alcoholism and other addictions.
The idea of using hallucinogenic drugs to treat drug addiction was abandoned as these drugs themselves became illegal. However, addiction treatment with hallucinogens is experiencing a renaissance with the increasing popularity of ibogaine therapy. Ibogaine is derived from a root used in an African religion to "visit the ancestors." Although illegal in the US, some 20 or 30 ibogaine clinics are in operation worldwide primarily to treat heroin addiction. Ibogaine is thought to rewire the addicted brain as the patient undergoes the intense multi-day treatment. Ibogaine is very controversial for many reasons including the occurrence of fatal heart arrhythmia in some patients.