Addiction Treatments Past and Present
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.
Suddenly stopping use of some drugs can cause painful withdrawal symptoms. In the past, suffering through withdrawal 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, there is no reason for the patient to suffer. In fact, allowing painful withdrawal decreases an addict's chances of recovery. To prevent withdrawal symptoms, patients can take medication that makes them feel similar to being on the addictive drug, and then gradually reduce the dose over time. This regimen stabilizes the patient'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.
Behavioral and Cognitive Therapy
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 problem 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
The Controversy of Maintenance and Medication
When we use medication or maintenance to treat drug addiction are we just replacing one drug with another? Does the addict simply become addicted to a legal drug? No. With pharmaceutical substance-abuse treatment, the user can begin to function normally again and stop the cravings. Using drugs to treat cravings and prevent relapse buys crucial time for behavioral and cognitive therapies to begin working.
Maintenance programs are controversial because the treatments are drugs that often have potent, intoxicating effects, and because patients often require continuous treatment, sometimes over many years. The classic example of a maintenance-based drug treatment is methadone, taken once a day to suppress heroin withdrawal.
Below are several drugs that are routinely used to treat addiction:
Naltrexone - alcohol and opiates
Naltrexone blocks opiate receptors, preventing dopamine release. Because the addict no longer receives pleasure from the drug, cravings diminish.
Disulfiram - alcohol
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 experience these symptoms to benefit from the deterrent effect of the drug.
Methadone and LAAM (Levo-alpha-acetylmethadol) - opiates
These drugs 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.
Acamprosate - alcohol
This drug 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.
Buprenorphine/naloxone - opiates
A combination of two drugs reduces craving and blocks the effects of opiates. Unlike methadone, it has mild withdrawal effects.
The Challenge of Treating Addiction in Prison
Treating addicts who end up in the criminal justice system adds a layer of complexity to the addiction problem. 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. Instead 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.
Psychedelic Addiction Therapy?
In the past, doctors used a shotgun approach to treating drug addiction. They 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 the 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.