Quote of the Week

"If I cannot do great things, I can do small things in a great way" ~ Martin Luther King, Jr.

Posted by:Max--Monday, July 11, 2011

In the last news article I shared with those of you who are PSST (enter in the search bar "It's The Dopamine, Stupid " to read), one of the top addiction researchers in the country (if not the world) shared undeniable evidence of why addiction needs to be classified as a disease, and sobriety treated in a way similar to a cancer patient in remission; with on going follow-up. It is the hope that the entire medical and legal community accept this evidance as fact, so it may positively affect courses of treatment, insurance coverage, and improve social attitudes in the community and the workplace. I was thrilled to read in this mornings' paper the following article. Medical schools are stepping up to the plate, having Addiction Medicine as an accredited specialty, in which a resident may train and practice. Addiction is a disease that must be managed over a lifetime, with on-going support similar to diabetes management. If only these people would come to a PSST meeting, we coulda told them!!

By Douglas Quenqua, The New York Times

There is an age-old debate over alcoholism: Is the problem in the sufferer's head -- something that can be overcome through willpower, spirituality or talk therapy, perhaps -- or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?

Increasingly, the medical establishment is putting its weight behind the latter diagnosis. In the latest evidence, 10 medical schools have just introduced the first accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.
"This is a first step toward bringing recognition, respectability and rigor to addiction medicine," said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pa., just north of Scranton.

The goal of the residency programs, which started July 1 with 20 students at the various schools, is to establish addiction medicine as a standard specialty along the lines of pediatrics, oncology or dermatology. The residents will treat patients with a range of addictions -- to alcohol, drugs, prescription medicines, nicotine and more -- and study the brain chemistry involved as well as the role of heredity.

"In the past, the specialty was very much targeted toward psychiatrists," said Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse. "It's a gap in our training program." She called the lack of substance-abuse education among general practitioners "a very serious problem."

Schools offering the one-year residency are St. Luke's-Roosevelt Hospital in New York City, the University of Maryland Medical System, the University at Buffalo School of Medicine, the University of Cincinnati College of Medicine, the University of Minnesota Medical School, the University of Florida College of Medicine, the John A. Burns School of Medicine at the University of Hawaii, the University of Wisconsin School of Medicine and Public Health, Marworth and Boston University Medical Center. Some, like Marworth, have been offering programs in addiction medicine for years, simply without accreditation.

The new accreditation comes courtesy of the American Board of Addiction Medicine, or ABAM, which was founded in 2007 to help promote the medical treatment of addiction. The group aims to get the program accredited by the Accreditation Council for Graduate Medical Education, a step that requires, among other things, establishing the program at a minimum of 20 schools. But it would mean that the addictions specialty would qualify as a "primary" residency, one that a newly minted doctor could take right out of school.

Richard Blondell, the chairman of the training committee at the ABAM, said the group expected to accredit an additional 10-15 schools this year.

The rethinking of addiction as a medical disease rather than a strictly psychological one began about 15 years ago, when researchers discovered through high-resonance imaging that drug addiction resulted in actual physical changes to the brain.

Armed with that understanding, "the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes," said Daniel Alford, who oversees the program at Boston University Medical Center.

Central to the understanding of addiction as a physical ailment is the belief that treatment must be continuing in order to avoid relapse. Just as no one expects a diabetes patient to be cured after six weeks of diet and insulin management, Dr. Alford said, it is unrealistic to expect most drug addicts to be cured after 28 days in a detoxification facility.

Increasing interest in addiction medicine is a handful of promising new pharmaceuticals, most notably buprenorphine (sold under names like Suboxone), which has proved to ease withdrawal symptoms in heroin addicts and subsequently block cravings, though it causes side effects of its own. Few addiction medicine specialists advocate a path to recovery that depends solely on pharmacology, however.

Equally maligned is the idea that psychiatry or 12-step programs are adequate for curing a disease with physical roots in the brain. Many people who abuse substances do not have psychiatric problems, Dr. Alford noted, adding, "I think there's absolutely a role for addiction psychiatrists."

Read more: http://www.post-gazette.com/pg/11192/1159630-115-2.stm#ixzz1Rnla8Kst


Wilma said...

Thanks for this great article.
All I can say is "Halleluiah"


Anonymous said...

I have always found it amazing when I hear people say things regarding the addict "well, they were in rehab for 5 days". Why don't the insurance companies get on the ball, too, and realize you can't 'fix' anything in 5 days. Heck--even God couldn't do that!


Joy said...

dopamine and serotinin are common issues in obesity (if not metabolic is really food addiction)and underlies both ADHD and depression. Not surprising a huge number of kids (and adults) with ADHD self medicate with drugs and alcohol. ADHD meds, including the non-stimulant varieties such as Strattera (atomoxetine) and stimulant varieties such as Ritalin target Dopamine (by different mechanisms) - some on the receptors, others on the breakdown of the synaptic Dopamine. This is a well established fact to those that have worked in ADHD research within the psychiatric community.


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