There do not seem to be any great statistics on the prevalence of addiction; however, there is quite a bit of information on the number of people using alcohol and other drugs. The National Survey on Drug Use and Health in 2010 reports that approximately 8.9% of people over the age of 12 use illicit drugs (defined as illegal drugs or nonmedical use of prescription drugs). Only about 3.1% of the population who use illicit drugs feel the need for treatment, although the majority of these people do not actually seek treatment for a variety of reasons including not feeling ready to stop and not having access to treatment programs. Accessibility can be difficult because most treatment options are very expensive. Insurance companies are beginning to include coverage for expensive stays at alcohol and drug treatment centers. (In this article, the term addiction and addict includes alcoholism and alcoholic, respectively.) Some facilities have funding for people who are indigent at the state or county level, but need for treatment far surpasses the funds budgeted. Looking at the biology of addiction, it is clear that treatment of some kind is required to get the disease under control. For any treatment to be effective, however, the addict must decide they are ready to stop using the drug. This can be a difficult decision because addiction is strongly tied to identity. Aside from the biological aspects, battling addiction is a long process that requires a lot of effort, usually a complete redesign of the addict’s lifestyle, and intense counseling to uncover issues that led to and resulted from the addiction.
Once a person is ready to stop using, inpatient or intensive outpatient treatment is often required. Depending on the length and intensity of use, medical supervision (often referred to as detox) can be required for alcohol, heroin, and some prescription painkiller addictions because withdrawal can cause seizures and hallucinations. Withdrawal from any drug can cause severe mood swings and depression and intense cravings. Inpatient treatment can often help an addict by keeping them away from people and places associated with their use. Once withdrawal has subsided, an effective treatment program will include outpatient counseling both one-on-one and in a group setting.
Arguably, the most well-known outpatient option is the 12 step program such as AA or NA. The 12 step format was developed in the 1930s and is based on the idea that only a spiritual awakening can free one from the power of addiction. While the 12 steps are rooted in the Christian religion, groups and philosophies have been adapted to incorporate any concept of a higher power. In these circles, addiction is viewed as a disease for which there is no cure, and even those who have been drug-free for significant amounts of time define themselves as “recovering addicts” as the 12 step program is important for life-long sobriety. 12 step programs hold meetings several times per week, are self-sustaining, and run by recovering addicts. The 12 step approach and variations on the theme are also used widely by addiction counselors in both inpatient and intensive outpatient treatment facilities.
There are currently no widely effective pharmacotherapy options for long term recovery from addiction. For alcoholism, a drug called Antabuse or disulfram can be administered in pill form that causes severe physical reaction, such as vomiting and dizziness, if alcohol is consumed. Antabuse does not reduce cravings or treat withdrawal symptoms. If a person really wants to drink, they can simply stop taking the medication. For heroin and other opioid dependence, a synthetic opioid called methadone can be used to manage symptoms. High doses can block the effects of morphine or heroin and lower doses can help with withdrawal symptoms and cravings. Proper dosing can be quite effective in managing this type of addiction. Because methadone provides some physiological effects similar to other opiates, patients can become dependent. Without proper counseling, methadone patients can be prone to relapse.
Two very promising approaches to cocaine addiction were published this year. A paper published in January 2012 in Biological Psychiatry tested delivery of an enzyme [butyrylcholinesterase (BChE)] involved in cocaine metabolism using a viral vector. Following a single injection, rats did not engage in cocaine-seeking behavior even when they were primed with cocaine injections! In May, a paper published in Human Gene Therapy reported a potential vaccine for cocaine addiction. These researchers also used a viral gene transfer delivery of an anti-cocaine antibody that appears to bind the drug in the blood stream to prevent it from crossing the blood-brain barrier.
While there is currently no cure for addiction, treatment options can be effective once the addict is ready. Treatment is even more effective when the addict has a strong support system. As society becomes more accepting of the idea that addiction is a disease and not simply a reflection of poor morals, families and friends of addicts may find it easier to remain supportive of their loved one without enabling the addiction. This is no easy task. Since addiction can take a major toll, counseling and 12 step programs are also available and highly recommended for friends and families.
Karen Reece
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