mortiz095

I've written about treating addiction in its chronic or recurrent form much like we treat other chronic illnesses. Arguably the most painful part of doing so is accepting the limitations of our current treatments. It does not diminish the progress we have made to acknowledge that our current treatments are far from ideal. They fail too many people. (Yes, fellow treatment providers, treatment does fail people, we can't keep blaming our patients for not responding.) Addiction has a significant mortality rate. Cigarette smoking alone kills close to half a million Americans a year, and hundreds of millions globally. Alcohol addiction kills 85,000, and other addictions perhaps another 10,000. It is hard to live with this, to work so hard with people only to see them struggle in spite of everyone's efforts. But as time goes on, and as I've done more clinical work again, I'm finding that mental illness is at least as hard if not harder to treat. Depression and anxiety are ...

I once heard George McGovern speak at a meeting of addiction psychiatrists. He spoke so movingly of the futility of efforts to save his daughter from alcohol dependence. Tragically, she froze to death in a snowbank. As a father of now adult sons, I can imagine but not really understand how painful this must have been. His daughter took advantage of all available treatments. Many, many attempts at rehab. "Worked the program." All to no avail. The disease killed her. This is the reality that people avoid at all costs. Addiction kills people. And they cannot help it. And neither can we, not yet. I've dedicated my career to developing ways to help people with severe addictions, people who often have other severe chronic illnesses. People on whom everyone else has given up , especially rehab programs and counselors, doctors and social service agencies. And yet, inevitably, if I talk about the limitations of current treatments, someone will accuse me of "giving up on them....

A comment from a Twitter follower (@AddictionDrW) asserted that studies supporting the effectiveness of opioid maintenance therapy for opioid addiction must have been funded or supported in some way by "Big Pharma" and therefore cannot be trusted. He rejected all the research, saying that we should be listening to recovering addicts instead, or that "evidence is mixed." Is that true? Methadone was invented in Germany as an analgesic during WWII. The first study of methadone maintenance, by Vincent Dole, Marie Nisswander and then-resident Mary Jeanne Kreek, was funded not by Big Pharma (who wanted nothing to do with "junkies"), but by the Health Research Council of New York City, due to the failure of abstinence-based approaches in the face of a growing heroin problem (Joseph et al., 2000). To my knowledge, it's never been a significant money maker for a large pharmaceutical company. Subsequent studies have for the most part been funded by government or...

I've recently been having a conversation with a colleague about implications of recent neuroscience research and free will (and therefore blameworthiness, or responsibility for our actions.)  Thought you might be interested. My colleague is Steven P. Gilbert, Ph.D., ABPP, LP. He is married to Anne Fletcher, who recently published a wonderful new book (more on that in a later post) called "Inside Rehab." If you haven't read it, you'll want to. There's nothing else like it on the planet. MW Mark, Anne sent me your blog below about the frustrations of appealing to reason in argumentation.  I thought you might be interested in both the column I've included below entitled "Reasons Matter (When Intutitions Don't Object)" and the attached PDF, both by psychologist Jonathan Haidt. I think Haidt's work is brilliant.  He demonstrates how evolutionary-based instincts shape our morality and thus our politics (see also  How Evolution Has Turned Us Int...

Yesterday, I was one of three experts participating in a new Huffington Post initiative called HuffPost Live . This one was on medications for SUDs, and it can be viewed here . What caught the attention of the producer of HuffPost Live was the Salon.com article , which was picked up from TheFix.com (thanks again to Sacha Scoblic , the author of the article.)  It was an interesting interchange. I got pretty incensed when one of the "experts," Justin Hewitt, who runs a sober living facility in Los Angeles, said that the evidence about the effectiveness of maintenance treatment for opioid addiction was mixed, that there was evidence on both sides. I don't think I handled it especially well from a communications standpoint, since the moderator then ignored me and went on to ask about his personal "story" about recovery from addiction. I also re-learned that talking about studies seems to put people to sleep, but anecdotes carry real power (see: election, President...

I'll be one of three guests on a Huffington Post Live segment on anti-relapse medications in the treatment of addiction. Tune in at 8:20 PM Eastern/5:20 PM Pacific! MW

Most people realize that the current system of care, developed in 1950 and based on the Big Book of Alcoholics Anonymous (AA), is not meeting the needs of patients, families, employers, the criminal justice system, or society at large. There is tremendous waste in providing the same series of lectures, group sessions, films and AA to people over and over again, thinking that someday it will "take." As a physician, that seems similar to treating one of the new "superbugs" with penicillin over and over, thinking that perhaps "this time" it will work. Even worse, in addiction treatment we blame the patient for not responding. At least the poor patient with treatment-resistant infection doesn't have to endure that: being blamed for not responding to available treatments. The good news is this: people who suffer from addictions, their families and friends, employers, payers, and health care systems are not only ready for change, they are desperate for a new...

Today, I've been working on the business plan for Alltyr. I've also had to complete some documentation of patient visits this past week. It's been a good week for science-based treatment of addictions! Sacha Scoblick wrote a great interview with me on The Fix, which was picked up by Salon.com. Her posting generated a significant increase to this blog, as well as emails from suffering addicts who need help. I appreciate the interest. It is interesting that basing addiction treatment on scientific evidence is controversial. This occurs in other areas of medicine, for example: is it good to take statins for primary prevention of heart attacks? or should I get a mammogram? or should I get a PSA test for prostate cancer? Science is constantly evolving. The most disconcerting aspect to science is that it doesn't care about tradition, values, opinions, or perspectives. It says what it says. I admit that too often, scientists, the media, industry and/or advocacy groups exagge...

Several of my patients had recurrences of their addictions this week. Each one of them struggled mightily with feelings of shame and guilt. "Why do I keep doing this? I'm a smart person, I know what's going to happen. And I was doing so well!" My response in each case was different of course, and depended upon that particular person's situation, disorders, severity, past history, and so on. But here are some common things I do pretty much every time: 1. Stopping suddenly and permanently is a rare outcome, with or without treatment or rehab or AA. In one study that followed people with alcohol dependence for 10 years following an episode of treatment the proportion of people remaining continuously abstinent for the entire period was 8%. So the norm is to struggle with recurrences. 2. Most people take several years of persistent effort to finally establish long-term remission, on average 5-10 years. The most important thing is to keep working at it. 3. I've begu...

I appreciate the two comments on my last blog, and they prompt a couple of responses from me. (If you didn't read them, click on the "Comments" link at the bottom of the blog.) First, I'd like to clarify something in response to Dr. Dawson's comments. I was not arguing that people who are living in a sober structured environment do not need programming, or do not benefit from it. What I am saying is that there is no such thing as "residential or inpatient treatment." That is, studies have shown that staying overnight in the same place while receiving treatment has no outcome advantages over going home or to some other place, like a sober residence. So, there is treatment, and there is housing structure. Just like addiction psychotherapy, addiction pharmacotherapy, vocational counseling, psychiatric treatment, treatment for conditions below the neck (CBTN) (often but erroneously called "physical or medical" as opposed to "psychiatric,"...