Another Insight into Addiction

Dan Umanoff, M.D.

National Association for the Advancement and Advocacy of Addicts, Inc.

Re: Another Insight into Addiction, http://time-blog.com/eye_on_science/2007/11/another_insight_into_addiction.html#comments

At the end of your blog you say: Here's a link to a really useful book on addiction. This little book, "Drugs, Brains, and Behavior - The Science of Addiction," written by NIDA (and I assume OK'd by Volkow) is 90% wrong factually and 100% wrong conceptually. I'd be happy to go through this book with you sentence by sentence to demonstrate this to you. It's the same old hijacked brain hypothesis (HBH), the plasticity theory, a theory of addiction causation that has been proven wrong. Read: Genetic susceptibility to substance dependence, Molecular Psychiatry (2005) 10, 336–344, by N Hiroi and S Agatsuma. You could also read my article on this at: http://www.nvo.com/hypoism/hypoismhypothesis/ Of course, plasticity does occur in those who become addicted but it isn't the cause of addiction. The drug doesn't cause the addiction as this book and its theory states, an underlying genetic disease does, an issue not even discussed in this book. The addiction is not the disease. The underlying genetic difference between those who get addicted and those who don't is the disease. Again, this disease is not even mentioned in this book. I've written about this to you in the past but you weren't interested. It may be that others will be.

The implications of all this NIDA misinformation about addictions spread by this book and now by your blog is the maintanence of the addiction epidemic, which is evident since Leshner invented the HBH theory in 1997, and the suffering and deaths of millions of addicts and their families. Until the country is allowed to know about the reality of addiction causation and where addictions come from and stop NIDA's monopoly on addiction information this will continue inexorably. Remember, Volkow as chief of NIDA is a political appointment, not one earned by success in preventing and treating addictions with a proven theory. She has none. I've been writing about this kind of misinformation in the field of addictions since 1992.

"Love is an action not a feeling.
Integrity is an action not a thought.
Anything less is too little." ---
Dan F. Umanoff, M.D.
Author of Hypoic's Handbook - The Hypoism Paradigm of Addiction.
http://www.hypoism.com
President and founder of The National Association for the Advancement and Advocacy of Addicts, Inc. (N4A), a not-for-profit 501 (c) (3) organization of addicts for addicts offering free educational and legal services to discriminated against and abused addicts of all varieties, "substances" and "behavioral," and their families.
http://www.nvo.com/hypoism/thenationalassociationfortheadvancementandadvocacyofaddicts/
8779 Misty Creek Dr.
Sarasota, FL 34241
941-929-0893

--I'm quite sure you'd be happy to go through the book and point out where you "know" it's wrong, Dan. I'm sure you'd be ecstatic. But we both know it ain't gonna happen, don't we?
M.L.

Dear Sir,

Spiritual research indicates that 96% of the causes of addictions are due to ghosts (demons, devils, negative energies, etc.) or departed ancestors. The seeds of addictions are introduced in the womb itself by ghosts. Due to the spiritual nature of the cause of addictions, only spiritual remedies can successfully alleviate addiction. A 3-step spiritual treatment program has been suggested that will ensure minimal withdrawal symptoms.

I am writing on behalf of Spiritual Science Research Foundation, Inc . We are a non-profit organization conducting Spiritual research. We have conducted and continue to conduct research into different aspects of spirituality one of which is addiction.

http://www.spiritualresearchfoundation.org/spiritualresearch/mentalhealth/addiction/

I would be glad if you could go through the details and am sure you will find the data intresting.

Thaking you,
Dr. Anjesh Kanaglekar
For www.spiritualresearchfoundation.org

Dear Sir,

Spiritual research indicates that 96% of the causes of addictions are due to ghosts (demons, devils, negative energies, etc.) or departed ancestors. The seeds of addictions are introduced in the womb itself by ghosts. Due to the spiritual nature of the cause of addictions, only spiritual remedies can successfully alleviate addiction. A 3-step spiritual treatment program has been suggested that will ensure minimal withdrawal symptoms.

I am writing on behalf of Spiritual Science Research Foundation, Inc . We are a non-profit organization conducting Spiritual research. We have conducted and continue to conduct research into different aspects of spirituality one of which is addiction.

http://www.spiritualresearchfoundation.org/spiritualresearch/mentalhealth/addiction/

I would be glad if you could go through the details and am sure you will find the data intresting.

Thaking you,
Dr. Anjesh Kanaglekar
For www.spiritualresearchfoundation.org

Dr. Anjesh,

So, if I understand you, what you're saying is that Spiritual research indicates that 96% of the causes of addictions are due to ghosts (demons, devils, negative energies, etc.) or departed ancestors; The seeds of addictions are introduced in the womb itself by ghosts; Due to the spiritual nature of the cause of addictions, only spiritual remedies can successfully alleviate addiction;, and a 3-step spiritual treatment program has been suggested that will ensure minimal withdrawal symptoms. Do have that right?

-BPL

I'm just waiting for the bad joke about whether ghosts funded the research. I guess I'll have to make it. ;)

Interesting blog post though. I have several friends who are 'recovered' alcoholics and I think they will find this new study interesting. I shall pass along the information. :)

M.L.: Of course it's going to happen. I said I'd be happy to go through the NIDA book with you sentence by sentence, not write it in this blog. I already wrote the paper and book that critiques the hijacked brain hypothesis. You can read them on my web site. These are referred to in my first comment. You can compare them with the NIDA book. I'm not about to re-write a whole book in this little box. Call me. My number's in my first comment. We can do it together as time allows you. I have all the time in the world.

--You're a funny guy, Dan.
M.L.

A reply to Anjesh,
You state the following:
"Spiritual research indicates that 96% of the causes of addictions are due to ghosts (demons, devils, negative energies, etc.) or departed ancestors."
Please explain spiritual research, and also provide us with the evidence you have, not onlu of your assumptions here, but also that ghosts even exist at all.
Isnt this a science blog anyhow?

"The ghosts implant the seeds of addiction right in the womb" If the researches come out with such bizarre findings then probably we look forward to ghosts fighting elections and one day some formidable ghost assuming the office of US President!A fine piece of imagination by Anjesh.The guy should have been the director of some ghost thriller taking place in some old dilapidated "dak bungala" in India.He has strayed into a wrong blog of ML who is a leading scientist and he certainly does not believe in ghosts.

Nandlal K Pancholi
(Senior English Teacher)
L K Singhania Senior Secondary School
Gotan,Dist. Nagaur,(Raj),India

I believe ML is actually a journalist, though he seems to know a great deal about several sciences.

--You believe? You mean after all this time you don't know?
M.L.

Can any of us truly know anything? oooo, provocative . . .

This study is pretty interesting, but I fear findings like this could provoke a "blame the addict" reaction, assuming that the addicts will play the "blame the neurochemicals" game (their second favorite game).

People need to learn that you can blame multiple causes for the same problem. The self-control crowd will argue that people don't need medication, just discipline. Unless they're heroine addicts, in which case quitting cold-turkey could kill them. But if medication will help an alcoholic stop neglecting their family faster, I say pill them up.

Sorry, ML, I will try to be more definite in the future. Everybody, Michael Lemonick is science editor for Time Magazine (see the top of the web page), and the author of several popular books on astronomy and physics subjects. I don't know if he has a science degree or not; I suspect, but don't know, that his degree is in journalism. But he can clarify that.

--Much better, thanks! My graduate degree is in journalism, my undergrad degree in economics. No formal science training. For a two-part interview with me that explains my background in some detail, see

http://kenyonreview.org/blog/?p=206
and
http://kenyonreview.org/blog/?p=207

M.L.

Sir,

Thankyou for the article, Having been a former addict myself I have found this yet another useful article on the topic.

Cheers

"As Volkow told TIME back in July: "Addiction is a medical condition. We have to recognize that medications can reverse the pathology of the disease.""

Addiction is not something that can be prevented by taking a pill, nor is it simply the result of dopamine saturation. If it was, why is it that some are much more susceptable to addiction than others? Why can addiction be traced through the family tree? Billions of people can have a drink and not become addicted. There are genetic vulnerabilities involved in the equation; its not just alcohol.

When you think about addiction, you have to recognize there are two types: physical addictions and mental addictions. Heroin and cocaine are physically addictive, alcohol is not. Physical addiction will happen in anybody, regardless of their genetic differences, but some people are more susceptable to mental addicitons--i.e. the risk/reward center places a greater emphesis on reward. The average person can have 1 drink and put it down, can eat one hotdog and not another, can play World of Warcraft for 2 hours and not any longer. The addict can not. One is never enough and because of genetic and behavorial factors, it is much much harder to say enough, regardless of the activity.

It's great that this study showed why addicts don't get as much pleasure from other activities, but we already knew that. We need to know more about that critical point and the mechanisms involved when the addict makes the choice of "just one more" more than once, and why/how this is passed on from generation to generation.

--Probably by genes, don't you think? At least in part? Which would explain why, even though we all have dopamine systems, some are more easily disrupted than others. Also, if you make the assertion that "we need to know more about the...mechanisms," it kind of takes the wind out of your assertion that addiction can't be prevented by a pill. If we understand the biochemical pathways that are involved, how are you so sure we can't create a pill that interrupts them?
M.L.

Of course its genes, hence the genetic vulnerability, or predisposition to addiction, and when it comes to pills that modify the chemisty of our brains, we already have those. Addiction is much like depression--depression also has genetic components, is heretable, and can be explained (so far) through chemical mechanisms. We have pills that modify the brain chemistry thought to be responsible for depression even though we still aren't exactly sure how it works. Now we have doctors that treat mental health by the bottle without advocating therapy, even though medication should only be used as a last resort, and ONLY for the short term. The patients want the quick fix, and the doctors want pharma's money. You can artificially modify the chemicals of the brain and shift someones personality out of depression, but it doesn't "fix" anything; it's a patch. I have no doubt that eventually someone will create a pill to do the same thing for addiction, but its like giving someone crutches for a broken leg and declaring him healed.

I cringe every time I hear about research being conducted with the end goal of developing more medication. Most addiction treatment centers use the disease model, which gives people the false impression that it can be "cured" with a pill, and that was my point.

--It only gives that false impression if people fail to make it clear that it's not likely to work that way. But I'm curious: when did you decide, and with what authority, that "medication should only be used as a last resort, and ONLY for the short term." I'm curious about your absolute certainty here.
M.L.

"It only gives that false impression if people fail to make it clear that it's not likely to work that way."

And people fail to make it clear all the time. Drugs treating mental conditions (and addiction is a mental condition) are over-used by the public. Why is this? Certainly its not because the drugs are freely available. No, its most likely because doctors are over-prescribing them. My father has depression, his father was an alcoholic, his mother has depression, and both me and my younger brother have inherited some of it. I've been through the treatment circles, so I know what its like. My Aunt is a psychotherapist and four of my other aunts and uncles are doctors. I'm not an M.D. (I'm actually an engineer), but I have about as much authority on the subject as you do.

There are two competing circles of thought in the therapy arena (perhaps you could do a story on it)--treating mental conditions primarily through medication, and treating mental conditions primarily through therapy. The problem with the first idea is that medications are prescribed even for mild cases and it gives people a false sense of security. They begin to rely on the pill and use it as a crutch, but the pill can only change the brain chemistry for as long as you continue to use it, and, as soon as the pill goes away, any kind of improvement vanishes as well. My Aunt will tell you that there's a lot of money floating around in the pharma circles, and when the drug reps come to town in their Mercedes and BMWs and Audis, theres lots of money spent on steak dinners with psychologists.

The best method of treating mental conditions is through therapy combined with medication, not medication combined with therapy. Not all medical schools or psychology/psychiatry programs teach this way, and its shifting more and more towards medication with therapy (partly because insurance companies have been slow to cover therapy and therapy takes more work than medication).

When I went in to see a counselor during a mild episode of depression, her first question was if I wanted to take medication. I refused. I thought I didn't need it, and I didn't. It's a shame that she asked me without evaluating whether I needed it. The simple fact is that, in most cases, anything medication can do (for mental conditions), therapy can do better and with more lasting results. It's analogous to excercise for physical health. However, there are a few cases, just as for physical health, where medication becomes necessary, but only for the short term until the patient can enter therapy successfully. Medication shouldn't be used long term. Your cover story on addiction had great statistics saying those who stayed addiction free and with fewer relapses where those who stuck with the therapy. Medication should be used only as a means to enable therapy, or enhance it, not take its place.

--You keep making these statements ("The best method of treating mental conditions is...") as though they're proven facts rather than your own personal conclusions. If you have studies or other actual evidence to support this, please cite them. If it's just that you've figured this out based on your own experience, or based on what your Aunt told you, don't expect me to take you seriously even for a moment.
--M.L.

Well, I've tried posting some studies for you. Check your spam filter.

Nathan posts:

[[There are two competing circles of thought in the therapy arena (perhaps you could do a story on it)--treating mental conditions primarily through medication, and treating mental conditions primarily through therapy.]]

Medication in medicine has had many failures, but it can't possibly have had as many failures as therapy has had. The main reason more doctors are using medication to treat psychiatric conditions is because therapy has such a miserable record at achieving any gains at all. Recall the famous study that said outcomes were just as good with not treating the condition at all as with treating them by psychotherapy.

--As I said before, the consensus is that medication plus therapy is more effective than either one alone. I'm sure Nathan can come up with some specific studies that argue against long-term medication, but that's some, not the preponderance. He's also right that psychiatric drugs are sometimes over-prescribed. "Sometimes" being the operative word.
M.L.

"Recall the famous study that said outcomes were just as good with not treating the condition at all as with treating them by psychotherapy."

And what study is this? I'm assuming they tested therapy against a placebo, and its been established for a long time that therapy (and ADM's for that matter) are much more effective than a placebo.

This cites two studies, one by the NIMH and another by a well respected CBT practitioner. Unfortunately, its posted by the New Jersey Association of Cognitive Behavioral Therapists, so you might object to its objectivity. However, some conclusions:

"After their first sixteen sessions, the CBT group received up to three booster sessions, while half of the ADM group continued on medication and the other half was switched to a placebo. One year later, 39% of the CBT group remained below 13 on the HRSD, compared with 30% of the ADM group and 16% of the group that was switched from ADM to placebo."

"Four months of CBT is more effective than 16 months of drug therapy."

"In real life, many patients are treated with CBT (cognitive behavioral therapy) plus ADM (anti-depressive medication) over months or even years, and it is pretty well established that during the usual four months of research treatment, CBT, ADM, and CBT plus ADM do about equally well. It is also well established that after treatment, ADM-only patients revert to their pre-medication levels of depression, while psychotherapy patients maintain their gains."

"As I said before, the consensus is that medication plus therapy is more effective than either one alone. I'm sure Nathan can come up with some specific studies that argue against long-term medication, but that's some, not the preponderance. He's also right that psychiatric drugs are sometimes over-prescribed. "Sometimes" being the operative word."

If there is a consensus, its shaky. And how do you define sometimes? Is it a minority of the time? A majority? I don't know of any surveys or studies on the over or under use of psychiatric drugs, but my own experience tells me that its significant enough to be more than just sometimes and a concern for the direction of mental health treatment in this country.

You can look at the APA guidelines for treating depression, and many studies support that combination treatment has better results than just drug treatment, and CBT treatment after drug treatment significantly reduces the risk of a relapse.

A systematic review of 16 trials entitled "Combined Pharmacotherapy and Psychological Treatment for Depression" found that "Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment". The simple fact of the matter is that people eventually stop taking the drug when they feel better, and without supportive or continuing therapy, they will not have learned any behavioral skills to help mitigate the risk of another relapse, also supported by this study. At this point, they either keep taking the drug, or risk relapsing after stopping the drug, which is the very definition of a crutch. With therapy, you also dont have to worry about adverse affects like liver failure.

Also, keep in mind that most of these trials study medium to major depression illness. Minor depression is rarely studied, and in my experience, many doctors prescribe medication for minor depression when a simple visit to a counselor or some behavioral changes can alleviate the problem for the long term.

Depression should not be treated by pharmacotherapy alone, and I dont see how this is any different than addiction.

--It isn't. But then, nobody said addiction should be treated, now or in the future, by pharmacotherapy alone. So that kind of suggests you've been wasting a lot of time on a strawman argument.
M.L.

"As I said before, the consensus is that medication plus therapy is more effective than either one alone. I'm sure Nathan can come up with some specific studies that argue against long-term medication, but that's some, not the preponderance. He's also right that psychiatric drugs are sometimes over-prescribed. "Sometimes" being the operative word."

If there is a consensus, its shaky. And how do you define sometimes? Is it a minority of the time? A majority? I don't know of any surveys or studies on the over or under use of psychiatric drugs, but my own experience tells me that its significant enough to be more than just sometimes and a concern for the direction of mental health treatment.

You can look at the APA guidelines for treating depression, and many studies support that combination treatment has better results than just drug treatment, and CBT treatment after drug treatment significantly reduces the risk of a relapse.

Please excuse the multiple posts, it's the only way I could get these links past the spam filter.

A systematic review of 16 trials entitled "Combined Pharmacotherapy and Psychological Treatment for Depression" found that "Psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment". The simple fact of the matter is that people eventually stop taking the drug when they feel better, and without supportive or continuing therapy, they will not have learned any behavioral skills to help mitigate the risk of another relapse, also supported by this study. At this point, they either keep taking the drug, or risk relapsing after stopping the drug, which is the very definition of a crutch. With therapy, you also dont have to worry about adverse affects like liver failure.

Also, keep in mind that most of these trials study medium to major depression illness. Minor depression is rarely studied, and in my experience, many doctors prescribe medication for minor depression when a simple visit to a counselor or some behavioral changes can alleviate the problem for the long term.

Depression should not be treated by pharmacotherapy alone, and I dont see how this is any different than addiction.

"But then, nobody said addiction should be treated, now or in the future, by pharmacotherapy alone."

Oh really? Then what is this:

"Addiction is a medical condition. We have to recognize that medications can reverse the pathology of the disease."

"This [is] one more step towards that crucial goal."

I guess you didn't understand my original argument. My argument is, and has been throughout all my posts, that statements like these in addition to the disparity of money and effort being spent on developing new drugs versus enhancing the efficacy of therapy and extending its availability to those most in need of it and the propensity of doctors to over-use psychiatric medicines shows otherwise, and, in my opinion, is not the right message to be sending to those suffering from addiction. There are those who advocate the correct approach of therapy combined with medication, but most people just hear one thing: "I can take a pill and be cured."

--You're entitled to your opinion. You may even know what "most people just hear." Or maybe you don't. I'm persuaded by people who actually know a great deal about this at the basic research level that medications that counteract some of the chemical imbalances involved in addiction could be extraordinarily helpful. Not a cure-all, not magic, but extraordinarily helpful.

You may know just as much as they do. But I kind of doubt it.
M.L.

Whoa dude. Enough with the ad hominem. And if I understand you correctly, you are only persuaded by people who hold the same opinion as you? That isn't very rational.

--You don't understand me correctly. I hold the opinion I do because I have been persuaded.
M.L.

There is danger in placing more emphasis on pharmacotherapy than personal therapy, in spending more money on medicines and medicinal research than therapists, on insurance covering drug treatments but not counseling, and you don't need a PhD in pharmacology to discuss it.

--But you need something more than your own strong feelingsto make such definitive statments as you do. Or to have them taken seriously, anyway.
M.L.

You may think it's ok for the system to work this way, but in my opinion, it should be the other way around.

--You may think it's OK to attack strawmen, but I don't.
M.L.

Don't get me wrong. Medicines can be extremely helpful, but there is a fundamental difference between Penicillin and Prozac. Our knowledge of how brain chemicals affect our moods is limited, and I know you know this. The data is empirical and based on causality. Long term studies (over a decade or more) aren't feasible or haven't been completed yet.

--And yet you're positive that medications should only be used in the short term. Hmm...
M.L.

I'm not comfortable taking medications that alter my brain chemistry without fully understanding the mechanisms behind them or the long term health effects.

--Which suggests that if you need major surgery, you'll do it without general anesthesia. Good luck with that.
M.L.

It's like radiation effects on humans. We know so very little about how radiation alters biological systems. There isn't much data on long term low dosage rates so we collect data on exposures at high levels and then project that data into lower levels without an understanding of how it works. Or we set a limit at the highest dose at which symptoms seem to appear. But then as we learn more, we keep lowering that dose. Now, the science says theres no such thing as an acceptable dose.

--So no X-rays for you either. Gotcha.
M.L.

At some point we just have to say "We don't know enough. Keep dosage at an absolute minimum". Its the same with psychiatric medicines.

And in the interests of conserving time, you may have the last word. It is your blog after all.

--That's very generous of you.
M.L.

Haha.

"--You may think it's OK to attack strawmen, but I don't."

Right. Since neither this

"--Which suggests that if you need major surgery, you'll do it without general anesthesia. Good luck with that."

nor this

"--So no X-rays for you either. Gotcha."

are strawmen.

You're a funny guy, M.L.

--Thanks, Jimmy. You picked up on the fact that I was obviously being facetious, rather than seriously critiquing a position Nathan actually held. Some people might not have gotten that.
M.L.

Nathan posts:

[["Recall the famous study that said outcomes were just as good with not treating the condition at all as with treating them by psychotherapy."

And what study is this? ]]

Eysenck, Hans 1952. "The Effects of Psychotherapy: An Evaluation." Journal of Consulting Psychology, 16, 319-324.

I heard about that study in Psychology 101 at Pitt. It's hard to believe someone active in the field and familiar with the literature wouldn't know it. It's like Sagan's 1960 paper on the Venus greenhouse effect in planetary astronomy, or Manabe and Wetherald's paper on radiative-convective models in climatology. Even if later studies didn't uphold its findings, someone familiar with the field would still know that paper.

--Unlike atmospheric physics, however, which was a pretty well established field in 1960, psychopharmacology was utterly primitive in 1952 compared with today. So while a historian of the field would probably know of this paper, it's pretty much irrelevant to any modern discussion, wouldn't you say?
M .L.

M.L. was being pretty snarky towards Nathan. Their constant arguing back and forth is more entertaining than anything that I would ever want to learn about addiction. They need to keep on arguing because I get a dopamine rush when I read their witty banter.

--Glad to amuse you, Yag. Here's more good news: any time someone comes in saying "the experts are wrong, here's the absolute truth and by the way I have no actual credentials" you'll be seeing more snark. People who present an alternative viewpoint in a less dismissive and less absolute way get a different treatment.
M.L.

Well Yadgyu, I'm happy to oblige.

Depending on which, and how many, experts you've talked to, M.L., you may not be accurately representing the scientific consensus, if it's even a consensus at all. Most studies focus on short term improvement over the course of a few months. There is scant data on long term drug use. Sure, drugs can help, but do you have to keep taking the drug for the rest of your life? Even the APA guidelines state the question on long term drug use versus therapy is not closed, but you insist it is. Where are your "credentials" for this absolute?

--Since I have never presented this so-called "absolute," the premise of your question is bogus--another of your patented strawmen. What's with that, anyway?
M.L.

To quote you directly, "I was obviously being facetious". Your "absolute" is no more of an "absolute" than mine.

You labeled me as one who challenges the consensus and then presents his own ideas as absolute truth without any data or credentials to back it up. For that characterization to be accurate, I have to actually be 1) challenging a consensus, and 2) presenting my ideas as absolute truth. I have done neither.

I am challenging treatment methods that are far from a consensus. Like I said before, there are two competing mainstream ideas, and I happen to hold an opinion that one is better than the other. You asked me to cite evidence, and I did.

--Was that the study from 1952?
M.L.

You are confusing generalization with absolute certainty. We are discussing general practice and it isn't practical to preface every statement with "generally..." or "in most cases..." or "in my opinion...".

--I think you're the one who's confused. The statement "A is good, B is bad," is not a generalization, it's an assertion, and if there's even a hit of doubt in it, you've hidden it very well.

Obviously treatment must be tailored to each individual, but I have made specific conclusions on "best practices" based on personal experience and available research.

--Then I invite you to submit a paper to the next Society for Neuroscience meeting.
M.L.

I'm actually confused on what position you hold. You've argued with mine quite a bit but haven't actually offered your own alternative view. Do you believe its acceptable practice to prescribe psychiatric drugs intending them to be used for the long term? If not, how long is too long? Is it ok to prescribe psychiatric drugs for minor illnesses? Which is more important, developing better therapy techniques or developing more effective medication?

--Sure I believe it's acceptable to prescribe drugs with the intention to use them for the long term, if there's no good evidence for long-term harm and if therapy alone is not sufficient. Do you believe it's acceptable to withold them in these circumstances. Or even ethical?

Do you think maybe you should define "minor illness" before posing a question about it?

Your last question presumes so many things not in evidence that it's absurd. How does one "develop better therapy," pray tell? If you think drug development is unscientific, "therapy development" must be exponentially more so.
M.L.

Also, I'm curious about what led you to believe that a prepoderance of experts say taking psychiatric drugs for the long term is perfectly acceptable:

--I'm curious about what your definition of "the long term" and "the short term" even is. Once again, you wave around vague terms without defining them.
M.L.

"I'm sure Nathan can come up with some specific studies that argue against long-term medication, but that's some, not the preponderance." Have long term studies been completed?

--Come to think of it, maybe not. So there's no evidence of harm from long-term use after all. So your point is...what again?
M.L.

Long term: longer than the length of most clinical trials or clinical studies on psychiatric medications--so a few months to a year.

Short term: less than long term.

"--How does one "develop better therapy," pray tell?"
Touche. I have no idea. Let the therapists figure that out. But there are ways to ensure that everyone who needs therapy has access to it, like pushing for better insurance coverage of long term therapy for one.

"--So there's no evidence of harm from long-term use after all."
There's a difference between no evidence and not studied. There's very little data on long term use. Period. This is a problem because no one knows what dangers an individual is exposed to when taking drugs for the long term, or if the drug even works for the long term. There are many examples in technology and medicine where devices and drugs were said to be harmless via the same argument you just used, and then turn out to be dangerous or ineffective over the long term. Remember the shoe fitting x-ray? People used it without knowing the dangers of high doses of x-ray radiation. Also, a recent long term study of ADHD medications seems to indicate they aren't effective long term and can even cause problems.
http://news.bbc.co.uk/1/hi/uk/7090011.stm

"--Was that the study from 1952?"
Funny. No, that was someone else. You can check my other posts if you like. The links are there.

"--So your point is...what again?"
There is no data on long term use of psychiatric drugs; patients have a tendency to want the quick fix without sticking with therapy; without therapy some or all of the benefits gained via pharmacotherapy are lost when the drug is stopped; and minor conditions (If you want a definition, you may use the HRSD or the DSM-IV definition of minor depression. I'm sure there are similar metrics out there for other mental illnesses) are often treated with drugs when it may not be necessary. Considering all of these risks, my position is that therapy should be the dominate method of treatment. Drugs should be reserved for the more severe cases and when patients are not responding to therapy alone. Eventually drugs should be tapered off when improvement is measured and then the patient should remain in long term therapuetic care, if necessary. Drugs are helpful but should not be the primary means of treating mental illnesses, including addiction, unless long term studies show that they are effective and don't cause any harmful side-effects.

So, in my opinion, and per the rationale above, addiction should not be treated by medication alone, for the long term, or without therapy...in most cases. I think I have enough caveats in there for you.

Does addiction only mean a physiological dependence on drugs and alcohol?

What about being addicted to sex or money or religion or other things?

--Good questions. The definition of addiction depends on whom you ask. Beyond that, the physiological dependence on drugs and alcohol and the psychological dependence are two different things. The latter is often dismissed as less signficant. Big mistake

Very interesting read...

Michael, I admire your patience and sense of humor. This whole blogging idea is awesome, in a dysfunctional kind of way.

Very interesting read...

Michael, I admire your patience and sense of humor. This whole blogging idea is awesome, in a dysfunctional kind of way.

--I love the way you put that. Thank you.
M.L.

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Addiction treatment and recovery resources for the addict and their families. http://www.addictiontreatment.net

Hi, i read the site.i read few para of the book of lemonick's eye on science.
it is useful and i agree with your view.
In many people addicts with alcohol and drug.

mostly young people addicts easily alochol and drug due to bad friendship and enjoyment.

this site definetly useful to them. they comepletely cure from alchol and drug addicts.

---------thank u------

=====

anne.

Suffering from an addiction. This website has a lot of great resources and treatment centers.

http://www.treatmentcenters.org

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