Eye on Science, Science Blog, Michael D. Lemonick, TIME

November 29, 2007 8:29

The Addiction Wars

Posted by Michael Lemonick | Comments (38) | Permalink | Trackbacks (0) | Email This

I wrote a post a few weeks back on a paper that described a step forward in understanding the neurobiological basis of addiction. In it, I mentioned the fact that understanding the underlying biology could help lead to new medications to treat the problem—and the comments have been raging ever since.

The most prolific poster by far, Nathan, took me to task for touting medication as a cure-all:

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.

Which is true of course, and I don't mean to suggest medication can necessarily cure addiction. But like insulin, which isn't a cure for diabetes, medication could very plausibly help an addict recover, and make relapse less likely.

Nathan goes on:

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.

Most of the mental-health experts I know would agree that simply handing a patient a pill and declaring him or her cured is totally irresponsible. Most would also agree that telling someone with a broken leg "no crutches for you" would be equally so. The suggestion about what medication is ONLY good for, however, is not nearly as settled as Nathan suggests.

He continues:

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.

Most treatment professionals, and lay groups like AA, use the disease model but explicitly say it can not be cured. Rather, they say it can be held in remission--again, like diabetes. The fact that there's no cure for diabetes shouldn't, however, make people cringe at the news that researchers are trying to find one. Seems to me that it should be the same with addiction, no?

Another of Nathan's key concerns is that there aren't enough long-term studies of psychiatric drugs to be sure of their safety—and he's right to be concerned. But then he asks:

Which is more important, developing better therapy techniques or developing more effective medication?

To which I answer: why do I have to choose one? I also wonder what "developing better therapy techniques" even means. Every so often, someone comes up with a new type of therapy, and at least one—cognitive behavioral therapy—has become widely endorsed by therapists in the bast 25 years or so, for a wide range of problems. But I don't know much about active programs to develop new therapies. Maybe someone can enlighten me on that. I'm all for it.

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Reader Comments (38)

Nathan:

"But I don't know much about active programs to develop new therapies."

Honestly, I don't either. But I do think one of the most important things that can be done is fight for broader insurance coverage of therapy. Therapists have a reputation (whether its accurate or not) of charging people out the nose. Additionally, people tend to scoff at the idea of going to see a therapist because of the stigma attached to it and would rather just take a pill and be done. Also, the experience and skills of the therapist greatly affect the quality and effectiveness of the treatment, so improving training and education programs could help.

Another thing we could do is pay more attention to mental health. We have general practitioners for physical health. Preventative medicine for physical health is generally 100% covered by health insurance. Governments and employers build public awareness and encourage improvement of physical health. We provide free physical medical care to the poor and uninsured. Why can't we encourage the same thing for mental health? Why does it seem like most people don't like to talk about mental health issues? I think this drives some people towards taking medication when they don't necessarily need it.

And I wouldn't say I was vehement. More like passionate. :P

--Well, OK. Passionate then. And I agree, insurance companies are pretty irresponsible at covering therapy. Their argument is that it often doesn't work—but given that it's far more effective than nothing, or than medications alone (on this, I think we also agree), it's not a great argument.
M.L.

Posted by Nathan | November 29, 2007 12:08 PM

KB:

I agree, in principle, with your thought that throwing pills at a problem is counter-productive and possibly dangerous. I've read studies that link suicide and violent outbursts to anti-depressants because, wouldn't you know, when you enable someone with a lot of negative feelings to act on those feelings without addressing the feelings...not so good.

However, a significant case can be made that drugs which help addicts cope with the physical symptoms and causes of addiction can help the behavioral changes take hold. The healing process can certainly be a two pronged approach, and frankly this is a more effective treatment method. Behavioral therapy simply will not be as effective if there's a chemical imbalance which tries very hard to undo all of a patient's progress.

I think the answer is both. The more we understand addiction and other mental disorders, the more effective treatment can become from both angles.

--Amen.
M.L.

Posted by KB | November 29, 2007 1:09 PM

Betty:

Michael,

Your post poses an interesting question. Many people constantly ask which is more important--the drugs, or the therapy? I think you hit the nail on the head, though. It shouldn't be a battle, a massive debate for high priced therapists and expensive pharmaceuticals. Therapists need to constantly be amending their approaches, and drug researches need to continue to find something that can continue to aid those with whatever genetic dysfunction that exists in their neurological functioning.

Addiction is such a difficult topic, with difficult questions and even more difficult answers. It's crazy to to think how some people can be so addicted and not even realize it. You can take someone with rational, logical thought, and they could still be oblivious to the fact that they have a problem. I've found that one of the most interesting shows about the topic is the A&E show, Intervention. It covers all types of addictions, makes the addict think that they're participating in a documentary, and then at the end, faces them with an intervention specialist and gives them the option to choose. You should really check it out: http://www.aetv.com/intervention. The new season premiere is on December 3rd. I think it shows the mental process of how addiction affects a person, which could give us a little more insight into this battle of psychosis vs. pharmaceuticals. I'm working to support this because I'm tired of watching friends of mine fail the battle of addiction. I want to see some concrete results, and I think we should help to get results for those of us that are struggling. The show is really an inspiration.

Posted by Betty | November 29, 2007 2:57 PM

Yadgyu:

I see that addiction only applies to drugs and alcohol. So if I want to use chemicals to induce euphoria, all that I have to do is use chemicals that my employer will not test for. I believe that a new wonder drug, an illicit one, will be invented in some lab somewhere. This drug will make some rogue chemist(s) very, very, very rich.

Posted by Yadgyu | November 29, 2007 8:11 PM

Saint Andeol:

I think the big reason therapy is helpful is that overcoming addiction is usually more than just quitting a substance, it's changing a lifestyle. your friends and circles you travel are often part of the problem, and medication can't advise you on what lifestyle changes you need to make.

for example, my former friend was a big-time painkiller junkie who got busted by his family and sent to rehab out of state. now, he NEEDS medication, because quitting cold turkey would literally kill him. but he also NEEDS a lifestyle adjustment, a change of scenery away from the environment that facilitated his addiction.

oh, and Yadgyu, good luck. : )

Posted by Saint Andeol | November 30, 2007 4:37 PM

THOMAS BILLIS:

What if addiction to drugs and alcoholin some people was discovered to be a chemical imbalance in the brain would that mean to give a pill that would cure that person would be wrong without therapy or changing lifestyles.We are at the frontiers of treating so many diseases and maybe just maybe addiction is a disease that can be cured.

Posted by THOMAS BILLIS | December 2, 2007 3:05 AM

Lindsay:

I seems like a general trend that people opt for medication over putting effort into behavior modification or anything that takes more time and energy (how many people would choose to take a statin everyday over completely changing their lifestyle of unhealthy dieting and no exercise?) Sounds like it's our culture's overemphasis of medical therapy that people are concerned about?

In treatment of psychiatric disorders, however, pharmacological therapy is usually accompanied by psychotherapy. I'm not familiar with any psychiatrist that would hand out a prescription for a SSRI as the only form of treatment.

And Nathan, why does the genetic basis for addiction discredit the importance of the neurotransmitter system? Don't individual differences in genes related to brain signaling proteins support your observation that addiction has a familial component?

Lastly, proof of efficacy isn't really the problem behind getting insurance coverage for psychiatric treatment. Companies can claim anything they want as experimental. Plenty of well-established procedures, including cervical cancer screening and MRI, have been categorized as experimental.

Posted by Lindsay | December 3, 2007 1:09 PM

nicobou:

Yadgyu: It has happened before. Remember MDMA?

Posted by nicobou | December 3, 2007 4:26 PM

Yadgyu:

"Yadgyu: It has happened before. Remember MDMA?"

Yeah, ecstacy had a stronghold on youth back in the late 1990's to early 2000's. I really don't hear too much about it anymore. I know that people still use it, but I believe that many that used it have either graduated to methamphetamine or use prescription drugs like Vicodin or Oxycontin.

--Is there any actual evidence for this?
M.L.

Posted by Yadgyu | December 4, 2007 4:46 PM

Yadgyu:

"--Is there any actual evidence for this?"

The evidence can only be found on the streets.

It's too bad that most researchers are cowards who are too afraid to go into streets and do more research on illicit drugs. The underground drug market is only a subset of the larger economy as a whole. I believe that if reasearch was done, the underground drug market could be eradicated.

I encourage you Michael to go into crackhouses and meth labs to uncover the reasons why people start using and cannot fight their addictions.

--I've got sad news for you, Yadgyu: active addicts in crackhouses or whatever are somewhat hampered in self-insight, and can't really be trusted to tell the truth about anything. So thanks, but your suggestion is pretty clueless.
M.L.

Posted by Yadgyu | December 4, 2007 7:05 PM

Saint Andeol:

Don't do it M.L., it's a trap! Meth labs are dangerous!

--Thanks! I mean, you just know I was on my way out the door. Yadgyu's insights are just too seductive to resist.
M.L.

Posted by Saint Andeol | December 5, 2007 9:50 AM

Yadgyu:

"--I've got sad news for you, Yadgyu: active addicts in crackhouses or whatever are somewhat hampered in self-insight, and can't really be trusted to tell the truth about anything. So thanks, but your suggestion is pretty clueless."

How do you know if you have not proven it? Don't make assumptions and excuses, Michael. I myself have been in a few crackhouses. I could tell you more about addiction than any double-blind, peer-reviewed, scientific journal entry.

--I don't have to prove that every nonsensical thing you say is wrong. And I don't really care how many crack houses you've been in. That you think you understand addiction by listening to the "insights" of active crackheads speaks volumes.
ML

Shouldn't you try to prove me wrong by going where drug addicts are and speaking with drug addicts yourself? Investigative journalism such as going into meth labs and crackhouses could really provide Time readers with the tools necessary to help themselves and relatives with drug abuse.
--See above under "nonsensical"

Not only this, but an expose on drug addicts could reduce drug related crime and set your career off.
This blog certainly will not do it.
--Note to self: seek career advice from Yadgyu more often. Hire agent to manage flood of publicity that will result. Buy new suit for ceremony where president will award National Medal of Freedom for reducing drug related crime.
M.L.

If you really want to take it to the next level, you should try some drugs yourself. Sigmund Freud used cocaine. He had more insight into the addictive powers of cocaine because he felt and went through what other users had went through. You must immerse yourself in the culture to learn and report about it. I mean, anyone can read a wikipedia entry and a few magazines about India and claim to be an expert on Indian culture. But how can you really know if you haven't been to India and lived, worked, played, cried, and dated Indians? The same goes with drug use. Get in the game before you commentate on it!

--Your thoughtful and well-reasoned suggestions make me wonder if someone isn't in the game already.
ML

Posted by Yadgyu | December 5, 2007 6:07 PM

Saint Andeol:

Yadgyu,

you know why your ideas are bad? because you suggest "going into meth labs".

um, you realize that meth labs are secret and usually defended with guns, and they're certainly not looking to explain their lifestyle choices to curious reporters.

plus, this post isn't about the "drug culture", it's about the scientific properties of addiction. it's as much about alcoholics as it is crackheads, and most alcoholics are not part of the "drug culture".

--I'm convinced Yadgyu is yanking everyone's chain. Nobody could be that clueless. Another thing about meth labs--aren't they were drugs are MADE rather than used?
M.L.

Posted by Saint Andeol | December 6, 2007 9:59 AM

Ben Bonsens:

Yadgyu,

Gonzo Journalism is fun, but remember Hunter S. Thompson also said,

"I hate to advocate drugs, alcohol, violence, or insanity to anyone, but they've always worked for me."

And,

"He who makes a beast of himself, gets rid of the pain of being a man."

Becoming an addict only biases the observer, which equals bad science (or nonscience).

Posted by Ben Bonsens | December 6, 2007 10:45 AM

Yadgyu:

Excuses, excuses, excuses.

Addiction will never be solved because no one wants to do the dirty work. Everyone wants to sit back and hypothesize but nobody wants to actually immerse themselves in the lifestyle of drug users. It's no problem though. Someone will write a pseudo-science report, a pharmaceutical company will manufacture a "treatment", and people will get rich and famous. Meanwhile, families will continue to be destroyed by the scourge of drugs and alcohol.

Clueless, I am. Right?!?

--Either clueless or with a very bizarre sense of humor. Can't decide which.
M.L.

Posted by Yadgyu | December 6, 2007 2:02 PM

Yadgyu:

I have a real question to ask. Is there a synthetic version of dopamine that people take to get high? It would seem like some rogue chemist out there has created a syntheitc form or a precursor drug that would get people high.

--you have a real question? This suggests that you've been wasting everyone's time with nonsense. Which is what I thought all along.
M.L.

Posted by Yadgyu | December 6, 2007 6:43 PM

Lindsay:

Dopamine is a neurotransmitter that has a lot of functions outside of the reward system in the brain.

Patients with Parkinson's (loss of dopaminergic neurons) are treated with a form of dopamine that can get into the brain (levodopa). Along with psychiatric side effects like euphoria and hallucinations, you get lots of annoying peripheral effects, like nausea, vomiting, ulcers, and pretty bad heart problems.

I'm not familiar with any abuse potentials of dopamine supplements or receptor agonists.

I don't think asking an addict why he's addicted to drugs will be all that promising. Plenty of people have done sophisticated studies on the nature of addiction, looking at behavioral, environmental, and physiological aspects. Take a look around.

--Nah. That would make sense.
M.L.

Posted by Lindsay | December 6, 2007 7:28 PM

Yadgyu:

"--you have a real question? This suggests that you've been wasting everyone's time with nonsense. Which is what I thought all along."

People need to be entertained as well as informed. That's the first rule of modern journalism.

Anyway, I do not think that addiction can be solved because we really do not have a clear definition of what addiction is. What you might call an addiction, I might call enthusiasm or passion.

--And now you're pretending to have a clue about journalism. Another joke, I guess. Just as "funny" as the last one.

Given your track record, what you call pretty much anything is of no interest to thinking people whatever.
M.L.

Posted by Yadgyu | December 6, 2007 10:16 PM

Ben Bonsens:

The difference between passion and addiction is the addict's self-destructive tendencies.

M.L. I think you are right about this "devil's advocate" and their strange sense of humor.

Posted by Ben Bonsens | December 7, 2007 1:45 PM

Yadgyu:

"The difference between passion and addiction is the addict's self-destructive tendencies."

Really? So if I use cocaine but hold down a high-paying job and take care of my family, I do not have a problem?

Posted by Yadgyu | December 10, 2007 8:53 AM

Saint Andeol:

@ Yadgyu

you'd only have a problem if you weren't sharing with your significant other.

but the hypothetical situation you're mentioning isn't really what's being discussed. We're talking about people who have problems, people who's "habits" subsume the other aspects of their life to the point that they need some kind of help.

no one's saying everyone who uses drugs is an addict who needs treatment. obviously there are people out there who can handle themselves. but there's also plenty of people who can't.

so just remember kids, if you can't handle your drugs, get help. And if you can handle them, make sure you share. no one likes a bogart.

Posted by Saint Andeol | December 10, 2007 9:34 AM

Anonymous:

People: Yadgyu is a troll, and trolls feed off negative attention. Next time Yadgyu posts, just ignore him.

--Sound analysis, sound advice. I second the motion.
M.L.

Posted by Anonymous | December 10, 2007 12:26 PM

Yadgyu:

I am sure that some of you have watched "Intervention" on A&E.

Do any of you know what exactly rehabs do? Do they use drugs to help people break their addictions? Do they use counseling? What is the success rate of these clinics? How are they funded?

Posted by Yadgyu | December 10, 2007 1:00 PM

Naty Rosado:

Many people that are mentally ill will medicate with illegal drugs which compounds the problem of mental illness and addiction. I do not see a cure for addiction in the near future with or without medication.

--I agree that mental illness can be a big factor. Got to find ways of dealing with that too.
M.L.

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