Pubdate: Thu, 04 May 2006 Source: Philadelphia Inquirer, The (PA) Copyright: 2006 Philadelphia Newspapers Inc Contact: http://www.philly.com/mld/inquirer/ Details: http://www.mapinc.org/media/340 Author: Michael W. Shore Note: Michael W. Shore, M.D., has a practice of psychiatry and addiction medicine in Cherry Hill. Bookmark: http://www.mapinc.org/coke.htm (Cocaine) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/oxycontin.htm (Oxycontin/Oxycodone) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) NEW DRUGS, KNOWLEDGE CAN HELP HALT ADDICTIONS Moral judgments and limits on treatment only hinder us. The deaths of heroin addicts in our area sadden me because as a psychiatrist specializing in addictive disorders, I know substance-abuse disorders usually can be treated. There has been an explosion of knowledge about the brain and how addiction changes it. Many new and effective medications are available. One extremely effective medication is buprenorphine (or Suboxone, its brand name). It has been available for about three years for treatment of dependence on opiates - such as heroin, OxyContin and Percocet. It can be prescribed by specially trained physicians and is delivered in the privacy of a physician's office. A Web site lists almost all of the approved physicians in each state. The site can be accessed by typing Suboxone in a search engine such as Google. Just look for the "Physician Locator" link. Unfortunately, the federal law that allows this wonderful treatment bars physicians from treating more than 30 patients at any one time. Many physicians are "full," myself included, but many listed doctors have openings. It is ironic that there is a limit on treating patients with opiate addiction but none those to whom a physician can prescribe OxyContin, Percocet or morphine for pain. I turn away five to 10 potential patients each week. I wonder whether any were among the reported heroin deaths. There also have been exciting developments in medications to treat alcoholism. A medication called acamprosate (Campral), which has been available for close to two years, helps decrease various measures of drinking behaviors and eases abstinence and recovery. Also, an old medication called naltrexone has been reformulated into a monthly injectable medication called Vivitrol that also helps reduce various measures of problem-drinking behaviors. Efforts to address cocaine addiction and other addictive disorders are continuing as well. A major impediment to acceptance of chemical dependency as an illness is the perception by many - including, unfortunately, many in the health-insurance industry - that these disorders stem from lack of will power or moral weakness. Such attitudes limit access to treatment. Nothing could be further from the truth. While resisting the first drink or the first drug may certainly be amenable to Nancy Reagan's "Just say no" mantra, once susceptible individuals introduce addictive chemicals, their brain chemistry changes. That has been demonstrated by neuroscientists. Cravings, compulsions to use, loss of control, and continued use despite often-severe consequences, as well as the frequently noted genetic and familial links of this condition, point to this being a real brain disorder. Addiction also is much more common in people with co-occurring psychiatric disorders, sometimes as they attempt to self-medicate their distress. This is truly a biological, psychological and social disorder. Finally, it is important for most patients with addictive disorders to be in the 12-step-model recovery program. The first step of Alcoholics Anonymous (and Narcotics Anonymous) affirms that the individual is powerless over his or her addiction. Accepting this allows the individual to see how the group's strength can help. I tell my patients it is a strong person who can admit there is something he or she is not able to accomplish by himself or herself and admit a need for help. Tens of thousands have been able to get well from their disease of addiction, one day at a time. The addict or alcoholic does not have to continue down the path of despair and self-destruction. - --- MAP posted-by: Richard Lake