Addiction of any kind is painful and complicated, both for the addict and his or her family. With new understanding, however, significant advances in approach and treatment are offering fresh hope for a condition that has lifelong implications.
outpatient vs. inpatient care
It can be hard to know what kind of treatment is best. In the past, inpatient rehabilitation was the standard, but nowadays, thanks to advances in addiction medications, outpatient programs offer great hope for successful recovery.
a medical issue
Dr. Arturo C. Taca Jr. is the founder of INSynergy, a Creve Coeur-based comprehensive outpatient treatment program for alcohol, opiate and tobacco addiction. Taca says he is alarmed by the increase in opiate (heroine and prescription pain medication) addiction in recent years, and that 99.9 percent of all the world’s manufactured hydrocodone is consumed in the United States. “We have enough pills out there to medicate every single person in America around the clock,” he says.
Taca also is president of the Midwest Chapter of the American Society of Addiction Medicine. The advances being made in addiction medications, he says, mean that outpatient treatment that combines drugs with behavioral counseling can be very successful.
Ashley Halker, director of operations at INSynergy, emphasizes that addiction is a medical condition. “Society says addiction is a moral defect, but it’s not,” she says. “We need to look at the brain.”
In addition to three- and six-week programs, INSynergy, offers a one-week outpatient detox. During this program, and depending on the severity of the condition, the patient is seen every day and contacted three or four times daily. Initially, epilepsy medications are prescribed for seizures. But for someone who cannot control their drinking or drug use and has no support system, inpatient treatment may be the better option. “However,” Halker cautions, “inpatient treatment is only as successful as the outpatient that follows.”
In the case of opiate addiction, INSynergy is currently using a device called The Bridge that is placed over the ear and stimulates the vagal nerve, which then releases natural endorphins to control pain, a primary withdrawal symptom, Halker says. “And of course the sufferer’s first instinct is to keep taking the opiate to control it.”
new drugs—more options
Percy Menzies, M.Pharm, is president and founder of Assisted Recovery Centers of America. There are three such outpatient locations in the greater St. Louis area (downtown, West County and South City). Menzies also is a proponent of outpatient treatment. He cites a new drug, Naltrexone, as protecting one of the neurons associated with addiction. It is non-addicting and controls cravings, he says. This approach has the added benefit of safeguarding the patient’s privacy. There is no loss of income and no risk to confidentiality, Menzies says. “The possibility of all these things with inpatient treatment causes great anxiety in people,” he notes. The centers require a minimum of three counseling sessions, many of which take place in the evenings and on weekends.
“The biggest problem with inpatient care is something we call the deprivation effect,” Menzies says. “When we are deprived of something, we want it more.” That’s one of the reasons Menzies believes it is preferable for addicts to undergo outpatient treatment in a natural, ‘real life’ environment filled with temptations and cues. Otherwise, he explains, cravings tend to be rekindled as soon as they go home. With the addition of outpatient behavioral counseling, the likelihood of relapse is lessened further, he says.
Menzies adds that an in-house, 28-day treatment program in the company of other addicts, not all of whom may be completely committed to the process, might delay recovery.
is it genetics?
new understanding
Joel Eissenberg, Ph.D., is a professor and associate dean for research who studies genetics at Saint Louis University. Although he says there isn’t a simple ‘gene’ for addiction, there are variants of genes that may have an effect on addiction. Variants are small differences in our genes which, by themselves, don’t have a big impact, but together, in certain combinations, may lead to genetic risks. For example, he says one gene variant may make a person especially tolerant of alcohol so that they may not stop drinking at the point when others would. More than a dozen genes have been implicated in add
Eissenberg notes that studies on twins have been helpful in determining a possible genetic propensity for addiction. “When identical twins (who share identical versions of every gene), are found to be addicts more often than non-identical twins, we conclude that there is a genetic contribution,” Eissenberg explains. However, it is still hard to know whether the dependency is a result of genetic inheritance or learned behavior. “If, at a young age, a person witnessed their parents abusing alcohol and they themselves become alcohol dependent,” he says, “learned behavior could certainly be a factor.”
What he says we can know is that abstinence almost certainly hedges against dependence. “In Muslim and Mormon households, alcohol is forbidden, so we don’t tend to see dependence.” But he notes that we still can’t say there is a genetic component because the aversion to alcohol has to do with belief rather than biology.
family history
Washington University psychiatrist Dr. Paul Glaser says genes play a role in addiction by either protecting people from or predisposing them to addictions. Although there is no genetic test for addiction on the clinical market, Washington University is one of the few places currently conducting related clinical trials. “Washington University is looking specifically at smoking addiction,” Glaser says. “We hope to understand better who will take to smoking at a younger age, who will smoke with greater intensity, and who will have more difficulty quitting.” Eventually, he says, DNA tests will help physicians pick the right treatment for a patient. “Because of genes, everyone responds differently to different treatments,” he says. “Having a test would reduce trial and error.” Smokers are invited to take part in the study, Glaser says, and will undergo a free DNA test and smoking cessation treatment. (For information, call 314.747.7849).
Glaser says the way different ethnicities respond to alcohol may also point to genetics. “Some people of Asian heritage have less of an enzyme that breaks down alcohol. This results in a flushed face and a feeling of sickness,” he says. “That is one of the protective genetic factors that can lead to lower rates of alcoholism because abuse is less likely.”
While there is no proof of addiction propensity being passed down through families, Glaser says that knowing about your family history is important. “If there is addiction, we might teach our children to steer clear of the substance altogether, or certainly delay the onset of use.”
facing the facts: moving forward
Coming to terms with an addiction means recognizing that recovery is ongoing. Understanding this is one of the keys to success.
Dr. Sindhura Saini of the St. Louis Behavioral Medicine Institute, whose main interest is drug and alcohol addiction, believes that ongoing behavioral and psychiatric therapy is vital to the recovery process. “There’s never an end point. People need to understand that recovery is always evolving, and they need to be cognizant always of having had the problem,” she says.
Saini emphasizes in particular the importance of stability. “Emotional and financial stability are key factors in the success of a recovery process,” she says. “People tend to relapse because those things are lacking.” When a person has limited financial resources, Saini says AA and NA are good places to turn. “A new thought about recovery,” Saini explains, “is that people need a home base. Sober living homes can help people transition back to a normal living situation. These are cooperative, supportive communities that teach people coping skills.” (For a list of sober living homes, visit soberliving.interventionamerica.org).
Major life stressors—death, job loss—might also cause relapse, Saini cautions. “In these cases, the first thing to do is rely on support—a sponsor, a friend. Being open about your feelings seems like common sense, but not all do it.”
food addiction: it’s complicated
Particularly complicated, as far as moving forward with one’s life, is food addiction. Unlike alcohol and drugs, food is necessary to our survival. Food addiction is one of Jennifer Lustman’s areas of expertise. Lustman is a licensed clinical social worker for St. Louis’ OneLife Weight Loss & Wellness Solutions, which provides coaching, advice, support and a customized diet for people struggling with food addiction.
She explains how our environment and relationship to food has changed over time. “Cave dwellers ate as much as they could when food was available because they were never sure when their next meal would be,” she says. “Today, with supermarkets, restaurants and vending machines, we have less to fear, but this has not lead to a healthier relationship with food.” There is more obesity—and disease related to obesity—than ever before, she notes.
Lustman says research in the area of food disorders is in its infancy so there is still disagreement among professionals as to how it differs from other addictions. One school of thought holds that the inability to control food craving is due, in part, to the food industry’s creation of foods that are hyper-palatable (loaded with sugar, salt and fat). These ingredients, some researchers believe, might lead to problems with brain function similar to those in alcohol and tobacco addiction, causing an inability to control intake. Other researchers believe that eating habits are within the control of the individual. If this is the case, Lustman says, treatment needs to focus less on food and more on behavior and what interferes with it. “There is compelling evidence to support both theories,” she says. “That makes the issue of disordered eating an area of fertile ground for neuroscientists.”
As with other addictions, the struggle to make better choices and lead a healthier lifestyle is ongoing. Because each person is different, Lustman says an assessment of the whole person is important. “Then we can understand more specifically which issues play a role in their behavior and the lifestyle changes that are needed to maintain health.”