Tuesday, October 9, 2012

Transformation in Action

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 approach. The bad new is this: in order to fully implement modern, scientifically based treatment for addiction, we have to confront a very difficult reality. With the exception of maintenance therapy for opioid (painkiller or heroin) addiction, most other treatments we currently have only have modest effectiveness. To state that is not to belittle it, or to imply that addiction treatment is less effective than treatment for other conditions. When was the last time you knew someone who was cured of their diabetes or high blood pressure? Most chronic ailments respond modestly to available treatments. That's not ideal of course, but it's OK. After all, chronic diseases in humans are extremely complicated and difficult to treat.

We have an easier time accepting that for diseases below the neck. That's my term for diseases we consider "physical" or "medical," as opposed to "psychological." But this is old-fashioned thinking. Consider "psychological" illnesses, such as depression, anorexia, addiction or schizophrenia. If these disorders aren't "physical" what are they? Do they occur without a body, a physical structure which in this case happens to be the brain? No, they don't. The brain is a flesh-and-blood organ that regulates things, just like other organs. And, just like other organs it can get "sick," dysregulated, where it cannot perform it's intended function as well as it should.


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