Increasingly, the medical establishment is putting its weight behind the physical diagnosis. In the latest evidence, 10 medical institutions have just introduced the first accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.
“In the past, the specialty was very much targeted toward psychiatrists,” said Nora D. Volkow, the neuroscientist in charge of the National Institute on Drug Abuse. “It’s a gap in our training program.” She called the lack of substance-abuse education among general practitioners “a very serious problem.”
The rethinking of addiction as a medical disease rather than a strictly psychological one began about 15 years ago, when researchers discovered through high-resonance imaging that drug addiction resulted in actual physical changes to the brain.
Armed with that understanding, “the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes,” said Dr. Daniel Alford, who oversees the program at Boston University Medical Center. “It’s hard necessarily to cure people, but you can certainly manage the problem to the point where they are able to function” through a combination of pharmaceuticals and therapy.
Central to the understanding of addiction as a physical ailment is the belief that treatment must be continuing in order to avoid relapse. Just as no one expects a diabetes patient to be cured after six weeks of diet and insulin management, Dr. Alford said, it is unrealistic to expect most drug addicts to be cured after 28 days in a detoxification facility.
“It’s not surprising to us now that when you stop the treatment, people relapse,” Dr. Alford said. “It doesn’t mean that the treatment doesn’t work, it just means that you need to continue treatment.” Those physical changes in the brain could also explain why some smokers will still crave a cigarette 30 years after quitting, Dr. Alford said.
Another live example holistic approach is needed for addictions