They tried to make me go to rehab, but I said ‘No, no, no’

                                         Singer Amy Winehouse, prior to her death from alcohol poisoning in 2011.

This is the second of three articles about substance abuse issues impacting Americans today.

A recent survey done by the US Department of Public Health showed that drug addictions (“substance use disorders”) are significantly undertreated.  Less than 10 % of people with these illnesses received specialized treatment in 2013, according to this survey.

Historically, people with drug addictions were thought to have a weakness of character or a moral defect.   Since addictions are mistakenly believed to be caused by a lack of willpower, the thought that they are not treatable continues to be one of the many barriers keeping people from going to rehab. 

Today, most doctors believe that drug addiction is a treatable chronic illness, similar to asthma or diabetes.  Treatment for drug addiction can be successful even if the individual is required, by the law or an outside agency, to engage in therapy.

Successful treatment will not be easy or quick.  It should include a period of long term follow-up, referred to as “aftercare” or “recovery.” And it may need to be repeated.

Addicts often return to their addictive behaviors.  As babies are expected to fall while learning to walk, people with addictions might be expected to fall “off the wagon” after achieving sobriety.  Effective treatment starts with sobriety, but must include a plan for behavior change, and for relapse, a hallmark of this disease.

Television shows such as “Celebrity Rehab” have contributed to one of the most common misconceptions surrounding the treatment of addictions: the geographic cure.  Many well-meaning family members believe that their loved ones with addictions should travel to receive treatment, so that they can be removed from bad influences in their local community or to get a “fresh start.”

There are times when removing addicts from their home situation for a brief time is needed.   A short hospital stay, for example, is often advised when the addict may not be safe at home due to severe psychological symptoms, the potential for dangerous withdrawal symptoms, or serious medical illness.

Still, addicts and their families ought to think twice before boarding a plane, no matter how glamorous the rehab facility may appear on TV.  Most addiction specialists believe that finding local sober supports and community resources (a home AA / 12 step group and sponsor) are crucial in maintaining sobriety.  Also, family involvement and education is difficult when the addict is far away, yet involvement of family and sober friends is another crucial piece in most people’s treatment and recovery.

Though it is tempting to believe that a loved one will stop using drugs for good if he is away from his drug dealer, or his drug-using cronies, this is almost never the case.  Addicts must find new local playmates and playgrounds, which is best started while they are still in active, local treatment. They must learn new ways of thinking and behaving.  Because, as the AA saying goes, no matter where you go, there you are.

Caution should also be exercised in seeking “alternative treatments” for addiction.  Standard medical treatments for addiction include taking prescription medications for withdrawal and/ or to prevent cravings, identifying and treating accompanying medical and psychological conditions, as well as attending therapy and 12-step community support programs.  Standard medical treatments do not include sauna “detoxification” or megavitamin treatments, both of which can be dangerous.  

Started in 1935 by professionals seeking to maintain sobriety, the 12 step community support program AA/ NA (Alcoholics Anonymous / Narcotics Anonymous) continues to be a mainstay of recovery.  

For families of those with addictions, beneficial support programs have grown out of the AA movement - these include Al-Anon , Nar-Anon, and Alateen.  

The use of medications, given along with counseling / support programs to help addicts maintain sobriety, used to be a controversial practice but has become more widely used in the past decade.

Some medications that are commonly used include:

• Antabuse (disulfiram) has been prescribed for decades as a psychological deterrent to drinking.  Anatbuse interferes with the body’s normal process of breaking down alcohol.  If alcohol is consumed while someone is on Antabuse, highly unpleasant and possibly dangerous symptoms (flushing, dizziness, headache, heart palpitation and vomiting) may occur. Although the threat of experiencing these symptoms is thought to discourage people from drinking, Antabuse might not work because many alcoholics simply stop taking the medication before they relapse.
• Naltrexone and Acamprosate (Campral) are two safer medication options to help addicts struggling with alcohol or opioid addiction.  These medications are used to ease cravings and are widely accepted by the medical community.  Unfortunately, a recently study done by University of North Carolina (published in JAMA, May, 2014) found that these medications are underused because of lack of public awareness and understanding that these medications do not cause the same adverse reaction as Antabuse.  As with any medication, the use of both naltrexone and acamprosate must be weighed for individual risks to each patient. These anti-craving medications are given only to individuals who have achieved sobriety and are only meant to be used along with counseling and support programs.  These medications are not a cure for addiction, but may provide additional ammunition to help individuals addicted to alcohol or opioids stay sober.
• Methadone and Suboxone are used for the medication treatment of heroin addiction. Though both Methadone and Suboxone contain opioid substances which can themselves be addictive, their use is believed to be preferable to, and safer than, IV heroin.  Suboxone, though more expensive, is generally safer than Methadone in overdose and cannot be used IV (as doing so will produce withdrawal symptoms). Both Suboxone and Methadone are prescribed daily to addicts to replace heroin similar to the way that a nicotine patch may be used to replace smoking.  As with a nicotine patch, there should be a plan in place to taper and eventually stop these medications.  Like other opioid medications, Suboxone and Methadone can be abused or illegally sold.  Both can also be dangerous in overdose, especially if taken with other drugs, and their use must be carefully monitored by a doctor.

Although drug addiction is a growing problem in America, it is a treatable condition. The combination of therapy and community support, a concept that has been around since 1935, with new medications that have been approved in the past decade, may represent the best chance for many addicts to remain sober.  

Did you know?

• AA / NA meetings can be found in most communities in the country – for a search by zip code, go to http://www.aa.org/pages/en_US/find-aa-resources?zipcode=Zip%2FPostal+Code
• There are 12 step program options for the minority of individuals who do not believe in God or “a higher power” (such as AAAgnostica - http://aaagnostica.org/). 
• Those without an addiction can attend “open” AA / NA meetings (for example, to support an addicted loved one).  Only those with an addiction can attend closed meetings.
• AA also offers online meeting options

In the third article of this series, I will discuss disturbing trends with new drugs that are being abused.

Dr Bonanno is a board certified psychiatrist with nearly 20 years of patient care experience. She currently serves as a behavioral health medical director for the Anthem central region.