According to the National Institutes of Health, the estimated total cost of alcohol abuse in the United States is at 235 billion. These costs include loss of productivity, health care costs and crime-related costs.
Current alcohol abuse treatment plans vary in their effectiveness, depending upon the alcoholic’s dedication to controlling his addiction and his ability to find adequate treatment. Many individuals try to quit “cold turkey,” simply refusing to indulge in their addictive behaviours. This method works for some, but is mostly ineffective. Others try to control their addiction through rehabilitative programs such as a twenty-eight day in-house detoxification. Unfortunately, such programs only address the behavioural side of addiction, leaving the physical side untreated in the long term.
Smart Recovery identifies alcohol addiction as both a physical and a psychological illness. The physical portion of the illness has its roots in the fact that an alcoholic cannot process alcohol in the same manner as non-alcoholics, in the same way that someone who is allergic to dairy products cannot process cheese. The psychological portion of the illness mandates that, in spite of the fact that he cannot process alcohol, he is compelled to consume them.
A diabetic may not want to admit that he needs insulin any more than an alcoholic wants to admit that he cannot drink. However, with insulin and lifestyle changes, diabetes is a manageable disease. With modern pharmaceuticals such as Revia and lifestyle changes, alcohol addiction is a manageable disease.
Think back for a moment to the anti-drug commercials of yesteryear. One of the most compelling commercials featured an individual holding an egg stating, “This is your brain.” He then broke the egg, dumping the contents into a heated frying pan. As the scrambled egg sizzled and bubbled, the narrator then stated, “This is your brain on drugs.”
In spite of this graphic and startling image of the effects of addiction on the human brain, the medical community remained reluctant to acknowledge the physical roots of addiction. One reason for this reticence may be the fact that the medical community still knows very little about the human brain, how it functions, why it can overcome some obstacles but not others.
The human brain serves as the body’s regulator by transmitting messages through a series of nerve cells. These nerve cells provide information to the brain. The brain then processes the information and takes appropriate action. When an individual places his hand into an open flame, the nerves in his hand send a signal to the brain that the hand hurts. The brain then responds to the hand that it should move to avoid catastrophic damage. All of this communication occurs within a fraction of a second.
Alcohol and drugs interfere with the brain’s ability to receive and transmit accurate information. They cause the brain to produce abnormally high amounts of dopamine – the naturally-occurring chemical that signifies a pleasurable experience. In response, the brain produces less dopamine on its own, requiring the addict to consume more of the substance that led to his euphoric feelings in order to achieve the desired pleasurable effect. The dopamine overload also slows down the brain’s ability to respond appropriately in a time of crisis. The crisis may be situational, such as lowering one’s inhibitions enough that he will do and say things that he would never consider if he were sober. The crises may be physical, such as lowering one’s heart rate to the point of stoppage.
Cures for diseases of the brain such as epilepsy, schizophrenia, and Alzheimer’s, remain elusive in spite of years of medical research and testing. “Recovery” entails the adequate management of symptoms so that the individual can maintain some quality of life. With proper medical treatment, epileptics can reduce the number of seizures that they experience; schizophrenics can lower the occurrence of psychotic episodes; Alzheimer’s patients can delay the onset of total memory loss. The same concept is true in the search for a cure for addiction. Modern medicine in combination with behavioural therapy provides a lifelong recovery process, not a cure.
The American Board of Addiction Medicine (ABAM) promotes the medical and behavioural treatment of addiction, and certifies a graduate-level medical degree in addiction treatment. Founded in 2007, ABAM certifies physicians in the specialized area of Addiction Medicine. ABAM also provides continuing education and certification for Addiction Medicine specialists. Their ground-breaking textbook, Principles of Addiction Medicine, leads students through the diagnosis and treatment of addiction, using current scientific evidence to support individualized treatment plans. Ultimately, ABAM is seeking accreditation by the Accreditation Council for Graduate Medical Education for its work with Addiction Medicine specialists.
Currently, physicians can choose from one of ten accredited post-graduate training courses to receive Addiction Medicine certification. Boston University Medical Center, Geisinger Health System at Marworth, Addiction Institute of New York at St Luke’s and Roosevelt Hospitals, University at Buffalo School of Medicine, University of Florida College of Medicine, University of Hawaii John A. Burns School of Medicine, University of Cincinnati College of Medicine, University of Maryland Medical System, University of Minnesota Medical School, and University of Wisconsin School of Medicine and Public Health all offer Addiction Medicine certification after the completion of a one-year residency program.
Students entering the one-year Addiction Medicine residency program must complete four components of training in order to receive certification. Core content for certification includes the study of the science of addiction, including genetics, pharmacology, and the physical changes in the brain the occur with addiction; the causes of addiction and its treatment; addiction prevention; clinical diagnostics; inpatient and outpatient detoxification; behavioural modification; multiple related diagnoses (both physical and psychological); and the social and legal issues surrounding alcohol addiction.
ABMA’s unified approach to managing addiction represents a great step forward in the treatment of both the psychological and physical aspects of the disease.