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What is Professional Addiction Treatment?

recoveryShort Definition of Addiction:
Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations.

Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premat ure death.

What is an Addiction Specialist?
An addiction specialist is a physician (MD or DO) certified by the American Board of Addiction Medicine (ABAM) and/or a psychiatrist certified by the American Board of Psychiatry and Neurology (ABPN), and who has demonstrated by education, experience, and examination the requisite knowledge and skills to provide prevention, screening, intervention, and treatment for substance use and addiction.

The addiction medicine physician is specifically trained in a wide range of prevention, evaluation and treatment modalities addressing substance use and addiction in ambulatory care settings, acute care and long-term care facilities, psychiatric settings, and residential facilities.  Addiction medicine physicians often offer treatment for patients with addiction or unhealthy substance use who have co-occurring general medical and psychiatric conditions.

Role of Self Help Groups
Although recognized as a valuable component of recovery, Self-Help groups should not replace professional addiction treatment. The American Society of Addiction Medicine (ASAM) recommends the following:

  • Patients in need of treatment for alcohol or other drug-related disorders should be treated by qualified professionals in a manner consonant with professionally accepted practice guidelines and patient placement criteria;
  • Self-help groups should be recognized as valuable community resources for many patients in addiction treatment and their families. Addiction treatment professionals and programs should develop cooperative relationships with self-help groups;
  • Insurers, managed care organizations and others should be aware of the difference between self-help fellowships and treatment;
  • Self-help should not be substituted for professional treatment, but should be considered a compliment to treatment directed by professionals.

Evidence-Based Approaches to Drug Addiction Treatment
Pharmacotherapies
Opioid Addiction

Buprenorphine
Buprenorphine is a partial agonist (it has both agonist and antagonist properties) at opioid receptors. It reduces or eliminates withdrawal symptoms associated with opioid dependence.

Vivitrol (Extended Release Naltrexone)
Vivitrol (Extended Release Naltrexone) is a long-acting synthetic opioid antagonist with few side effects. An opioid antagonist blocks opioids from binding to their receptors and thereby prevents an addicted individual from feeling the effects associated with opioid use. To prevent withdrawal symptoms, individuals must be medically detoxified and opioid-free for several days before taking naltrexone. When used this way, naltrexone blocks all the effects, including euphoria, of self-administered opioids. Naltrexone itself has no subjective effects (that is, a person does not perceive any particular drug effects) or potential for abuse, and it is not addictive.

Tobacco Addiction
Nicotine Replacement Therapy (NRT)
A variety of formulations of nicotine replacement therapies now exist, including the transdermal nicotine patch, nicotine spray, nicotine gum, and nicotine lozenges. Because nicotine is the main addictive ingredient in tobacco, the rationale for NRT is that stable low levels of nicotine will prevent withdrawal symptoms—which often drive continued tobacco use—and help keep people motivated to quit.

Bupropion (Zyban®)
Bupropion was originally marketed as an antidepressant (Wellbutrin®). It has mild stimulant effects through blockade of the reuptake of catecholamines, especially norepinephrine and dopamine. A serendipitous observation among depressed patients was the medication’s efficacy in suppressing tobacco craving, promoting cessation without concomitant weight gain. Although bupropion’s exact mechanisms of action in facilitating smoking cessation are unclear, it has FDA approval as a smoking cessation treatment.

Varenicline (Chantix®)
Varenicline is the most recently FDA-approved medication for smoking cessation. It acts on a subset of nicotinic receptors (alpha-4 beta-2) thought to be involved in the rewarding effects of nicotine. Varenicline acts as a partial agonist/antagonist at these receptors—this means that it mildly stimulates the nicotine receptor, but not sufficiently to allow the release of dopamine, which is important for the rewarding effects of nicotine. As an antagonist, varenicline also blocks the ability of nicotine to activate dopamine, interfering with the reinforcing effects of smoking, thereby reducing cravings and supporting abstinence from smoking.

Alcohol Addiction
Vivitrol (Extended Release Naltrexone) and oral Naltrexone

Naltrexone blocks opioid receptors that are involved in the rewarding effects of drinking and the craving for alcohol.

Acamprosate
Acamprosate (Campral®) acts on the gamma-aminobutyric acid (GABA) and glutamate neurotransmitter systems and is thought to reduce symptoms of protracted withdrawal, such as insomnia, anxiety, restlessness, and dysphoria.

Disulfiram
Disulfiram (Antabuse®) interferes with degradation of alcohol, resulting in the accumulation of acetaldehyde, which, in turn, produces a very unpleasant reaction that includes flushing, nausea, and palpitations if the patient drinks alcohol.

Can Addiction be Treated Successfully?
Yes. Addiction is a treatable disease.

Discoveries in the field of addiction have led to advances in drug abuse treatment that help people stop abusing drugs and resume their productive lives. However, research shows that combining treatment medications with behavioral therapy is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient’s drug abuse patterns and drug-related medical, psychiatric, and social problems.

How to Find An Addiction Specialist in your area?
To find an ASAM member go to the ASAM Physician Finder.

To find an ABAM certified physician go to the website of the American Board of Addiction Medicine (ABAM) and use the Find a Doctor tool.

Much of the content of this article was lifted from Policy Statements from The American Society of Addiction Medicine (ASAM) with permission and The National Institute of Drug Abuse (NIDA) which permits free dissemination of their content.

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