Tag Archives: Brain

What Does It Mean When We Call Addiction a Brain Disorder?

When the 2016 Florida Legislature allocated funds for the formation of the Palm Beach County Sober Homes Task Force, my first instinct was that the State of Florida was looking at the conundrum we here in South Florida were facing through the wrong shade of glasses. To target “sober homes” was simply feeding into the local movement to eradicate addicts in recovery from living amongst society, a long-standing issue which required the U.S. Department of Justice to intervene nationally under the Fair Housing Act and the Americans with Disabilities Act.

The “problem” that we were all experiencing was not “sober homes” [a term, by the way, which has taken on a pejorative meaning, and therefore now rightfully distinguished as either a “Recovery Residence” or a “flop house”], but rather the economy created within the health care sector for delivery of clinical services; the “churn and burn” of patients’ insurance benefits. Law enforcement and government regulators were unable at the time to grasp the vast underground network that was truly the foundational underpinning of everything that was going wrong. Flop houses were merely the effect; the cause was the demand from “health care entrepreneurs” for bodies to put through the machine to bill insurance and make money and the failure of the entire system to sufficiently develop a standard for treatment and post-treatment recovery that health insurance would be required to pay for as being “medically necessary.” This disconnect was further exacerbated by old school, traditional ways of recovery, such as AA and sober living providers, for whom “treatment” was not available decades ago, and who today understandably question the “medicalization” of addiction treatment and care.

As one of the original appointees to the Task Force, it was a pleasant surprise to find that the Palm Beach State Attorney’s Office inherently understood this as well. Their focus was on the entire health care industry serving those afflicted with Substance Use Disorder, and would NOT allow itself to be used as a puppet to develop more sophisticated exclusionary zoning tactics that for far too long had been used to ostracize addicts from cities and make access to care difficult at best. The empaneling of the Palm Beach Grand Jury to study the entire industry simply underscored and emphasized Dave Aronberg’s commitment to fact-finding.

The “Proviso Committee” of the Task Force were made of up health care practitioners, government officials, and industry representatives, who themselves, as a committee, would examine the modern paradigm of addiction care and associated recovery organizations to make recommendations to the Florida Legislature on how to effectively address where the wheels came off the wagon in Palm Beach County and to prevent similar issues developing statewide. Mr. Aronberg noted early on both that “we can’t arrest our way out of this problem” and that addiction treatment and recovery communities have been a long-standing, respectable, and honorable part of the fabric of Palm Beach County.Early on, the Task Force came to recognize the disparate opinions within the field itself. While some felt strongly the focus should be on recovery support services, others leaned towards a medical model of care (to include MAT). Advocates on both sides seemed (and appear to continue to be) at odds over what is the “right” way to address the current opioid epidemic, and well as how to define “best practices” for our future. Even those on the medical/clinic side seemed to debate whether addiction was rightfully classified as a “disease” or a “brain illness.”

As our science has evolved (rather quickly, it seems of late), Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), which is part of the National Institutes of Health (NIH), attempted to address the medical side of addiction care and the role that recovery support services has, in her article published in Scientific American entitled “What Does It Mean When We Call Addiction a Brain Disorder?” In the article, she writes:

Yet the medical model of addiction as a brain disorder or disease has its vocal critics. Some claim that viewing addiction this way minimizes its important social and environmental causes, as though saying addiction is a disorder of brain circuits means that social stresses like loneliness, poverty, violence, and other psychological and environmental factors do not play an important role. In fact, the dominant theoretical framework in addiction science today is the biopsychosocial framework, which recognizes the complex interactions between biology, behavior, and environment.

Critics of the brain disorder model also sometimes argue that it places too much emphasis on reward and self-control circuits in the brain, overlooking the crucial role played by learning. They suggest that addiction is not fundamentally different from other experiences that redirect our basic motivational systems and consequently “change the brain.”

Some critics also point out, correctly, that a significant percentage of people who do develop addictions eventually recover without medical treatment. It may take years or decades, may arise from simply “aging out” of a disorder that began during youth, or may result from any number of life changes that help a person replace drug use with other priorities. We still do not understand all the factors that make some people better able to recover than others or the neurobiological mechanisms that support recovery—these are important areas for research.

But when people recover from addiction on their own, it is often because effective treatment has not been readily available or affordable, or the individual has not sought it out; and far too many people do not recover without help, or never get the chance to recover. More than 174 people die every day from drug overdoses. To say that because some people recover from addiction unaided we should not think of it as a disease or disorder would be medically irresponsible. Wider access to medical treatment—especially medications for opioid use disorders—as well as encouraging people with substance use disorders to seek treatment are absolutely essential to prevent these still-escalating numbers of deaths, not to mention reduce the larger devastation of lives, careers, and families caused by addiction.

My takeaway from this is article is that my layperson opinion remains unchanged – medical treatment and recovery support services are the “yin” and “yang” of the same medallion. They cannot be separated but rather should be integrated into a continuous model towards sustainable recovery. Each path is different, as each person’s genetics as well as upbringing and life-experiences are unique. We are each a small universe onto ourselves. Therefore, it is my opinion that the billions of dollars being thrown into the “medical” side of the equation but failing entirely to fund the “recovery” side is to simply a band-aid. While I recognize and appreciate American hesitancy to adopt a welfare state for anyone, including the disabled, we must therefore double our efforts to fund and explore brain science so that effective modalities can be implemented which provide people seeking recovery with an accelerated jump start. Medication-Assisted Treatment is but one of those more recent efforts. But we can do more, and as a nation, should spend more, doing so.

What We Are Reading This Week From Across the Nation

A lot of reporting in the treatment space over the past few days, and we appreciate the Kaiser Family Foundation for aggregating the stories so we can provide them to you here.

  1. Drug Overdose from Fentanyl Spinning Out of ControlThe New York Times: The First Count Of Fentanyl Deaths In 2016: Up 540% In Three Years
    Drug overdoses killed roughly 64,000 people in the United States last year, according to the first governmental account of nationwide drug deaths to cover all of 2016. It’s a staggering rise of more than 22 percent over the 52,404 drug deaths recorded the previous year — and even higher than The New York Times’s estimate in June, which was based on earlier preliminary data. (Katz, 9/2)
  2. Controversial Nomination for Director of Office of National Drug Control Policy
    Stat: Trump Nominates Republican Congressman Tom Marino As Drug Czar 
    President Trump on Friday nominated Rep. Tom Marino (R-Pa.) to lead the Office of National Drug Control Policy as the nation’s “drug czar,” months after he had officially withdrawn from consideration. Marino, an attorney who has served in the House of Representatives since 2011, has a lengthy track record of supporting enforcement-side drug policy as well as improved drug treatment. (Facher, 9/2)
  3. Abuse of OTC Drugs Can Be Harmful As Well
    The New York Times: Opioids Aren’t The Only Pain Drugs To Fear 
    Last month, a White House panel declared the nation’s epidemic of opioid abuse and deaths “a national public health emergency,” a designation usually assigned to natural disasters. A disaster is indeed what it is, with 142 Americans dying daily from drug overdoses, a fourfold increase since 1999, more than the number of people killed by gun homicides and vehicular crashes combined. A 2015 National Survey on Drug Use and Health estimated that 3.8 million Americans use opioids for nonmedical reasons every month. (Brody, 9/4)
  4. Private Equity Continues Investment in Drug Treatment Facilities in 2017
    The Wall Street Journal: Private-Equity Pours Cash Into Opioid-Treatment Sector 
    Private-equity firms are piling into a new business opportunity: the opioid addiction crisis. Drawn by soaring demand, expanded insurance coverage and the chance to consolidate a highly fragmented market, firms plowed $2.9 billion into treatment facilities last year, up from $11.4 million in 2011, according to research firm PitchBook Data Inc. The number of private-equity deals rose to 45 from 25. (Whalen and Cooper, 9/2)
  5. The Science of Addiction – Do We Finally Have the Tech to See Inside the Brain?
    The Washington Post: Addiction And The Brain 
    Today’s war on drugs isn’t fought by first ladies or celebrity advocates. Armed with MRI machines, electromagnetic pulses and experimental drugs, scientists are on the battle’s front lines. In the cover story of September’s National Geographic, Fran Smith explores the different fronts of a war being fought in laboratories and universities all over the world. Armed with the tools of science and with the help of people who struggle with addictions to substances and self-destructive behavior, researchers are working to unravel the mysteries of the addicted brain. (Blakemore, 9/2)
  6. Crystalmeth Continues Its Journey Outside Rural America and Into Our Cities.
    The Wall Street Journal: Drug Traffickers Push Meth Into New York City  
    Mexican traffickers are supplying the New York City area with methamphetamine, attempting to create new clients in what historically has been a weak market for the drug. “The Mexican cartels have been sending loads up to New York and telling traffickers, ‘See if you can get customers,’ ” said James Hunt, special agent-in-charge of the Drug Enforcement Administration’s New York division. “They want to create an addict population.” (Ramey, 9/4)
  7. Vivitrol Marketing Continues to Capture the Attention of State Funded Programs.
    New Orleans Times-Picayune: Louisiana Prisons Start Administering New Drug To Treat Opioid Addicts  
    The use of Vivitrol is the latest trend in opioid treatment. In the first quarter of 2017, Vivitrol sales totaled $58 million, a 33 percent increase over the previous year, according to a June report by ProPublica. Several state prisons, including those in Illinois, Wyoming and Wisconsin, started administering the drug to inmates last year. Even more drug courts and local jails are using it: ProPublica tallied up more than 450 public Vivitrol initiatives in 39 states. (O’Donoghue, 9/1)
  8. The War on Drugs and Caring for the Addicted Inmate.
    The Baltimore Sun: Baltimore County Facing Higher Costs For Inmate Care Due To Addiction, Mental Health Services  
    The cost of providing medical care for inmates at the Baltimore County jail in Towson is rising more than 50 percent — several million dollars a year — due primarily to an increase in inmates and detainees with opioid addiction, mental illness or chronic diseases. The County Council is set to vote Tuesday on a contract for a private company, PrimeCare Medical, to manage medical, dental and behavioral health treatment for the jail’s roughly 1,200 inmates. (Wood, 9/5)
  9. Recovery High Schools – the Continuation of Recovery Educated-Based Programs.
    St. Louis Public Radio: New Missouri High School Will Help Teens Struggling With Addiction Avoid Temptations 
    Teens who struggle with drug and alcohol abuse face many temptations after complete treatment. A new private high school opening soon in suburban St. Louis will offer them an educational environment free of some of those potential triggers. (Delaney, 9/4)
  10. Is Insurance Also to Blame for Addiction?
    Idaho Statesman: Insurers Tell Idaho Pain Patients: Try More-Addictive Drugs 
    In at least three cases, patients with Regence BlueShield of Idaho plans were denied Radnovich’s choice of a Butrans patch — a long-acting version of the opioid buprenorphine that is “Schedule III,” with a “moderate to low potential for physical and psychological dependence.” Instead of the patch, Regence was willing to pay for a fentanyl patch or morphine tablets. (Dutton, 9/4)