Drug Addiction Is A Disease

  So What Do We Do About It?

Addiction has many dimensions and disrupts many aspects of a person’s life. Scientific research and clinical practice have yielded a variety of effective approaches to treatment for addiction to certain drugs, such as heroin. Continuing research is yielding new approaches to developing medications to treat addiction to other drugs, such as cocaine, for which no medications are currently available.

Drug abuse and addiction lead to long-term changes in the brain’s chemistry and anatomy. The changes in the brain cause drug addicts not only to lose the ability to control their drug use, but their addiction also changes all aspects of their lives. Drug addicts often become isolated from family and friends and have trouble in school or work. In addition, the compulsive need for drugs can lead to significant legal problems. While the biological foundation for drug addiction does not absolve an individual from the responsibility of his or her actions, the stigma of drug addiction needs to be lifted so individuals may receive proper medical treatment, similar to that for other chronic diseases.

Addiction is a recurring chronic disease.

No cure is available at this time, but addiction can be treated effectively. Drug addiction is often viewed as a lapse in moral character. This value judgment influences how society deals with the disease, both socially and medically. Unfortunately, because people, including physicians, have often viewed addiction as a self-inflicted condition, drug addicts have not always received the medical treatment common for other chronic diseases. Treating addiction requires more than a “just say no” approach.

Treatment for addiction is often very effective. Treatment is successful when the addict reduces or abstains from drug use, improves his or her personal health or social function, and becomes less of a threat to public health and safety. Certain addictions, such as heroin addiction, can be treated with pharmacological agents.

Methadone, the most common pharmacological treatment, prevents craving and withdrawal symptoms in heroin addiction. Methadone is an opiate receptor agonist. That is, methadone binds to the opiate receptor just as heroin does. Methadone, however, does not produce the euphoria or “high” that results from heroin use.

Methadone as dispensed at a Methadone Maintenance Treatment Facility.

Methadone is a synthetic opioid that is typically administered orally as a liquid.  Methadone is the medication  that  is most commonly used for Opiate Agonist Pharmacotherapy of opioid dependence.  Methadone maintenance treatment is also an extensively researched treatment modality. There is strong evidence, from research and monitoring of service delivery, that Opiate Agonist Pharmacotherapy Maintenance  with methadone 9Methadone Maintenance Treatment) is effective in reducing illicit drug use, reducing mortality,reducing the risk of spread of HIV, improving physical and mental health, , improving social functioning and reducing criminaility.  HIgher doses of methadone are generally associated with greater reductions in heroin use than either low or moderate doses.

Methadone Maintenance Treatment is associated with a low incidence of side-effects and with sustantial health improvements.  Around three-quarters of people who commence "Opiate Agonist Pharmacotherapy" with methadone respond well. However, for various reasons , methadone does not suit all people with opioid dependence.  For this group it is important that alternative approaches are available to encourage their retention in treatment. Some require several episodes of treatment before major progress is achieved. 

As second medication prescribed for heroin addiction is naltrexone. Unlike methadone, naltrexone is an opiate receptor antagonist. Instead of competing with heroin for the opiate receptor, naltrexone prevents heroin from binding to the receptor, thereby preventing heroin from eliciting the euphoric high.

Buprenorphine is a prescribed medication with weaker opioid agonist activity than methadone. Buprenorphine is not well absorbed is taken orally, therefore the usual route of administration in treatment of opioid dependence is sublingual. With increasing doses of buprenorphine, effexts reach a plateau.  Consequently buprenorphine is less likely than either methadone or heroin to cause an opioid overdose condition, even when taken with other opioids at the same time. The effectiveness of buprenorphine is similar to that of methadone at adequate doses, in terms of reduction of illicit opioid use and improvements in psychosocial functioning, but buprenorphine may be associated with lower rates of retention in treatment. Buprenorphine is currently more expensive than methadone.

Suboxone (Buprenorphine and Naloxone)

Buprenorphine is acceptable to heroin users, has few side effects, and is associated with a relatively mild withdrawal syndrome. When used in Opiate Agonist Pharmacotherapy for pregnant women with opioid dependence, it appears to be associated with a lower incidence of neonatal withdrawal syndrome.

Dihydrocodeine is used in some countries for detoxification and Opiate Agonist Pharmacotherapy.  Tincture of opium (laudanum) is used in some countries in Asia for the management of opioid withdrawal and, less commonly, for Opiate Agonist Pharmacotherapy.  The various oral preparations of morphine formulated to provide slow release ( also called sustained release, controlled release and timed release preparations) are also of potential value in the treatment of  opioid dependence.  However, controlled studies of the effectiveness of these preparations for Opiate Agonist Pharmacotherapy  are yet to be undertaken.

Pharmacological therapies, if available, are not sufficient for effective treatment. Behavioral treatment in combination with pharmacological treatment is the most effective way to treat drug addiction. Recovering addicts need to address the behavioral and social consequences of their drug use and learn to cope with the social and environmental factors that contribute to their illness. Behavioral treatments can occur either individually or as a group.

Relapse is a common event for recovering drug addicts. In many ways, relapse should be thought of as a normal part of the recovery process. A recovering drug addict is more likely to experience a relapse if he or she also has other psychiatric conditions or lacks the support of family and friends.

Despite the preconceptions and value judgments many people place on addiction, it is, in many ways, similar to other chronic diseases such as diabetes and coronary artery disease. Genetic, environmental, and behavioral components contribute to each of these diseases. Some people may argue that drug addiction is different because it is “self-inflicted.”

The initial choice to use drugs is voluntary but, once addiction develops, drug use is compulsive—not voluntary. Moreover, voluntary choices do contribute to the onset or severity of other chronic diseases as well. For example, a person who chooses to eat an unhealthy diet and not exercise increases his or her risk for coronary heart disease.

Successful treatment for any chronic disease necessitates patient compliance with the prescribed treatment regimen. Adhering to a treatment plan is difficult for those with any chronic disease. Less than 50 percent of diabetics follow their routine medication plan, and only 30 percent follow their dietary guidelines. Problems adhering to a treatment plan lead to about 50 percent of diabetics needing to be treated again within one year of diagnosis and initial treatment. Similar statistics hold true for other chronic diseases: approximately 40 percent of patients with hypertension need emergency room treatment for episodes of extreme high blood pressure, and only about 30 percent of adult asthma sufferers take their medication as prescribed.

Although treatment for drug addiction statistically is more successful than treatment for other chronic diseases, drug addicts commonly have relapses during treatment and recovery and begin using drugs again. The difficulties in following a treatment plan and coping with the stresses of a chronic disease illustrate how difficult changing human behavior is.

Scientific research is likely to change how drug addiction is treated. Research to understand how the brain works and how drugs cause changes in the chemistry and function of the brain may lead to new medications to treat disease. Scientists continue to work on developing medications that relieve the cravings, experienced when drugs are withdrawn. Also, scientific advances may reveal ways to reverse the long-term damage to the brain that drugs inflict.

References:  (1) The Brain:  Understanding Neurobiology Through The  Study of Addiction Lesson 5~Drug Addiction Is A Disease  So What Do We Do About It? NIH/National Institute on Drug Abuse
                    (2)    WHO/UNODC/UNAIDS position paper; Substitution TherapyIn TheManagement of Opioid Dependence 
 and HIV/AIDS 2004 

Compiled & Edited By:  D. Shrira      Dated:  January 12, 2007

Asst. Editor: Dee Black                           Updated: March 16, 2012