Drug, alcohol abuse finally being seen as a health issue
Posted: March 14, 2008
Renie Schapiro
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In nearly three years of writing this column, I have yet to write about drug or alcohol abuse, even though they are major public health problems. My neglect of these topics may reflect the challenge that substance abuse has faced becoming part of mainstream medicine and public health.
People with abuse problems are more likely to be "treated" by the criminal justice or social welfare system than the health care system.
But driven largely by neuroscience research over the past couple of decades, addiction is increasingly being regarded as a brain disease rather than stigmatized as self-imposed bad behavior.
And as substance abuse has come into the health tent, important advances both in treating and preventing addiction have emerged.
Neuroscience has been generating dramatic images of specific brain changes associated with the loss of control that addicts experience. And it is fascinating that once a person has broken the addiction, the images show the brain can return to normal.
Experts speak of addiction "hijacking" the brain as the pleasure centers that reward us for survival behaviors like eating and sex come to drive the addict's cravings for alcohol and drugs.
This research has led to new, more effective pharmacologic treatments for treating addiction. But it is hardly as easy as taking a pill. Addiction treatment is a long, difficult haul that requires hard work and commitment from the patient.
It is tragic that even when patients are ready to make that commitment, they often face substantial bureaucratic and financial obstacles, including wait times of several months, to get treatment.
Treatment supported
The health care system's historic marginalization of addiction is nowhere more blatant than in our reimbursement policies. But earlier this month we had some promising news on that front.
The U.S. House of Representatives passed a bill requiring most group health plans to provide more generous coverage for addiction treatment and mental health services. Similar legislation has already passed the Senate.
Addiction treatment suffers from a double-standard when it comes to what constitutes effective treatment.
Chemotherapy with a 25% success rate is a valued part of the cancer treatment arsenal, while the same success rate at a drug treatment program could shut it down.
This double-standard creates a widespread feeling of hopelessness about treatment that many addiction experts are trying to reverse.
Richard L. Brown, a University of Wisconsin family physician and expert in alcohol and drug problems, says we should think of addiction as a chronic condition like diabetes, asthma or hypertension.
We don't expect a short-term cure for these conditions. We wouldn't, he points out, discontinue a diabetic patient's insulin or stop treating patients with hypertension. Instead, they receive ongoing therapy that improves their symptoms, function, quality of life and lifespan.
New strategy
Such new approaches are critical, but some of the most exciting news comes from studies showing that simple screening and interventions can keep many people from becoming addicted in the first place.
And Wisconsin is putting that research into practice.
Brown is leading the effort through the Wisconsin Initiative to Promote Healthy Lifestyles, with a $12.6 million grant from the federal Substance Abuse and Mental Health Administration.
Patients at 21 primary-care clinics are being asked four simple questions about their alcohol and drug use. Those found to be at risk are referred for one-to-three sessions with a health educator. This is often enough to have a significant impact on their use of alcohol or drugs.
Patients needing more intensive therapy - about 6% of those screened - are referred for treatment, with some financial support available.
The program can head off addiction in individuals before their brains are "hijacked" when they have more control over their behavior, says Brown. And there are more of these at-risk patients than those who are already addicted.
About 5% of primary-care patients already are alcohol-dependent, he says. But another 8% are suffering the health or social consequences of their use and another 9% may soon if they don't change their behavior.
"That's more than three times as many not yet dependent," says Brown, "and with a pretty simple intervention we can really change the course of their lives."
More clinics will be added this spring.
Renie Schapiro works at the University of Wisconsin School of Medicine and Public Health on the Innovations in Medical Education Team. Her column usually appears on the third Monday of each month. She can be reached at renieschapiro@hotmail.com.
From the March 17, 2008 editions of the Milwaukee Journal Sentinel
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