Dr. Kevin Most: Addiction
We always take the opportunity to discuss health related issues during this time segment, often it is after the diagnosis of someone in the news. We use this opportunity to educate and inform about a specific illness and what we can do to identify it, avoid it, and treat it. Unfortunately, there are some medical conditions that socially we don’t want to discuss. Addiction is one of them, many see it as a sign of weakness and embarrassment and thus avoid the discussion.
How about some stats to set the tone of this problem:
- 30 million individuals in the US used an illicit drug in the past month
- 22 million have a substance abuse disorder
- 54 million individuals have used prescription drugs for a non-medical reason some time in their life
- The US makes up 5 % of the worlds population yet we consume 80% of the worlds opioids
- 100 individuals a day day from opioid overdoses, oh and another 250 a day die from alcohol abuse
- There are 14,000 treatment centers in the US, which served only 12% of those needing care, many are full constantly
- Only 2.5 million individuals receive treatment each year
- Drug overdose deaths are now the number 1 cause of injury death in the United States
- The cost of these addictions related to crime, lost work and health care is $700 billion a year
- Much of that cost is shouldered by tax dollars and non for-profit hospitals
We hear daily about the war we are fighting about opioids in this country. Just last week the FDA approved a new opiate for patients with pain, in the past we would have celebrated the new drug as a new way to keep patients comfortable as they heal from an injury or illness. Not now, there was public outrage that the FDA had approved this new drug as we fight the war against the misuse and addiction of opioids.
If we go back to the formation of many of our discussion points have, we missed the opportunity to realize that an addiction is a medical condition and that we should use the celebrity status to again inform the public of the issues with addiction. Many may think that heroin use is only used in the alleys and drug houses in the city. Would it surprise you that experts now say that heroin or other opioids can be purchased at every high school in this listening area. This is a medical problem that must be dealt with and if celebrity sharing their stories will help, then let’s use it.
Historically we know that Charles Dickens used opiates daily. John Belushi died from an overdose, Elvis Presley was found to have various prescription painkillers in his system at the time of his death. We all remember two years ago the stunning news that Prince had died from an over dose of Fentanyl a very strong opioid. The recent focus on opioids should not be minimized, however the bigger focus should be on the problem with addiction in this country. Would it surprise you is I told you that estimates are that 1 in 8 American adults is an alcoholic. Now many will argue that the definition of an alcoholic is spread from mild, moderate or severe alcohol use or alcohol dependence. Many of us have lost a loved one due to the impact of DUI. I lost a cousin who was struck by a drunk driver. The impact is felt beyond the immediate family.
Remember when the story was cocaine as the big drug of abuse? Glad that is over? Well it is not. The media focus on opiates is apparent and needed but we need to understand that cocaine addiction is also making a comeback and cannot be overlooked. Would it surprise you that the number of overdose deaths due to cocaine in 2015 was the second highest number ever recorded. The percentages of individuals who have tried or continue to use cocaine is staggering and almost all of it is due to the increase crop in Columbia.
Marijuana is in the news daily as more states vote to allow recreational use as others expand the exceptions for medical use of marijuana. There are many that think that Marijuana is addictive, in fact the National Institute for Drug Abuse has its definition for Marijuana Addiction. Marijuana continues to be the most commonly used illicit drug in the US. Estimates are that up to 25 million Americans have used it illicitly in the past month. Recent surveys show that close to 25% of freshman in High School had used marijuana in the past year.
Why do we get addicted? For decades we thought that addiction was from a lack of will power, in fact many in the public continue to feel that way. These thoughts have lead people to believe this is not a medical condition and just a sign of weakness or bad morals. In fact, we still continue to punish for abuse rather than look at treatment options. It is said that Cook County Jail is the largest psychiatric hospital in the state. Many of those incarcerated are probably addicted in some fashion. The science of addiction and treatment of addiction has been studied and will continue to be studied as we look to improve on treatment success. This research has shown that addiction is a medical disorder that effects the brain. They have identified changes in brain activity for those addicted and are now using that information to develop effective prevention as well as treatment options. Even with all of the findings we still do not have a great understanding of why some individuals become addicted while others do not.
For many the addiction starts with an exposure that in some cases is due to a medical condition. In 2001, The Joint Commission rolled out to all providers that the level of pain should be considered the 5th vital sign. With that physicians and hospitals were pushed to eliminate pain as part of their accreditation. This was coupled with pharmaceutical companies coming out and saying that the new opiates were not addicting. When we put these two points together you can see how we got to the place we are now. Countries where opium is produced then walked in and fed the addiction that unfortunately had been started by treating a medical condition. Has this changed, absolutely, physician now look for non-opiate alternatives to treat pain or limit the number of narcotics given. Drug take back days encourage patients to return any unused medication that could lead or be abused by others with addiction.
Have we advanced treatment? The rate of relapse in the past was very high and continues to be above what we would like to see. The most staggering fact is that only 10% of individuals who need treatment actually receive it. This lack of treatment can be related to many factors. The three biggest are lack of awareness of the addiction, denial to the addiction and availability to treatment. Availability can be looked at from the view of actual treatment centers in your area to the fact that insurance coverage is lacking and thus not affordable for many. We think of drug and alcohol addicted individuals as non-working or homeless when in fact they are very small portion of the patients who are addicted. Many of those addicted are highly functioning individuals who are doing damage to not only themselves but also their family and the community.
Treatment in many cases has improved, we have medications that we can use that eliminate the pleasure associated with the addiction and help with addiction. For those fighting alcohol abuse the treatment should be started in a medical facilitiy as the stopping of alcohol can be dangerous and medical treatment is often needed. After the initial detox program, 12 Step programs and rehab programs are often helpful. There is also a medication called Antabuse which helps the body breakdown alcohol in a different fashion in the body. Taking this medication and drinking will cause the individual to become very ill. This is good for individuals who are at their last chance with their family or employer. Naltrexone is a drug that takes away the pleasure associated with drinking alcohol that some expierieince. Other medications like Campral can help with the side effects of withdrawl that can often be felt for months.
Opiate addiction is one of the strongest addictions and in some people it can occur after just a few doses. For treatment of opiate addiction, we have a medication called suboxone. This is a medication that is able to reduce the symptoms of opiate addiction and withdrawl. The downside of this medication is can also be addictive. It is a very popular drug when treating an opioid addict who wants to quit. Treatment consists of using the drug to wean the individual from their addiction. This is a multi billion dollar drug, which just shows us the demand for those who need treatment.
The number of treatment centers in this country is lacking. One of the reasons is the lack of reimbursement for treatment form the insurance side. Without adequate reimbursement you do not see many centers being developed even as the demand increases. That combination shows simple market economics, the patient with good insurance and the ability to pay has a better chance of getting in a treatment center than those with poor or no insurance. This a social issue that we need to figure out quickly. Without the ability to get treatment addicts will usually fall back to their addiction until they hit rock bottom with their family or in many cases with overdose.
We all have heard of the Betty Ford Treatment Centers, they have partnered with Halzelden and have treatment centers across the country. There are many high-end treatment centers that rival many 5 star resorts so you can imagine the cost of these programs is well outside the reach of the common patient. In the Chicago area we are very fortunate to have some great treatment centers, Gateway, Rosecrance, Banyan along with many hospitals and health systems that offer drug and alcohol rehabilitation programs. Each of these sites are filled with professionals that understand the addicition issue, treatment issues and relapse avoidance issue. The patient who admits to their addiction and wants treatment is best served doing it thru a professional resource rather than thinking they can do it alone.
One of the biggest messages of the day is the help needed in identifying the individuals in need of help and addressing it with them. Too many families and friends probably know of an individual who is addicted but do nothing to help the individual. We understand it is difficult as often it is a family member or dear friend and discussing the issue many fell may lead to a loss of friendship. Getting to the point of helping someone takes courage and in some cases time. We encourage you not be an enabler and start with subtle actions. For each it is trying to avoid the situation where the addiction is fueled, for the alcoholic, stop drinking yourself when out, end the night earlier, attend events where alcohol is not served. It does take strength to address an addiction with a friend or family member. It also will live with you forever if that addicted individual harms themselves or others.
If you have friends who have gone thru treatment understand that they may not want to go back into the environment that lead to their addiction but in all cases still need friends and support to lower the chance of a relapse. The individual who has beat an addiction is proud and that pride should be acknowleged when possible.
There is a lot of reaserch going on for many addictions. Certainly there is a big focus on the two biggest concerns which are opioids and alcohol. A donation to NIDA National Institute on Drug Abuse will be used to fund research to help us with this disease that we often are afraid to discuss.