What is the greatest challenge in treating addiction?
Guilt. Feeling guilty about something that you’ve done doesn’t tend to drive change, and I don’t see it as something that’s beneficial. We’re looking to help somebody feel more hopeful about the future and when you feel guilty all the time about your relapse or the lies you’ve told, the people you’ve betrayed, the mistakes you’ve made, that leads somebody back to the bottle because they feel bad and then they go back to the thing they know will make them feel good. Guilt doesn’t drive change; hope drives change.
What do we know about the effects of substance use on the brain?
We’ve learned more about the brain and have been able to take highly refined images of the brain as a person is craving a drug or being reminded of a drug in some way. You can see unique neurological pathways that are present in a person who is dependent on substances that is not present in the general population. So we know that the architecture of their brain changes and continues to lead them back into behaviors they know are not healthy, that they know are not good for them. There’s a whole host of genes which are associated with our responses to substances of intoxication and there’s a whole bunch of vulnerabilities that are passed down through genes. We know that addictions are heavily loaded genetically and probably in very complex ways. It’s not a matter of one gene or two genes. There could be a family where one child develops an addiction and the other child develops depression and a third child doesn’t have either one because they got lucky and different genes mixed together in a way that they were spared.
How does this understanding help inform treatment and care?
We know that people can’t just walk away from an opiate addiction, and that their brains have changed. The only way they can feel healthy and normal again is with some sort of replacement therapy in a vast majority of cases. These replacement therapies are very safe and they relieve physical cravings and uncomfortable feelings of withdrawal that drive people back to using heroin or Percocet or hydrocodone or whatever opiate-related drugs they are using. They are able to take a medicine that doesn’t make them high, doesn’t make them want to steal all the money in their mother’s purse, doesn’t lead them into criminal activity or make them so drugged-up that they crash their car. But, it allows them to really get back on their feet and function normally.
What make addictions different from other illnesses?
Being able to put a label on a problem, especially in mental health or addiction, is hard. It’s very different from having a broken leg. You can point to your leg and say, “The rest of me is fine but my leg is broken so I need to see a doctor and get a cast on it.” But if you’re behaving in a way that you know is wrong but you don’t even know what can be done about it, you can’t really point to a place. Where would you point to? Addiction is something you do when you don’t even realize you’re doing it, like biting your nails.
Can recovery only happen after someone hits rock bottom?
Everybody’s story is unique and what their rock bottom is going to be. What we want to do as a health system is to create a place where whenever that person is ready to talk about it or ready to come in for help that we have the resources at our fingertips to provide that.
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