Pubdate: Thu, 27 Feb 2003
Source: Sun Herald (MS)
Copyright: 2003, The Sun Herald
Contact:  http://www.sunherald.com
Details: http://www.mapinc.org/media/432
Author: Bonnie Erbe

AN ADDICTION NEED NOT LAST FOREVER

Call me a reformed non-believer. For the longest time I had given up on 
peoples' ability to change. But new data convinces me substance abusers can 
free themselves from addictive and harmful behaviors (smoking, drinking, 
drug abuse) in much greater percentages than we ever imagined.

Researchers have developed mountainous advances in the field of substance 
abuse during the last 15 years. We now understand so much more about how 
addictive chemicals (alcohol, tobacco, opiates) change brain function.

Using this newfound knowledge, doctors and treatment experts combine 
pharmacological and therapeutic intervention to boost success rates.

On the pharmacological side, methadone and lesser-know drugs such as 
buphrenophine ease withdrawal from opiates. Naltrexone ameliorates alcohol 
cravings. On the psychological side, researchers have a much clearer idea 
of the social and emotional factors that send people down the long, hard 
road to substance abuse. This in turn gives people the tools they need to 
control and overcome harmful behaviors.

One leading researcher is Dr. James Prochaska, professor of clinical and 
health psychology at the University of Rhode Island. Dr. Prochaska last 
year won an "Innovator Award" from the Robert Wood Johnson Foundation for 
his path-clearing research, revolutionizing the field of substance abuse 
treatment and prevention.

What he's done seems simple on the surface, but its impact is nothing short 
of amazing. Dr. Prochaska developed a phased-in view of abusers, 
recognizing for the first time they are not one indistinguishable mass.

Rather, counselors achieve much higher success rates when they recognize an 
addict or abuser's ability and desire to change progresses in distinct 
phases, and then tailors an approach to a particular abuser's situation.

Those stages are:

Precontemplation - Abusers have no current intention of changing. They use 
hopelessness, denial and defensiveness to fend off change.

Contemplation - Contemplators accept or realize they have a problem and 
begin to think seriously about changing it.

Preparation - People in this stage are planning to take action within a 
month. Smart preparation includes a detailed scheme for action.

Action - This stage speaks for itself. The person takes action and makes a 
commitment.

Maintenance - Often more difficult than action, maintenance can last six 
months to a lifetime.

Termination - The temptation to abuse substances is gone. Some experts 
believe termination never occurs, only that less vigilance is required over 
time.

Why is this work so important? According to some of Dr.'s Prochaska's 
followers, by delineating stages he explains why abstinence-oriented 
substance abuse treatment models fail 80 percent of the time and more. It 
is too much to expect people to leap from a state of "ignorance combined 
with lack of motivation," directly into action. First, abusers and addicts 
must recognize they have a problem and then decide they want to change.

There's another piece we need to address. Society makes it harder to get 
treatment than it is to acquire abusive substances - be they tobacco, 
alcohol, prescription drugs or illegal drugs. President Bush took the 
unusual step of trying to change this in his State of the Union address.

He devoted two minutes of the speech (more than any prior president) to 
substance abuse treatment. He promised a $200 million boost in federal 
spending on treatment. Now he must match his words with deeds.

American taxpayers spend $11 billion per year on treatment already, or 
roughly one-third the amount we spend on the war on drugs. That figure is 
also less than 1 percent of what we spend on health care overall. The 
president's proposed increase, forward-looking as it is, represents an 
increase of one-thirtieth of one percent in spending on treatment.

Throw this information into the mix. We are able to offer treatment to 3.1 
million out of 16.6 million Americans who told the 2002 National Household 
Survey (a federal survey) they have problems with or are addicted to 
alcohol and drugs.

All told, does this mean we are doing enough to change destructive 
behaviors? I used to think so. I don't anymore.

Bonnie Erbe, host of PBS' "To the Contrary," writes for Scripps Howard News 
Service,
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MAP posted-by: Larry Stevens