Pubdate: Tue, 15 Aug 2006 Source: Charlotte Observer (NC) Copyright: 2006 The Charlotte Observer Contact: http://www.charlotte.com/mld/observer/ Details: http://www.mapinc.org/media/78 Author: William Celis /Public Access Journalism Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal) Bookmark: http://www.mapinc.org/coke.htm (Cocaine) Bookmark: http://www.mapinc.org/heroin.htm (Heroin) Bookmark: http://www.mapinc.org/rehab.htm (Treatment) PIONEERING RESEARCH, EVOLVING ATTITUDES ENHANCE RECOVERY OPTIONS Hospitals and treatment centers are making stronger efforts to prevent people with addictions from falling through the cracks as they are passed between institutions. New and effective medicines now suppress drug cravings. Joseph Bryant's seventh -- and last -- try to overcome his addictions, in 2004, couldn't have been better timed. Bryant tried repeatedly to kick addictions that began with alcohol when he was 10, heavy marijuana use in his teens, and topped by a $700-a-day heroin habit in his 20s. After he served prison sentences for car theft and drug peddling, and lived in abandoned houses at the age of 27, he realized he had to change his life, or he would find himself, as he put it, "in jail for the rest of my life or dying on the streets of Baltimore." Even as he bounced in and out of a string of ineffective treatment centers, innovative research and changing attitudes about drug addiction, treatment and recovery were starting to take hold. The strongest treatment programs have always offered a variety of services or connected critical lifelines for their clients. But the push across the country is fueled by groundbreaking brain research in the late 1990s that indicates addiction isn't driven by weak character, loose morals or lax discipline. While downing those first few drinks or pills may be a choice, many studies indicate that addiction is a matter of genetics for up to half of addicted Americans. Researchers at Brookhaven National Laboratory in Upton, N.Y., documented alterations in the brain linked to drug abuse, alcoholism or other impulse behaviors that suggested a genetic predisposition to addiction. This has led to a growing sense that a connect-the-dots approach is needed at every turn to help people such as Bryant, who has been clean since that summer two years ago. Bureaucratic, financial barriers "The treatment is beginning to catch up with research," said Thomas McLellan of the Treatment Research Institute in Philadelphia, a think tank that attempts to influence clinical practice and public policy. "This will save a ton of money and, more importantly, lives."At the same time, medical, addiction and treatment experts are paying attention to "the continuum of care" -- addiction treatment and recovery for patients who work with a variety of specialists on the way to new lives. Stigmas and misconceptions about addiction hinder vital partnerships between institutions and make it harder for patients to talk to their doctors about their problem. Health-care providers also make it exceedingly difficult for people with addictions to get help; insurers limit coverage, leading to what amounts to a class divide in treatment. Services can exceed $20,000, and many Americans struggle to find financial help or go without. Addiction also gets relatively low priority in the medical community, starting with training. That's important, because physicians, researchers say, are key in making the link between addiction and chronic disease, a connection that historically hasn't been strong. "As a country, we took alcoholism out of the medical milieu," said Dr. Jennifer Smith, a physician at John Stroger Hospital of Cook County in Chicago and a professor at Rush Medical College. "For many years, addiction didn't belong to doctors. This is changing with time." Higher risk for family members If addicts today stand a much stronger chance of getting and staying sober and clean, science is largely the reason. While environment and stress play a role, the studies indicate strong genetic and biological links passed through addicted parents make offspring more susceptible to addiction. If your parents or siblings are hooked on alcohol or drugs, these studies concluded, you have a 50 percent chance of addiction; some studies put the likelihood of addiction as high as 70 percent. What's more, once addicted, the part of the brain linked to the pleasure-reward system heightens cravings for the drug, so trying to stop addiction without treatment is nearly impossible. Pharmaceutical companies have responded with three different drugs to combat the cerebral cravings: buprenorphine, acamprosate and naltrexone. The drugs, available only this decade under a variety of commercial brands, are designed to curb or even eliminate cravings and cut the side effects of withdrawal for alcohol and specific drugs, such as opiates, marijuana and cocaine. The drugs alone don't ensure successful recovery; they need to be part of a larger strategy, doctors say. But the medicines, taken over days, months or years, have offered new hope. $19,000 bill; small orange pill For Bryant, one new medicine provided the antidote to failed recovery efforts, when, he says, treatment centers "didn't pay attention to details. There was no one-on-one to help you find out why you were on drugs. Therapy was not available."On his last try, Bryant turned to an uncle in New York, who enrolled him in a Phoenix House treatment facility in Brooklyn, N.Y. What Bryant found there is everything researchers and social scientists recommend in a drug rehabilitation and recovery program -- beginning with buprenorphine. The small orange pill, quickly dissolved under his tongue, eliminated Bryant's cravings. The intense physical pain common to withdrawal was so minimal that Bryant found he could sleep through the night. "I could eat," he said. "The hot and cold sweats, the chills -- the drug minimized all of that." Within his first week of treatment, Bryant was off buprenorphine and transferred from his detoxification room to a bed under the same roof, a logistical godsend at a critical time in treatment. Following his previous detox experiences, he had been sent to recovery centers often miles away; sometimes they had available beds, but more often Bryant had to wait two or three days -- and invariably found himself back on drugs. Bryant had to use Medicaid to pay for his treatment and recovery at Phoenix House, the nation's largest nonprofit addiction treatment and recovery organization, which charges $19,000 a year. Drug-free for 18 months and in the last stages of his recovery program, Bryant still lives there, leasing a room for $15 a week until he saves enough money from his job as a carpenter to find his own place. Housing assistance is key, Phoenix House officials say, because the low-cost shelter allows patients a solid shot at long-term stability as they piece together their lives. Said Bryant: "I take my life one day at a time." About This Story Public Access Journalism collaborates with news organizations and foundations to bring solutions to life's challenges. PAJ translates research on health, education, cultural and environmental issues for each project. This story was distributed free through McClatchy-Tribune News Service, a global service owned by McClatchy (the Observer's parent) and Tribune Co. For information: www.pajournalism.com. Resources . Substance Abuse Prevention Services (formerly Drug Education Center), 704-375-DRUG (3784).. Chemical Dependency Center, 704-376-7447. . Mecklenburg County Substance Abuse Services Center, 704-336-3067. . McLeod Addictive Disease Center, 704-332-9001. . Alcoholics Anonymous, 704-332-4387. . Mental Health Association of Central Carolinas, 704-365-3454. - -- Karen Garloch Finding Help HOT LINES AND LOCATORS . Substance Abuse Treatment Facility Locator: www.findtreatment.samhsa.gov/facilitylocatordoc.htm -- Searchable directory of treatment programs nationwide. . Buprenorphine Physician Locator: www.buprenorphine.samhsa.gov/bwns-locator/index.html -- Resource designed to help states, medical and addiction treatment communities, patients and families locate physicians who can prescribe buprenorphine (Suboxone and Subutex ) for treatment of opioid addiction. . National Helpline: www.samhsa.gov -- Hot line offering confidential information on treatment and referral. . National Committee for Quality Assurance: www.ncqa.org -- Online report cards on health plans that lets you compare hundreds of health plans, Medicare and Medicaid, for the best treatment coverage. . More info: www.silenttreatment.info. [Sidebar] 5 Addiction Myths . Myth 1: Drug addiction is voluntary behavior. Occasionally using alcohol or other drugs is a voluntary decision. Over time, continued use of addictive drugs changes your brain in ways that result in compulsive and even uncontrollable drug use. . Myth 2: Drug addiction is a character flaw. Drug addiction is a brain disease. Every type of drug -- from alcohol to heroin -- has its own mechanism for changing how the brain functions. Effects range from changes in the molecules and cells that make up the brain to mood and memory processes -- even on motor skills such as walking and talking. . Myth 3: You can't force someone into treatment. Treatment does not have to be voluntary. Those coerced into treatment by the legal system can be just as successful as those who enter treatment voluntarily. Myth 4: Treatment for drug addiction should be a one-shot deal. Some people can quit drug use cold turkey, or they can stop after receiving treatment one time. Most people who abuse drugs require longer-term treatment and, in many instances, repeated treatments. . Myth 5: No one voluntarily seeks treatment until they hit bottom. Pressure from family members and employers, as well as personal recognition that they have a problem, can be powerful motivators. For teens, parents and school administrators are often driving forces in getting them into treatment before situations become dire. - -- Public Access Journalism - --- MAP posted-by: Beth Wehrman