Pubdate: Sun, 24 Apr 2016
Source: Orlando Sentinel (FL)
Copyright: 2016 Orlando Sentinel
Contact:  http://www.orlandosentinel.com/
Details: http://www.mapinc.org/media/325
Note: Rarely prints out-of-state LTEs.
Author: Kate Santich

SCIENCE OF ADDICTION IS CHALLENGE TO APPLY

He was 40 years old, a father of three and an Orlando house painter, 
clean and sober for eight years. One night last summer, he climbed 
into his truck, stuck a needle in his arm and injected himself with 
what would be his final dose of heroin.

"The paramedics worked on him for a long time... and when they 
declared him dead, he was still clutching his last bag of the drug in 
his fist," says Pastor Spence Pfleiderer. "That's the power of addiction."

As president and CEO of the Orlando nonprofit treatment program 
Central Care Mission, Pfleiderer has served seven years on the front 
lines of the war on drugs, fighting for those whose often-fragile 
grip on sobriety pits them against an unrelenting enemy.

"I tell my guys, 'One of the easiest things in the world is getting 
you off drugs,' " he says. "It's staying off that's the hard part."

Despite decades of public-awareness ads to "Just Say No," the nation 
still has little to show in the battle to overcome addiction. In 
fact, the American Society of Addiction Medicine reports a 
"staggering rise" in the problem, particularly with heroin.

The failure, scientists believe, stems from a misguided mentality 
that addiction is a moral flaw - and that overcoming it is a matter 
of willpower. The reality, as brain research now shows, is far more 
complicated.

Addiction is not only a disease, they say, it can apply both to 
substances such as drugs and alcohol and to behaviors.

"This is why people just can't quit: Their brains have been changed," 
says Dr. Valerie Westhead, a psychiatrist and chief medical officer 
for Aspire Health Partners in Central Florida. "And we've just really 
fully understood that within the past five years or so, and I don't 
think the understanding is pervasive even among medical 
professionals. It's going to take a while."

Through advances in medical scanning equipment, researchers can now 
trace the brain's neurotransmitter activity, energy use and blood 
flow as it is exposed to addictive substances. They can also see how 
the brain alters itself over time as it attempts to maintain normalcy 
despite overwhelming stimulation - which is why addicts need greater 
and greater quantities to experience the same result.

The research led the American Psychiatric Association to a 2013 
landmark decision to classify "gambling disorder" as the first and so 
far only condition in a category of behavioral addictions that create 
the same brain responses, rewards, cravings and tolerance levels that 
addictive drugs do.

Internet gaming disorder could be added next. It's officially under 
consideration, while other behaviors and food are being investigated 
for possible consideration. Dr. Mark Gold, director of research for 
the Drug Enforcement Administration Educational Foundation and the 
retired chairman of the UF College of Medicine's psychiatry 
department, says sugar demonstrates strong addictive potential. And 
even something normally considered healthy, such as exercise, can be 
weakly addictive, he says.

Westhead agrees. "I think there are a lot of unanswered questions 
about compulsive exercise and eating disorders," she says. "We're 
just beginning to understand the aspects of behavioral addiction."

While addiction and physical dependence were once used 
interchangeably, scientists have shown the process of addiction 
uniquely targets the brain's so-called "pleasure centers" by flooding 
them with dopamine, a neurotransmitter. The more powerful the 
addictive substance, and the more quickly it reaches those dopamine 
receptors, the more addictive it is.

"The drug becomes more important than anything else," says Darrell 
Stevenson, 54, who has spent the past year in an Orlando residential 
treatment program, staying clean and working. The recovering cocaine 
addict once easily blew through $400 of the drug in a weekend.

It cost him a marriage, a relationship with his children and five 
years in prison when, craving his next high, he grabbed a fistful of 
cash at a bank.

"I went to cash a check, and the teller was taking too long, so I 
just reached over the counter," he says. "I had always worked, I had 
always paid my bills, I always thought of myself as a good guy. But I 
couldn't wait. ... I never want to go back to that."

Stevenson got clean the hard way - behind bars - but researchers say 
their work may lead to medical solutions instead of criminal-justice ones.

"The progress has been so great that you can detox a heroin addict 
without giving them heroin, morphine or methadone, and you can then 
give them another medication that makes them immune to opiates," Gold 
says. "They can't even feel it. So they can't tell the difference 
between saline and heroin."

Of course, as Gold points out, they have to take the medication. And 
that's the problem.

The main drug currently used for alcohol and opiate abuse - 
naltrexone, marketed as Revia and Vivitrol - for years came only in 
pill form, which must be taken at least three times a week and tends 
to be expensive, Westhead says. A newer, long-acting injectable form 
may be more reliable, she says, freeing addicts from the constant 
cravings that make it nearly impossible to think about anything else.

But why does someone become addicted in the first place?

Dr. Yngvild Olsen, an addiction medicine specialist who leads the 
public policy committee of the American Society of Addiction 
Medicine, says roughly half of an individual's vulnerability to 
addiction stems from genetics - the way our brains are wired when 
we're born. The rest is what happens along the way, including, 
especially, what happens very early in life.

"It's thought that early childhood trauma, particularly trauma that 
is sexual or physical in nature, leads to changes in the brain as the 
child develops," Olsen says. "Because the other thing we know is that 
the brain is not fully formed - particularly certain key parts - 
until about age 25."

Early exposure to drugs, especially that of a child in the womb, is 
the most devastating and the most likely to lead to addiction later, she says.

But there are other vulnerabilities - having depression, anxiety or 
other mental illness, for instance, or being in an environment where 
you have access to drugs, face peer pressure or are surrounded by the 
type of chaos that drives people to want to escape reality.

And no one thinks science alone will solve the problem.

Olsen, for instance, compares drug addiction to the nation's epidemic 
of diabetes. Even if doctors could give every addict a pill to block 
the addictive impact of drugs, alcohol or gambling, users would still 
be vulnerable.

"Medication alone doesn't solve their chronic problem, and that's 
where people need the behavioral intervention," she says. "People 
with diabetes need to learn how to shop, how to cook, how to go to a 
birthday party and explain to their friends why they can't eat that 
piece of cake."

It is why, she says, many people get tripped up on whether drug abuse 
is a disease or a choice. At some level, it's both.

To Pastor Pfleiderer, relearning the business of life is essential. 
At Central Care Mission, men stay up to two years. They have to work, 
save money, attend counseling, volunteer and pray if they want to 
succeed, he says. The time alone helps their brains heal, but they 
still have to address what led to their addiction to start with.

The place always has a waiting list.

"As soon as someone leaves or graduates," he says, "someone new moves in."
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MAP posted-by: Jay Bergstrom