The number of persons afflicted with addiction is growing with an estimated 40 Million diagnosed patients and another 80 million risky substance users one third of America. It is costing America an estimated $486 Billion annually. Most of the money is going to the judicial system and not treatment or research on better treatments. An estimated 600,000+ die from addiction annually (more than the Vietnam war). It causes 71 other diseases of all kinds. And less than 10% of people with addiction fail to ever get help for it. In 2010, the United States spent $43.8 billion to treat diabetes which affects 25.8 million people, $86.6 billion to treat cancer which affects 19.4 million people and an estimated $107.0 billion to treat heart conditions which affect 27.0 million people, but only $28.0 billion to treat addiction which affects 40.3 million people.
Addiction is still a highly stigmatizing illness and is still perceived by most people even medical professionals as a character defect, moral weakness, or inability to self control. Organized Medicine has done little training of interns and residents about the disease (some improvement in recent years). It’s the least likely health category to be asked about inannual physicals as is the brain itself. How often have you ever had a physician ask you when is the last time you had your head examined. More often that phrase is meant to be either funny or denigrating to whom its directed. Ironically, it’s the single most important organ in the body. You can live without most every other organ even your heart (which can be replaced). You cannot get a new brain. That is in part the result of the fact that the brain is the single most important part of your body. And it is also the single most complicated thing in the entire universe as it has more connections in its cerebral folds than stars in the Milky Way Galaxy.
Over 100 billion nerve cells
More connections than stars
Information travels ~ 268 miles/hour
Brain is 2% of body’s weight, but uses 20-30% of your calories
Loses an average of 85,000 cells/day
Addictions accelerate the brains aging process!!
Do you know why auto companies require a driver be at
least 25 years of age? Because the brain is so complicated and
difficult in its total formation it takes 25 years for the brain to
complete the billions of synapses connecting each of the major
brain sections together. Car rental companies have learned that
young incomplete brains make more mistakes in sudden split
second decisions. This leads to accidents and or injury to the
driver and others.
Columbia calculated that risky substance use- and addictionrelated
spending accounted for 10.7 percent of federal, state
and local spending, and that for every dollar federal and state
governments spent, 95.6 cents went to pay for the consequences
of substance use; only 1.9 cents was spent on any type of
prevention or treatment. The taxpayer tab for government
spending on the consequences of risky substance use and
addiction alone totals almost $1,500 a year for every person in
America. Nearly one-third (32.3 percent) of all hospital inpatient
costs are attributable to substance use and addiction.
So what is addiction anyway and how best to treat it. Many
theories have been advanced over the decades. One thing we
now know is that the basic outline of an inpatient standard 4-6
week stay in a treatment program with an admixture of cognitive
testing; individual therapy, group therapy, AA or other self help
group, drug testing, family therapy, etc. (with many additions like
yoga, equine therapy, gourmet nutritious meals, etc.) about 60 %
of patients discharged will relapse in six months or longer. Our
outcome success rate has been stuck at that general level since
1980. There has been little real progress with the exception of
interventions aimed at the brain. That is because addiction is
a complex brain disorder. There is something going on in the brain which is still not completely understood. No small wonder
in that the brain again is far more complicated than your heart,
lungs, stomach, kidneys, etc.
Some research has led to progress in the treatment in the
brain though it still needs further work and evaluation. Here
is a sample of more scientifically validated therapies aimed
specifically at the brain itself. This new type of treatment
is aimed at impacting the brain itself and is referred to as
Medication Assisted Treatment (MAT). It’s less time intensive,
less costly and does interfere with dopamine reception in the
brain in different ways. Dopamine is primarily responsible for
the euphoric affect one gets when drinking or using drugs. But
the brain is still vastly more complicated than taking a pill or
injection to cure addiction. It appears to be a first step to assist
the patient however.
Next we need to look at some great research on identical
twins raised apart. Here the data is pretty clear that such twin
pairs have a high probability of becoming addicted to alcohol
or drugs regardless of their upbringing or location. In other
words, identical twin with a specific combination of 89 genes in
their DNA have between a 40%- 75% probabilities of becoming
addicted based on their genes. A simple way to think about this
is that a person with normal genes (not the 89 that appear to
predispose a person) can say drink a 12 ounce beer with little
effect while the person with those 89 genes has a 4X euphoric
effect. So, seeking to better understand what allows those 879
genes to express is an area of future research. Also why do drugs
like cocaine have a much higher rate of addiction in identical
twins. Likely the power of cocaine on dopamine and a sense of
euphoria is a factor that needs to be better understood.
a.America’s approach to addressing risky substance use
and providing addiction treatment has evolved outside of the
mainstream public health and medical systems. As a result:
Most primary providers of intervention and treatment for
risky substance use and addiction do not have the requisite
training or qualifications to implement the existing range of
evidence-based practices and face many organizational and
structural barriers to providing services;
Most health professionals do not implement evidencebased
addiction care practices;
Performance and outcome measures that should be a
routine part of quality assurance in mainstream medicine
are limited and rarely implemented in addiction treatment;
The pharmaceutical industry lacks the incentive to
develop new and effective pharmaceutical interventions for
addiction treatment; and
Insurance coverage for evidence-based intervention,
treatment and disease management is inadequate.
Because of the vast chasm between the health care system
and approaches to preventing risky substance use or treating
addiction, medical professionals fail to address risky substance
use or addiction or take responsibility for intervention or
treatment, risky substance use is addressed primarily in terms of
its consequences and addiction treatment providers are not held
to the same standards as providers of mainstream medical care.
The ultimate goal we must achieve is to deploy Neuroscience
and genetics with evidence based interventions if we are to find
a more successful outcome for our patients.
b.Neuroscience, over the past 50 years has shown that every
thought, sensation, emotion, physical movement is accounted
for in terms of brain structures and chemistry.
c.This is not to say that everything is caused by neurons, butnothing happens in human behavior except by the mechanisms
of the brain.
d.Behavior, including addiction is related to:
Anatomical characteristics of brain regions;
The functions of neurons, including their connectivity into
pathways or “circuits”; and,
The neurochemistry that exists between neurons that
allows them to interact.
Brain neuroscience explanation of addiction is as follows:
The brain consists of millions of “circuits” and pathways.
The more a particular pathway is “exercised”, the greater
the “strength” of that pathway and the more it begins to
dominate mental space.
However, with neurotransmitters, when an excess is added
to the brain system, the brain tries to compensate by getting
rid of the excess. So, the more you import, the harder the
brain works to get rid of the excess.
Over time, the whole distribution of neurotransmitters
gets out of kilter and the person can only function when
importing the desired neurotransmitters to activate the
pleasure parts of the brain.
In summary, I have created a nonprofit Foundation (In process
for 501C3 status) seeking a cure for addiction. It plans to mimic
the City of Hope in Duarte Calif. With a focus on hard research,
multidisciplinary teams working together, collaborations with
biotech, genetic, medical device and neuroscience organizations
as well as fund raising all aimed at our goal of a cure. The name is
Addiction Medicine Institute 1024 Bayside Dr. Ste. 459 Newport
Beach, Ca. 92660