Knowing the Science of Addiction

I recently watched the PBS documentary, “Addiction” on the NOVA science series several times. I have seen book and movie reviews of Beautiful Boy. In an important and most informative part of the NOVA presentation, I was pleased to see the face and hear the voice of Nora D. Volkow, M.D., Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. Dr. Volkow’s work has been instrumental in demonstrating that drug addiction is a disease of the human brain. She pioneered the use of brain imaging to investigate the toxic effects and addictive properties of abusable drugs. Her studies have documented changes in the dopamine system as the brain strives to find balance between pleasure, pain, and motivation. Research has produced irrefutable evidence of the value of medicine in addiction treatment and recovery.  The documentary states  “addiction is a very treatable disease.”

I took advantage of a Faces & Voices of Recovery’s training on The Science of Addiction, conducted by Flo Hilliard. I quickly forgot all the brain parts names and focused on the brain receptors and their role in producing overwhelming craving and pain of withdrawal. To allow the brain to function, both must be reduced or eliminated and that is the role of medications. The elements of the documentary prompted me to review the titles of previous blogs I have written for the Faces & Voices Blog site. I have outlined some titles, in italics below, that relate to the elements portrayed in “Addiction.”

It Takes a Villain: We ignored known brain science that told us of the addictive nature of opiates.  We have an opiate crisis. The “Addiction” documentary describes the devastating effect on communities, families, and individuals.  It too briefly points out that there are other deadly and well-known villains—alcohol and nicotine.  Misuse of alcohol is deadly and addictive. It causes 80,000 deaths a year and untold negative economic impact because of health care costs.  My observation is that the introduction of vaping has eliminated some harmful effects of smoking tobacco. Vaping is a treacherous delivery system for nicotine and flavored nicotine is invading (invaping?) our youth culture. Unfortunately, vaping can include marijuana in the delivery system.  It threatens young brain development and may lead to addiction. We must focus on prevention through creative approaches.

A Spoonful of Wisdom Helps the Medicine Go Down: Fortunately, we have a new depth of focus on the science of addiction. From this has come medication-assisted treatment recovery and prevention of death from overdose. To better occupy our space on earth with hope and health we can also find a path to MARS— Medically Assisted Recovery Services. (Thanks to Ben Bass of El Paso for this idea) “Addiction” spends a great deal of time discussing the drugs that can overcome craving and the pain of withdrawal. For many, craving may be more powerful than fear of death! Methadone (requires clinic visit), Suboxone, and a number of the newer drugs such as VIVITROL, can be effective.  All medications will have a prescribed purpose. This treatment must be accompanied by appropriate therapy and recovery services support—MARS.

Addiction Recovery— A Family Affair: The process of a family’s recovery requires the hope of healing, healthy change, and regaining trust. “Addiction” told stories of families who had totally wiped out all financial assets in pursuit of solutions for their child or other family members. There were dramatic portrayals of family distress in “Beautiful Boy.” I read some words in another place that somehow defined the family’s fate. It was “chronic sorrow.” What a sad and apt descriptor of a paralyzing state of mind. There is little hope when the coper’s broke.

Infrastructure—Building Recovery after Addiction. Just as roads and bridges transport us from one location to another, a strong public health infrastructure serves as the framework to bring those suffering from active addiction to a place of safety and recovery. Infrastructure must include effective recovery support programs and be open to innovative but controversial approaches to harm reduction. Addiction provides insight to a Canadian program of safe and supervised injection sites. There are clean needles, drug testing for Fentanyl, and care and concern. It appears to overcome, outta site, outta mind.  There are efforts in cities and states across the America to overcome legal issues and adopt similar programs.

The Foundation of Fellowship and Friendship:  The reduction or elimination of craving and the pain of withdrawal allow the individual to absorb and think about healthy solutions to living daily life. In “Addiction,” a group of individuals was shown, sharing their stories of feeling better and telling of their achievements, big and small. The power of stories shared could lead to long-term recovery. Connections allow elimination of isolation and the seeking of fellowship and friendship. Peer support becomes invaluable and responsibility and accountability become realistic goals. The connections are made and kept between the heads and hearts of others with a positive common purpose and with mutual support. Recovery happens.

The Communities’ Role in the Opiate Crisis: Congress has taken action in the passage of the SUPPORT for Patients and Communities Act.  It includes policies and resources that support people in recovery from addiction across the lifespan. The act provides for building communities of recovery. This provision reauthorizes and modifies the Building Communities of Recovery program to include peer support networks. This program provides funding for community organizations providing long-term recovery support services related to substance use disorder.  It is hoped that agencies and entities will pursue the available funding for their communities. Beyond medications, there must also be attention to prevention as well as treatment and recovery support.