By William Leach, MD
In the field of addiction medicine, many “professionals” have had differences of “opinion” about treating the brain disease of addiction either as a physical disease or as a behavioral entity or choice. As is always the case, human medical conditions are extensively multi-factorial and rarely have a simple causation or treatment. Environment and biology are always inter-dependent and inter-influencing.
“Addiction” is a chronic, progressive, relapsing, terminal (ending in death if untreated) brain disease which has biological, psychological, sociological and higher consciousness manifestations. Science, as the basis of logical medicine, requires that scientific, evidence-based, standard-of-care-driven best practices dictate the appropriate medical care, which is then delivered compassionately to the patients. “Opinion” has no business entering into the treatment of a human being who is afflicted with a life-threatening brain disease. With the advance of sophisticated brain-imaging technology, researchers have identified changes in the brains of persons with the brain disease of addiction.
Fifty-Five years of Brain research have proven the relationship between brain chemistry and addiction, as well as between heredity and addiction. Previously, the “psychiatric” disciplines played a more significant role in treating this brain disease. Because the symptoms of this brain disease are predominantly behavioral, the disease was previously viewed as a “mental” illness. The brain disease of addiction is being proven to have at its origin, a genetically inherited structural difference in parts of the brain. Schools of medicine are responding to the lack of physician training in this physician sub-specialty by creating fellowship programs in addiction medicine, such as the one I attended at the University of Florida.
New research proving a structural brain difference as the primary cause of the brain disease of addiction encourages research into both biological treatments and behavioral modalities. In essence, both are one in reality. Behavioral modalities have even been shown to change the structure of the brain! This redefinition has created the impetus to manage patients with addictions through a combination of appropriate medication and “therapy” or what I refer to as “self-awareness training,” which is ongoing and lifelong. Consequently, in order for a patient with this brain disease to regain the ability to maintain a high level of functioning and keep the brain from being hit with its drug of choice for example (the brain chooses the drug!), treatment must be continuous, exactly as it is for a patient with diabetes, cancer, or heart disease.
This new knowledge of the causation of the nature of addiction has led to the development of many new treatment options with more in the pipeline. One of the newer treatment strategies is to use immunotherapies, for example, drugs that act as “vaccinations.” These immunotherapies block the entry of stimulant substances (drug) into the brain, thereby preventing perpetuation of the disease should the patient initially fail to refrain from ingesting the substance to which the brain is addicted. Pharmaceutical treatment works best when augmented with behavioral and spiritual approaches that prove effective for the patient, such as cognitive behavioral therapy, motivational interviewing, 12-step facilitation therapy, and most importantly, mindfulness-training practice.
About the author: With over 30 years’ experience as a practicing physician, Dr. William Leach maintains a comprehensive, private, addiction medicine practice in North Florida. Dr. Leach is board certified by the American Board of Addiction Medicine. Additionally, Dr. Leach provides clinical consulting, business consulting, and pharmaceutical treatment advocacy.