Addiction has been defined by the Surgeon General as the most severe form of substance use disorder, associated with the compulsive or uncontrolled use of one or more substances. Addiction is a chronic brain disease that has the potential for both recurrence (relapse) or recovery. Relapse is defined as the return to the use of substances after a significant period of abstinence.
The latest research in neuroscience suggests that the process of addiction is a three-stage cycle starting with binge and intoxication, then withdrawal and negative effect, and preoccupation and anticipation. The cycle becomes more severe over time with continued use and abuse of the substance. Dramatic changes in brain function lesson an individual’s ability to control their substance use.
Disruptions in the basal ganglia, the extended amygdala, and the prefrontal cortex enable cues to trigger substance seeking, reduce brain sensitivity systems in the experience of reward or pleasure and heighten activation of brain stress systems and reduce the executive control systems which regulate decision making, actions, emotions, and impulses. These changes in the brain remain long after the individual stops using substances.
Euphoric feelings motivate people to continue to use the substance despite the risks; all addictive substances have powerful effects on the brain. Continued misuse of substances causes progressive changes in the structure and function of the brain, these are called neuroadaptations. These lead the change from controlled or occasional use to chronic misuse; they may produce continued, periodic cravings for the individual’s drug of choice that can be the catalyst to relapse.
There is a saying in the rooms of twelve-step recovery programs, “The definition of insanity is doing the same thing over and over and expecting different results!” Sometimes I wonder if they’re talking about the pathology of addiction of describing the current paradigm of treatment. Short-term treatment is not effective. This is not an attempt to condemn or pass blame; it is an attempt to find better solutions to an insidious disease. Our young are dying in record numbers there must be a more effective solution to the problem.
In today’s recovery world, experience and science have shown us that the addicted person’s family must also be addressed, not just the addicted person. Addiction has proven itself to be a family disease. Not necessarily that more than one person in the family is addicted, but the whole family is affected by the disease. The family needs to understand addiction and recovery, so that they can support recovery without enabling addiction. They need to be educated as to the true pathology of addiction. The problem defines the solution. There are no short cuts; there is no easier way out. I heard someone say the other day, “It takes a village” to help the addicted to recover. It’s clear that today more than ever before the community also needs to change and get involved if we really want to have lasting change and save thousands upon thousands of lives.
Think about the facts. How do most people start off in recovery? If they’re willing to get help, they go to detox, if not they have an intervention, or take more lumps. Then they go to a short-term stay in a residential program. (Less than 90 days.) A professional drives the process. Then there is total disengagement. The family may not even communicate with anyone else but their addicted family member. Their loved one returns home and the family thinks that their loved one is cured. Does this sound familiar and about right? This process doesn’t work! Treatment works, the process does not.
Let’s look at some of the problems. Not every person that needs help gets help. More than 50% of the people who go for treatment don’t stay to complete the program, and their families enable them. Only a small minority get continuing care. Most people don’t get a long enough stay for initial treatment. Most people relapse within a year of treatment, those that consume alcohol and other drugs relapse within 90 days. Those that have a high rate of recovery and low rate of relapse get there at between four and five years of remission. The professionals have all disengaged with the addicted person when they need more help.
The opioid addiction recovery world is about to undergo a major paradigm shift in addiction recovery treatment. There has to be more focus on post-treatment. There needs to be continuing education for the whole family and community of those suffering from addiction, professionals, peers, and those addicted. The whole process needs to be results and client driven. There needs to be case managers externally from treatment programs that monitor from assessment to disengagement which should not conclude prior to five years. Early re-intervention when needed. Just like everyone links up to social media, those addicted will need to link up with recovery communities. We also need to continue to develop recovery community resources such as community centers with recovery support services, learning as we go. Give more credibility to those with years of addiction recovery, they know what works and what doesn’t. Give reasonable choices to those addicted in different modalities. This is why Medication Assisted Treatment and Technology is working. The use of Suboxone and other medications coupled with counseling and technology building new sober lives and sober communities of support through modern technology.
The single best tool to overcome opioid cravings and withdrawal symptoms from detoxification is Suboxone medication management. When Suboxone is coupled with counseling and technology, the three become a powerful solution to opioid addiction.