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Sonoma County Gazette
Wellness Corner by Dr. Gary Pace

Some Thoughts on
Contemporary Addiction Treatment

Sep 25, 2017
by Gary Pace M.D.


“The opposite of addiction is not sobriety, it is human connection” — Johann Hari.

Last month we looked at research exploring environmental influences on addictive behavior, Current scientific thinking is shifting away from previous models of a “moral deficiency” and of a “disease state” being the only issues behind addiction. More recent approaches view it as a complex interaction between the neurotransmitters in the brain, early childhood experiences (especially trauma), and current environmental stressors and reward systems. Yet contemporary treatment approaches tend to be mired in older views.

Current Approach

The 12 Step model of Alcoholics Anonymous has been the template for much of today’s addiction treatment, yet current statistics are not very impressive. The numbers are hard to nail down, but most observers say that approximately 10% of people involved in AA or other 12 step programs actually “recover.” One study found that 40% of people don’t go back after the first few meetings.

The medical model aims to find medications that induce illness if someone uses, block the effect of the drug of choice, or decrease cravings. As an example, Suboxone (used to treat opioid addiction) binds to the opioid receptors and satisfies the cravings and prevents withdrawal in much the same way a regular opioid does. Due to some unique biochemical properties, people on Suboxone tend to have a more normal lifestyle and no longer seek increasing doses, but there is no real “cure” here. Basically, it is a way of helping people “maintain” in light of having a chronic problem. And if they run out of Suboxone, they will have significant withdrawal and are at risk of relapsing.

Change the Environment, Change the Neurobiology

So, some of the newer findings discussed last month suggest that underlying neurobiology may be causing addicts to augment themselves just to feel normal. How can we actually change the underlying problem in dopamine levels and receptors that may be driving the addicts to a short-term solution, while actually making things worse in the long run?There is promising preliminary research that exercise, diet, mindfulness meditation, finding meaning in life, and improving interpersonal relationships can improve dopamine and receptor levels in the brain.

• A recent, small UCLA study showed that adding an exercise program to traditional behavioral health treatment for amphetamine addiction led to a measurable increase in dopamine receptors in the patients.

• Tyrosine is a precursor of dopamine, so increasing intake of tyrosine is a potential route to increasing dopamine levels.

• Recent research published in Cell Metabolism showed that mice fed high fat diets ended up having lower numbers of dopamine receptors and gained more weight as compared to those fed regular diets.   

These results reinforce what several studies have suggested previously-- changes in the environment can alter the number of dopamine receptors. This is an important link which uncovers a pathway by which non-medication interventions can impact the neurobiology of someone struggling with addiction, which then can change their cravings and their behavior. Whereas medication helps people to manage their problem, these interventions get closer to the root cause.

What is Available?

Currently, only 10% of people suffering with Substance Use Disorders are in treatment. 12 step programs are available throughout the country, and serve a very important role, but have a limited impact. Access to decent treatment programs can be hampered by insurance issues, geographical distribution, and adequate training and staffing, and the for-profit treatment industry is riddled with examples of poor patient care. There is clearly a shortage of effective treatment programs. (for more information, see the CASA Columbia study).

Given these constraints, most programs focus on Medication Assisted Treatment (like the use of Methadone and Suboxone for opioid addicts), and/or group and individual counseling models. There are some more holistic treatment programs, but most of them are financially out of reach of most people dealing with addiction. This is an area ripe with possibility for the future.


Another important provision of the ACA ensured coverage for substance abAn important underlying cause of addiction stems from people boosting their dopamine and other neurotransmitters for short-term effects, with a subsequent gradual long-term decline. Shifting to an emphasis on effective lifestyle changes is promising, since environment is more changeable than moral fiber or genetics.



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