|
By Paul Earley, M.D., FASM
Medical Director
At the 2007 SECAD conference, I had the honor of sitting on a panel with some of the finest minds in the addiction field. We were there to discuss the topic “Is Buprenorphine Maintenance Recovery?” The panel seemed to agree that treatment was distinct from recovery, that treatment is a vehicle for recovery, and that treatment is an action
directed by professionals.
We disagreed as to what recovery is. It struck me as odd that after 50 years of having a treatment industry, we cannot define the core concept that we hope to instill in our patients. Until recently, no one has taken on this difficult task. But the time appears to be upon us. In September 2005, the Center for Substance Abuse Treatment hosted the National Summit on Recovery. The definition of recovery was one of the many tasks at hand. That consensus report from the conference stated: “Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness and quality of life.”
One year later across the U.S., the Betty Ford Institute gathered together research and industry experts to better define recovery. A consensus statement from that group stated: “Recovery is a voluntarily maintained lifestyle comprised of sobriety, personal health and citizenship.”
The consensus panel report goes on to state: “Sobriety refers to abstinence from alcohol and all other non-prescribed drugs” Bill White authored a conceptual article in the same issue of the Journal of Substance Abuse Treatment dedicated to this conference in which he discusses the tricky issue of abstinence and recovery.
“Why is the definition of recovery such a big deal at this point in our history?” The answer, I believe, is that we are at a time of crisis in the field of addiction treatment and research. I hope to convince each of you of the urgency of our situation; every one must weigh in on the definition of recovery to ensure we reach a clear and common consensus. To examine why we are here, we have to review recent history. I see at least two reasons we are in this dilemma. The first has to do with the increased public attention and research on addiction as a brain disease. The second is the increased use of medications, addicting and non-addicting, in the mainstream addiction treatment market. This divides my discussion into a two- part article, mostly because Carol Bowers set a limit on the amount of space I could consume in the Talbott Times (imagine that, Carol setting limits…). In Part One, this part, I will describe the dilemma of brain versus spiritual disease. In Part Two, I will explore how new medications have muddied the waters when it comes to defining recovery. As always, we welcome your feedback.
Brain Disease and Its Recovery
Paradoxically, advancements in the treatment of addiction have caused confusion in the definition of the very same disease. This happens in other areas of medicine as well, but the disagreement reaches a religious fervor in the definition of what “recovery” means. Addiction is a disease that most experts believe resides in the brain. This does not minimize the holistic nature of the disease process and recovery process. Being a neuroscience functionalist, I believe that all aspects of the experience of being human reside in the brain and body. For me, this means that every emotion, including things such as the mystical aspects of love, are recorded in the neural circuitry of the brain. Religious and spiritual experiences are part of our neural discharges as well. This does not upstage God or other external spiritual forces such as community and altruism. It simply means that all that we are is recorded in the brain and in the body’s physical mirroring of brain functioning. Newer neuroscience research validates this notion. Deep brain stimulation in certain areas of the brain elicits a spiritual experience, which is like that of prayer or experiencing God. MRI studies describe the areas of the dorsolateral prefrontal cortex that grow and expand due to the practice of meditation. Buddhist monks, who practice a meditation based upon a compassion for mankind, interestingly enough develop a massive and distinct neural firing pattern during their meditative state. I see this functionalist approach to the brain / spiritual experience as rejoicing in the wonder of God’s work, not a reductionist attempt to replace spiritual concerns with hard wired communication between nerve cells.
When we introduce the problems of addiction to this discussion, we create an expansive, rather than reductionistic view of a brain disease. As the addict zooms down the rabbit hole of addiction, they lose their ability to comprehend or receive joy from seeking God. Addicting drugs alter the brain environment, exchanging the spiritual experience for the hunger for “spirits” (alcohol and other drugs, compulsive sex, gambling and food addictions). The addicted individual becomes incapable of walking down a spiritual path, and falls deeper into the confusing maelstrom of addiction hell.
The way out must reconnect the recovering individual with their own particular experience and journey with God. And this too is a brain biochemistry and neurophysiology experience which is guided by behavioral, emotions-based and, most importantly, spiritual principles. This means that as our knowledge of the brain and the mind grow, we will continue to need the 12-Steps and the spiritual path to recovery. As our knowledge grows, I believe we will be able to map neuronal changes that occur as a person matures though their 12-Step experience. And, more importantly, seeing addiction as a brain disease does not exclude the A.A. and its sister mutual help groups.
Seeing addiction as a brain disease also encourages us to explore adjunctive tools to help the suffering addict or alcoholic. At Talbott, we currently use dialectical-behavioral therapy (DBT including mindfulness training), emotions-based psychotherapy, cognitive-behavioral therapy, the community-based insight model, grief management, EMDR, psychodynamic formulations, and experiential therapy to assist recovery. They all interact in a fluid and flexible manner, different modalities applied in different strengths to different people. We plan on adding cue response prevention training in the near future. None of these modalities supplant the basics of 12-Step addiction treatment. In fact, they increase the probability that 12-Step recovery will be effective in the long run.
Next time, we will tackle the dilemma of medications in recovery. Stay tuned and keep in touch.
|
Home 
Employment
