03/30/2007 12:10 pm ET | Updated Nov 17, 2011

Understanding Addiction

Three years ago Sheila Nevins, president of HBO Documentary Films, asked me to research and produce what has become the HBO series, Addiction, which premiered Thursday, March 15th and can be seen online anytime at
Up until that time I had been on the periphery of a few family and friend's struggles. To be perfectly honest, their struggles confused me. I didn't really comprehend what could cause someone to be incapable of stopping themselves from taking a drink or using a drug even when they knew it was ruining their life and, frequently, the lives of others.

I realize now that for me and many others, understanding addiction is a profound challenge. My producing partner, Susan Froemke, and I engaged in hundreds of hours of conversation with research scientists, physicians, psychiatrists, government leaders, treatment providers, treatment advocates, people in recovery, people actively using, families of active users, as well as families of those in recovery, twelve-step advocates, and experts studying how addiction affects the workplace. And yet, with every available resource at our disposal we still found it terribly difficult to attain a comprehensive, working understanding of the topic.

Addiction, as it turns out, is a problem that is messy--riddled with misconceptions, profoundly lacking in nationally recognized treatment standards, and highly stigmatized. But, through this fog are emerging a few clear and important messages for all of us who are concerned about someone struggling with an addiction. While the science of addiction is relatively new, tremendous advances are being made and shifts in attitudes are occurring.

The biggest change in addiction is the growing acceptance by the medical community and the general population that addiction is a chronic relapsing brain disease. A vivid contributor to this change in attitude is the fact that science now gives us the ability to see inside the brains of addicted people. We can see that the addicted brain is different; that it's damaged. With brain research has arrived great advances in the medical treatment of addiction and the promise of even more effective treatments to come. The advances in medications for alcoholism are so great that leading experts in this field will tell you that there is now reason for every alcoholic to use these medications (naltrexone and acamprosate) to help control their cravings.

Another shift is the increasing understanding that addiction is often coupled with other mental disorders and that these problems and the addiction must be treated simultaneously or the chances of a sustained recovery are slim. Approximately forty percent of addicts suffer from co-occurring mental disorders.

Those who watch Addiction or read its companion book will learn, as we did, that alcoholism is not, contrary to popular belief, just a middle-age disease. Problem drinking most often begins in youth, and that prevalence drops after the age of twenty-five. Addiction is a developmental disease that people need to get help for early and they need to keep at treatment until they find what works for them. The prevalent myth that an addict has to hit rock bottom for treatment to work has to be exploded. Why would anyone wait for diabetes, asthma, hypertension or any other chronic illness to get worse before seeking treatment? The same holds for the disease of addiction. And, while Alcoholics Anonymous is a great support system for the recovering addict, it alone is not treatment.

With all the scientific advances the series showcases the question still remains, how does a family access effective long-term treatment for a loved one struggling with addiction? None of the professionals we met could really give us a consistent answer, and sadly we remain baffled as to why there are no national treatment standards for providers. Someone who is trying to change all this is Tom McLellan, PhD, director of the Treatment Research Institute (TRI) in Philadelphia. McLellan is a nonconformist who is challenging the status quo in Washington, the medical establishment, the treatment community, and the insurance industry to handle addiction the same way they handle any other chronic disease. McLellan will tell you that most addiction treatment facilities lack supervisors trained in addiction medicine. In the United States there is no standard of care for addiction treatment providers, so buyer beware. A family must educate themselves and learn the elements of care. The two important questions to ask a provider are:
1. Are you accredited?
2. Is the medical leadership certified by the American Society of Addiction Medicine (ASAM)?

Families must have a realistic understanding of what to expect from treatment, since there is no cure for this disease. Only twenty percent of addicts fully recover. The idea is to manage the disease, the way diabetes is managed. But there may be relapses, as there are with any chronic illness.

Sadly, with all the advances that are occurring, families in a desperate struggle with a severely addicted loved-one face great obstacles accessing inpatient treatment because insurance companies often deny these benefits. After a decade of managed care, ninety-two percent of addiction treatment is outpatient. And, even though forty-three states require group health insurance plans, including managed care, to provide coverage for addiction treatment, managed care providers continually deny adequate levels of care.

The fastest path to resolving this crisis in healthcare is the passage of mental health and addictions parity legislation. Eventually the stigma of addiction will fall away and addiction will be commonly viewed as a manageable illness.