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Lloyd I. Sederer, MD

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Addiction: Help You Can Get Beyond 12-Step and Conventional Western Medications

Posted: 07/16/2012 9:05 am

"Every form of addiction is bad, no matter whether the narcotic be alcohol, morphine or idealism." -- C.G. Jung

"When you can stop you don't want to, and when you want to stop, you can't..." -- Luke Davies

The concept of addiction has evolved from its ancient roots in alcohol and drug dependencies to what now has been aptly called "... self-induced changes in neurotransmission that result in problem behavior." (Milkman, H.) What continues to astound so many is that these ruinous, compulsive behaviors persist despite their obvious -- at least to others -- painful consequences. Quite amazingly, the addict in the throes of addiction may be most blind of all to the losses he or she incurs in love, health, work and everyday life -- that is, until recovery begins.

Because there is magic in naming, old habits can die hard about what we call an addiction. "And Rumpelstiltsken was his name..." said the imprisoned queen, and by uttering his name she freed herself and her child and destroyed that greedy creature. Even great wizards and witches of Harry Potter fame trembled at the name of Voldemort! Addiction too is a name (and thus a concept) with great power and one that needs changing: It is time for its updating. Addiction is more than alcohol and drugs. Addiction is a complex phenomenon with expression in a multitude of compulsive behaviors. Addiction is also the end point of the convergence of a ménage of brain, behavior and social forces. Addiction today needs to be considered anew, and so should be its remedies.

The director of the National Institute on Drug Abuse, Dr. Nora Volkow, writes that there is good evidence for non-substance-induced addictions. Dr. Volkow wrote the brain is:

"... composed of a finite number of circuits for ... rewarding desirable experiences ... So it is almost by necessity that we'll find significant overlaps in the circuits that mediate various forms of compulsive behaviors. We have yet to work out the details and the all important differences, but it stands to reason that there will be many manifestations of what we can call diseases of addiction. Thus, addiction to sex, gambling, alcohol, illicit drugs, shopping, video games, etc. all result from some degree of dysfunction in the ability of the brain to properly process what is salient, accurately predict and value reward, and inhibit emotional reactivity or deleterious behavior."

Dr. Volkow was speaking to the ubiquitous presence of compulsive behaviors that we see all around us. She was talking about the pleasures that compel so many of us to act in ways we know are destructive to our lives (and to those we love) yet which we cannot seem to resist. We witness these unbridled behaviors in gambling, sexual promiscuity and porn, overeating, drug and alcohol abuse, "shop til you drop" and video games, to name a few.

Recovery from addiction traditionally has been the domain of 12-step programs, dating back to Dr. Bob and AA. More recently, recovery has been aided by a variety of Western medications that diminish craving and reduce painful withdrawal symptoms and thereby help control drug and alcohol abuse. The first one used on a large scale was methadone; more recently, doctors are using buprenorphine and naltraxone. But as we learn more about the brain and its reward centers, new methods of controlling addictive behaviors are emerging.

In this series we will consider a variety of interventions beyond 12-step and medications. We will examine alternative and non-conventional recovery paths for people with compulsive and addictive behaviors. These have been called "complementary and alternative medicine" (CAM) -- but the term "medicine" seems too narrow, and we will go beyond medicine but not beyond what evidence and experience suggests can be helpful.

Addiction is a dark life, full of misery for the addict and all who love and support him or her. For those scores of millions of Americans and hundreds of millions of individuals world-wide who suffer the consequences of unchecked compulsive behaviors, there is hope; there are alternatives.

Life need not continue to be dark: "One must wait until the evening to see how splendid the day has been." (Sophocles) By reviewing a variety of approaches to addiction beyond 12-step and Western conventional medications, we hope to offer readers prospects for changing how their day shall end.

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We want to invite your thoughts and comments about addictions. We want to bring your voice to the debate about what interventions work based on what you have seen effective. We also want to hear from you about what does not work, what snake oils might be out there luring people in trouble away from what might indeed be helpful to them.

Submit your thoughts in the comments section below. Some questions to get you started:

1. Do you think addiction is a disease?

2. Is addiction only about alcohol and drugs?

3. Have you heard about Complementary and Alternative Medicine (e.g., acupuncture, yoga, homeopathy, supplements) approaches to addiction?

4. Do you think nutrition plays a role in recovery from addictions?

Let's talk about addiction and its solutions.

Lloyd I. Sederer, M.D.

Medical Editor for Mental Health, The Huffington Post

www.askdrlloyd.com

The opinions expressed here are solely mine as a psychiatrist and public health advocate. I receive no support from any pharmaceutical or device company.

Visit Dr. Sederer's website (www.askdrlloyd.com) for questions you want answered, reviews, commentary and stories.

 
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