Myroslava Romach Karen Parker

MYTHS ABOUT ADDICTION AND ITS TREATMENT As of the year 2000, many medical facts about the causes of addiction, its nature, the best ways to treat its symptoms, and the possibility of devising a full, permanent cure remain unknown. However, research has already established that the myths listed below are false. Unfortunately, these common myths cause the general public and even many physicians to be needlessly unsympathetic to addicts.

Myth: Addiction is an acute condition, like a broken leg or pneumonia.

Fact: Addiction is a chronic disorder, like arthritis, high blood pressure, asthma, or diabetes.

Myth: Addiction ends when detoxification removes all of the abused substance from the addict's body.

Fact: Changes in the pathways of the brain, which had been caused by the abused substance, persist long after the last particle of the abused substance has left the body.

Myth: Addiction ends when the pain following detoxification (the withdrawal syndrome) is gone.

Fact: At the end of the withdrawal process, pain caused by the body's dependence on the abused substance stops, but the underlying addictive disorder (the cause [or set of causes] which made the person liable to become addicted in the first place) remain.

Myth: When a patient relapses (returns to addiction) after detoxification, then the detoxification of this patient must have failed as a treatment.

Fact: As a chronic disorder, addiction needs ongoing treatment, not just a one-time detoxification. One does not expect a single injection of insulin to cure a diabetic, or any single administration of medicine to relieve a patient forever of arthritis, asthma, or high blood pressure. Each treatment is successful if it improves the condition at the time; each needs to be repeated, often throughout the rest of the patient's life.

Myth: Once an addict is detoxified, as long as he or she does not take the abused substance (or a different abused substance) again, any medical, social, and occupational difficulties that had been associated with the addiction disappear.

Fact: Medical, social, and occupational consequences may last long after an addict has stopped taking any abused substance. Let us assume, for example, that because of alcoholism a person has lost an eye while driving drunk, has been divorced for cruelty and non-support, and has been fired from a job. Getting sober (detoxification) and remaining sober (compliance with the prescribed treatment) do not restore the eye, and usually do not rebuild the broken marriage or regain the lost job. Active alcoholism in an individual may be gone, perhaps forever, but the destruction it may have caused often lasts indefinitely.

Myth: Once an addict is detoxified, as long as he or she does not take the abused substance (or a different abused substance) again, any changes in the pathways of the brain that had been caused by the abused substance disappear, and the brain returns to a more fully healthy state.

Fact: The brain usually returns to a better state of health than when the addiction was at its worst, but it takes a very long time to return completely to the health it enjoyed before the substance abuse began. For many addicts, part of the brain damage is permanent.

Myth: A single, simple course of treatment ought to produce a permanent total cure in an addict.

Fact: As a chronic disorder, addiction needs a lifelong treatment, like diabetes, asthma, arthritis, and high blood pressure.

Myth: Since most persons treated for addiction relapse sooner or later, treatment is by definition unsuccessful, and it makes no sense to try it.

Fact: Treatment is not unsuccessful because further treatments are needed. Suppose a diabetic is brought to the Emergency Room unconscious from extremely high blood-sugar, is treated with insulin, regains consciousness, and reduces the blood-sugar level to normal. The patient will probably need insulin every day for the rest of his or her life, but this emergency treatment was certainly successful. With addiction, as with diabetes, we must see treatment as an ongoing process, successful if at the time it reduces the severity of the disorder. It unfortunately does not have a permanent fix, like setting a broken bone or surgically removing all of a cancer. The goal is improvement, not cure.

Myth: Addiction is voluntary; addicts ''bring it on themselves.'' Everyone has enough free will not to become an addict.

Fact: The choice to try an addictive substance for the first time may be voluntary. Freedom even in this choice may be weakened by such factors as peer pressure, an inherited biological condition predisposing one to a craving for this substance, or a valid reason for taking it once (for example, as a pain-killer prescribed by one's physician). But as the person slips from the first use to repeated use to misuse to full-fledged addiction and chemical dependence on the substance, freedom of choice diminishes and usually disappears.

Myth: There are no degrees of addiction. It is an all-or-none condition. A person is either a non-addict and never takes the tiniest amount of an abused substance or is a hopeless addict whose life centers on enjoying maximum amounts of the abused substance (or substances) all day every day for life.

Fact: At one extreme, there is an occasional addict who is satisfied with a low dose of an abused substance and who functions at a normal level at home and on the job. At the other extreme is the addict who regularly takes such huge doses of the abused substance as to pass out in a life-threatening coma. There is, indeed, a formal system for measuring the severity of a patient's addiction and the success of treatment at any given moment. It is called ASI (for Addiction Severity Index). It considers such factors as whether the patient's substance abuse is decreasing, whether the patient is functioning better socially and enjoying better general health (rarely a complete return to the state before the first use of the abused substance), and to what degree, if any, the patient presents a danger to public health and safety (treatment of an alcoholic who continues to drink but has stopped driving after drinking as a result of psychotherapy would be a partial success).

Myth: If treatment were possible, it would cost millions of dollars to treat a single patient. Treatment would cost more than putting a young person in prison for life. In terms of dollar value, treatment would cost even more than a single addict would be apt to steal in a lifetime.

Fact: One study in California showed that the benefits of treatment outweighed the cost of treatment at least four-to-one and as high as twelve-to-one, depending on the type of substance abused and the type of treatment employed. It is non-treatment which costs the United States billions of dollars a year.

Myth: Even if methadone keeps an addict away from heroin, the methadone itself will leave the patient drugged and dangerous, so the patient might as well have stayed on heroin.

Fact: Methadone simply does not cause a drugged state, or even the appearances of a drugged state.

Myth: Even if methadone keeps an addict away from heroin and even if the methadone does not seem to leave the patient drugged and dopey, the patient could function successfully only at undemanding jobs such as raking leaves or checking out books in a library. Even this relatively fortunate patient would be, in effect, in a dangerous position in a job requiring quick reflexes or motor skills, a job such as driving a subway train or operating a fork-lift.

Fact: Many persons on methadone can safely drive trains and run fork-lifts. Some people on methadone cannot do so. The difference between these two groups is not caused by the methadone, but by factors such as lack of education (we don't want people driving trains or busses who can't read traffic signs or safety notices), physical problems (a patient who lost both eyes while driving drunk obviously cannot drive anything), or psychological problems (a patient who panics to the point of paralysis or fainting should not drive). Methadone will not create or increase a danger even for these high-risk jobs, but neither will methadone remove a risk caused by a previously existing condition.

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