Addictive disorders are among the most common chronic diseases faced by physicians, and yet they are among the least understood by the average clinician. Most medical schools provide only 1 or 2 lectures on addiction throughout the 4-year course, and information provided by teachers at the bedside is often wrong or misleading. It is common for physicians to assume that evidence of tolerance and physical dependence (withdrawal) implies the presence of addiction. In reality, many drugs produce adaptive changes in the body that result in the appearance of tolerance with rebound symptoms (withdrawal) when the drug is stopped abruptly. This can occur with beta blockers, antidepressants, sedatives, and opiates, among others. This phenomenon does not define or imply addiction.
Addiction is compulsive, drug-seeking behavior, and it is relatively rare among patients with pain who receive prescribed opiates or opioids under medical supervision. If addiction does develop, there are effective treatments available, including medications that reduce drug craving. The proper treatment of pain requires an understanding of addiction and how to prevent it. A multidisciplinary approach, including behavioral interventions, is ideal instead of relying totally on medications to relieve pain.
There is a common misperception that medications should not be used in the treatment of addiction. In reality, medications are available that reduce craving for alcohol and nicotine, and recent research suggests that medications for stimulant addiction are on the way. Of course, no medication can cure addiction, and all medications for addiction should be used in combination with psychotherapy. When treated properly, addictions respond with reduction in symptoms and the appearance of remissions, but not total cures. Thus, bona fide chemical addiction can and should be treated as another serious chronic disease.
That's my opinion. I'm Dr. Charles O'Brien, Kenneth Appel Professor of Psychiatry at the University of Pennsylvania.
01/23/2006.
Article Source:
www.medscape.com/viewarticle/521277
Posted by: Dee
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