USING DRUGS TO GET CLEAN

It was six feet to the floor. Paula Lowry, 52, of Fairview Heights
tumbled off a ladder and landed on her back in a world of hurt.

Her doctor gave her the pain reliever oxycodone, a narcotic related to
morphine and heroin.

He upped the dose when the pain got worse after back surgery. When her
pain didn't go away, he raised it again. And again. But she got no
relief.

Her heart was racing. She was short of breath, in constant pain, and
worried.

"I felt like was just losing my mind worrying about whether I was
going to be able to get this medication," Lowry said.

She had fallen off the ladder in 2001 while stocking shelves at work.
Now, five years later, she was hooked on pain pills. And the doctor,
realizing she was addicted, cut off her supply.

An expensive stay at a treatment center or a quick detox were out of
the question. She found help in an emerging but debated treatment:
another drug.

Despite volumes of scientific data showing that addiction has a firm
biological basis, its treatments reflect established attitudes that
addiction results from a lack of willpower or a failure of character.

But with a relapse rate of 80 percent to 90 percent, it's clear that
most traditional treatments don't work for many addicts. So a still
small but growing number of addiction treatment programs are adding
medications to their toolboxes. Assisted Recovery Centers of America,
in St. Louis, is one of them.

The treatment center is guiding Lowry's recovery.

"There are some people who treat addictions who don't believe in
treating their patients with medication," said Frank Vocci, director
of the division of pharmacotherapeutics and the medical consequences
of drug abuse at the National Institute on Drug Abuse. "It's an
ideological thing. They just think the issues that patients are having
won't be solved by giving them another drug. It flies in the face of a
lot of data."

Many doctors and counselors who treat addiction pay lip service to it
as a medical condition, but treatments reflect a different attitude.

"Since the temperance movement it's been (regarded as) moral fiber
disease," Vocci said.

Treatments for addictions rarely mirror those of other chronic
diseases, nor match their success rates.

"We know the circuitry of most addictions in the brain, but we tell
people, 'You've got to go to AA, be honest with people and find a
spiritual side.' That's interesting, but we don't tell people who've
had a heart attack the same thing," said Dr. Jon Grant, associate
professor of psychiatry at the University of Minnesota.

Crutches?

Many doctors and counselors argue that medications are crutches and
shouldn't be part of treatment because they don't force patients to
confront their problems and addictions.

At the Betty Ford Center, one of the most famous addiction
rehabilitation programs in the United States, success rates for
treating opioid addicts -- people addicted to substances including
heroin, prescription pain pills, opium and morphine -- were
discouragingly low. Opioid addicts walked out before completing
treatment at twice the rate of alcoholics, said John Schwarzlose,
president and chief executive of Betty Ford.

Then the center joined a clinical trial for a medication called
buprenorphine, the drug that helped Lowry. The medication works by
blocking access to receptors on brain cells that trigger euphoria. It
relieves withdrawal symptoms but doesn't give people a high.

"All of a sudden, opioid addicts were staying in treatment,"
Schwarzlose said.

With their worst withdrawal symptoms relieved, the addicts felt well
enough to continue treatment. The Ford center now uses the drug
regularly for detoxing people addicted to narcotics, but the center
doesn't continue patients on the medication once they have gotten past
the withdrawal stage. Nor does the center use naltrexone or other
drugs to treat alcoholism in its regular inpatient program. Alcoholics
who have frequent relapses may get the drugs to help them resist
cravings, but the center doesn't use the medications as a first
resort, Schwarzlose said.

"Building a life is more than just getting clean and sober," he said.
Addiction is a biological, psychological, social and spiritual
disease, Schwarzlose said. "We don't believe that if you give a shot
that takes away 30 days of craving that you'll deal with all those
other issues."

Chance to Heal

Chrys Parmentar, 46, of St. Louis, disagrees. The daughter of two
alcoholics, Parmentar could pour a perfect Manhattan by the time she
was 7. She started drinking at 15 and crossed the line into alcoholism
soon after. She tried inpatient rehab. She tried Alcoholics Anonymous.
Still she drank, consuming half a gallon of vodka every two days.

The injectable form of naltrexone is helping her overcome more than
three decades of alcoholism, Parmentar said. Each month, she goes to
the Assisted Recovery Center's office for an injection of a
long-acting form of naltrexone. The shot helps with her craving for
vodka.

"Now that I don't have to deal with the physical part, I can start
healing mentally," Parmentar said. She attends group meetings at the
center two to three times a week, and her husband, Bob, goes to a
weekly meeting for family members of patients.

Such counseling sessions are key to recovery, said Dr. David Ohlms,
the medical director of the chemical dependency program at
CenterPointe Hospital in Weldon Spring.

"None of these drugs are a major breakthrough, in my opinion," Ohlms
said. But, coupled with counseling, the medications can be useful
tools for helping some alcoholics and addicts stay sober.

When naltrexone was first approved more than a decade ago, Ohlms tried
it for his alcoholic patients.

"I was pretty quickly disillusioned," he said. The drug has many side
effects, including nausea and vomiting, and can damage the liver,
something people who drink heavily can ill afford.

About three years ago, the Food and Drug Administration approved a new
drug, called acamprosate, for dampening alcohol craving.

Ohlms was skeptical after prior experiences, but he saw a high number
of his patients experience drastically decreased cravings while on the
medication. It also didn't have the severe side effects of the earlier
drug.

Ignorance, Fear

Many doctors aren't even aware that the medications exist. Others
don't want to alienate their patients by bringing up substance abuse
problems. But mostly, doctors would rather not identify alcoholism or
addiction in their patients because they don't know to treat it and
don't want to deal with it, Ohlms said.

Ohlms and other addiction medicine specialists are trying to train
other doctors, particularly psychiatrists, about the new medications.
So far, the response has been tepid. At a recent workshop, only 14 of
the 360 attendees were physicians, he said.

The Substance Abuse and Mental Health Service Administration lists
only 25 doctors in the metro area who are authorized to prescribe
buprenorphine. A new website called Live Outside the Bottle has 14 St.
Louis-area doctors listed in its alcoholism treatment database as
physicians who prescribe medications to aid recovery. The database is
incomplete, so other doctors may also treat alcoholic patients with
medications.

Part of the blame for the skepticism lies with those who tout
addiction medications, said Percy Menzies, a pharmacist and director
of the Assisted Recovery Centers of America. Beer was once considered
a remedy for vodka and wine addiction, and morphine, LSD and Valium
were used to treat alcoholism before people knew the drugs were addictive.

"People say, 'We do not trust science because every time we put our
trust in you, you let us down,'" Menzies said.

Menzies insists the new drugs are different. Naltrexone and
acamprosate used to treat alcoholism are nonaddictive. Buprenorphine
can be used to get high, but to prevent abuse, it is usually laced
with another drug that will send a user into withdrawal if the pills
are pulverized and snorted or injected. Its use is highly regulated by
the federal government.

Paula Lowry wants everyone with a prescription drug problem to know
the medications are available. She's been in treatment with
buprenorphine for seven months. As her dependence on narcotic pain
relievers lessened, so did her pain. Lowry is now able to exercise and
spend time with her granddaughter. It's a long way from the depths of
addiction.

"I was so dead inside," she said. "I just didn't have any feelings at
all. Now it's all coming back and I feel like myself again."