PIONEERING RESEARCH, EVOLVING ATTITUDES ENHANCE RECOVERY OPTIONS

Hospitals and treatment centers are making stronger efforts to
prevent people with addictions from falling through the cracks as
they are passed between institutions. New and effective medicines now
suppress drug cravings.

Joseph Bryant's seventh -- and last -- try to overcome his
addictions, in 2004, couldn't have been better timed.

Bryant tried repeatedly to kick addictions that began with alcohol
when he was 10, heavy marijuana use in his teens, and topped by a
$700-a-day heroin habit in his 20s.

After he served prison sentences for car theft and drug peddling, and
lived in abandoned houses at the age of 27, he realized he had to
change his life, or he would find himself, as he put it, "in jail for
the rest of my life or dying on the streets of Baltimore."

Even as he bounced in and out of a string of ineffective treatment
centers, innovative research and changing attitudes about drug
addiction, treatment and recovery were starting to take hold.

The strongest treatment programs have always offered a variety of
services or connected critical lifelines for their clients. But the
push across the country is fueled by groundbreaking brain research in
the late 1990s that indicates addiction isn't driven by weak
character, loose morals or lax discipline.

While downing those first few drinks or pills may be a choice, many
studies indicate that addiction is a matter of genetics for up to
half of addicted Americans. Researchers at Brookhaven National
Laboratory in Upton, N.Y., documented alterations in the brain linked
to drug abuse, alcoholism or other impulse behaviors that suggested a
genetic predisposition to addiction.

This has led to a growing sense that a connect-the-dots approach is
needed at every turn to help people such as Bryant, who has been
clean since that summer two years ago.

Bureaucratic, financial barriers

"The treatment is beginning to catch up with research," said Thomas
McLellan of the Treatment Research Institute in Philadelphia, a think
tank that attempts to influence clinical practice and public policy.
"This will save a ton of money and, more importantly, lives."At the
same time, medical, addiction and treatment experts are paying
attention to "the continuum of care" -- addiction treatment and
recovery for patients who work with a variety of specialists on the
way to new lives.

Stigmas and misconceptions about addiction hinder vital partnerships
between institutions and make it harder for patients to talk to their
doctors about their problem.

Health-care providers also make it exceedingly difficult for people
with addictions to get help; insurers limit coverage, leading to what
amounts to a class divide in treatment. Services can exceed $20,000,
and many Americans struggle to find financial help or go without.

Addiction also gets relatively low priority in the medical community,
starting with training.

That's important, because physicians, researchers say, are key in
making the link between addiction and chronic disease, a connection
that historically hasn't been strong.

"As a country, we took alcoholism out of the medical milieu," said
Dr. Jennifer Smith, a physician at John Stroger Hospital of Cook
County in Chicago and a professor at Rush Medical College. "For many
years, addiction didn't belong to doctors. This is changing with time."

Higher risk for family members

If addicts today stand a much stronger chance of getting and staying
sober and clean, science is largely the reason. While environment and
stress play a role, the studies indicate strong genetic and
biological links passed through addicted parents make offspring more
susceptible to addiction.

If your parents or siblings are hooked on alcohol or drugs, these
studies concluded, you have a 50 percent chance of addiction; some
studies put the likelihood of addiction as high as 70 percent. What's
more, once addicted, the part of the brain linked to the
pleasure-reward system heightens cravings for the drug, so trying to
stop addiction without treatment is nearly impossible.

Pharmaceutical companies have responded with three different drugs to
combat the cerebral cravings: buprenorphine, acamprosate and
naltrexone. The drugs, available only this decade under a variety of
commercial brands, are designed to curb or even eliminate cravings
and cut the side effects of withdrawal for alcohol and specific
drugs, such as opiates, marijuana and cocaine.

The drugs alone don't ensure successful recovery; they need to be
part of a larger strategy, doctors say. But the medicines, taken over
days, months or years, have offered new hope.

$19,000 bill; small orange pill

For Bryant, one new medicine provided the antidote to failed recovery
efforts, when, he says, treatment centers "didn't pay attention to
details. There was no one-on-one to help you find out why you were on
drugs. Therapy was not available."On his last try, Bryant turned to
an uncle in New York, who enrolled him in a Phoenix House treatment
facility in Brooklyn, N.Y. What Bryant found there is everything
researchers and social scientists recommend in a drug rehabilitation
and recovery program -- beginning with buprenorphine.

The small orange pill, quickly dissolved under his tongue, eliminated
Bryant's cravings. The intense physical pain common to withdrawal was
so minimal that Bryant found he could sleep through the night. "I
could eat," he said. "The hot and cold sweats, the chills -- the drug
minimized all of that."

Within his first week of treatment, Bryant was off buprenorphine and
transferred from his detoxification room to a bed under the same
roof, a logistical godsend at a critical time in treatment. Following
his previous detox experiences, he had been sent to recovery centers
often miles away; sometimes they had available beds, but more often
Bryant had to wait two or three days -- and invariably found himself
back on drugs.

Bryant had to use Medicaid to pay for his treatment and recovery at
Phoenix House, the nation's largest nonprofit addiction treatment and
recovery organization, which charges $19,000 a year.

Drug-free for 18 months and in the last stages of his recovery
program, Bryant still lives there, leasing a room for $15 a week
until he saves enough money from his job as a carpenter to find his
own place. Housing assistance is key, Phoenix House officials say,
because the low-cost shelter allows patients a solid shot at
long-term stability as they piece together their lives.

Said Bryant: "I take my life one day at a time."

About This Story

Public Access Journalism collaborates with news organizations and
foundations to bring solutions to life's challenges.

PAJ translates research on health, education, cultural and
environmental issues for each project. This story was distributed
free through McClatchy-Tribune News Service, a global service owned
by McClatchy (the Observer's parent) and Tribune Co. For information:
www.pajournalism.com.

Resources

. Substance Abuse Prevention Services (formerly Drug Education
Center), 704-375-DRUG (3784).. Chemical Dependency Center, 704-376-7447.

. Mecklenburg County Substance Abuse Services Center, 704-336-3067.

. McLeod Addictive Disease Center, 704-332-9001.

. Alcoholics Anonymous, 704-332-4387.

. Mental Health Association of Central Carolinas, 704-365-3454.

- -- Karen Garloch

Finding Help

HOT LINES AND LOCATORS

. Substance Abuse Treatment Facility Locator:
www.findtreatment.samhsa.gov/facilitylocatordoc.htm -- Searchable
directory of treatment programs nationwide.

. Buprenorphine Physician Locator:
www.buprenorphine.samhsa.gov/bwns-locator/index.html -- Resource
designed to help states, medical and addiction treatment communities,
patients and families locate physicians who can prescribe
buprenorphine (Suboxone and Subutex ) for treatment of opioid addiction.

. National Helpline: www.samhsa.gov -- Hot line offering confidential
information on treatment and referral.

. National Committee for Quality Assurance: www.ncqa.org -- Online
report cards on health plans that lets you compare hundreds of health
plans, Medicare and Medicaid, for the best treatment coverage.

. More info: www.silenttreatment.info.

[Sidebar]

5 Addiction Myths

. Myth 1: Drug addiction is voluntary behavior.

Occasionally using alcohol or other drugs is a voluntary decision.
Over time, continued use of addictive drugs changes your brain in
ways that result in compulsive and even uncontrollable drug use.

. Myth 2: Drug addiction is a character flaw.

Drug addiction is a brain disease. Every type of drug -- from alcohol
to heroin -- has its own mechanism for changing how the brain
functions. Effects range from changes in the molecules and cells that
make up the brain to mood and memory processes -- even on motor
skills such as walking and talking.

. Myth 3: You can't force someone into treatment.

Treatment does not have to be voluntary. Those coerced into treatment
by the legal system can be just as successful as those who enter
treatment voluntarily.

Myth 4: Treatment for drug addiction should be a one-shot deal.

Some people can quit drug use cold turkey, or they can stop after
receiving treatment one time. Most people who abuse drugs require
longer-term treatment and, in many instances, repeated treatments.

. Myth 5: No one voluntarily seeks treatment until they hit bottom.

Pressure from family members and employers, as well as personal
recognition that they have a problem, can be powerful motivators. For
teens, parents and school administrators are often driving forces in
getting them into treatment before situations become dire.

- -- Public Access Journalism