ADDICTION A DISEASE OF BRAIN THAT REQUIRES LONG-TERM CARE

For all that has been written and spoken about addiction as a medical
disease, most people, including most physicians, understand little about
what draws people to drugs and keeps them hooked, often despite severe
consequences and repeated attempts to quit.

A better understanding of addiction can help those who want the monkey off
their backs for good.

The savings in life-years, quality of life and lost income can be huge, not
to mention the costs of drug-instigated crime and medical care.

According to the National Institute on Drug Abuse, $133 billion a year is
spent just on treating the short-term and long-term medical complications of
addiction. Among the many health consequences of addictions are sudden
cardiac arrest, irreversible kidney and liver damage, AIDS, fetal harm and
many cancers, including cancers of the lung, bladder, breast, pancreas,
larynx, liver and oral cavity.

The nature of addiction is the same no matter whether the drug is cocaine,
heroin, alcohol, marijuana, amphetamines or nicotine.

Every addictive substance, according to a report this month in The New
England Journal of Medicine, induces pleasant states or relieves distress.

Furthermore, the authors of the report, Dr. Jordi Cami and Dr. Magi Farre of
Barcelona, Spain, wrote, ``Continued use induces adaptive changes in the
central nervous system that lead to tolerance, physical dependence,
sensitization, craving and relapse.''

In other words, addiction is a brain disease, not a moral failing or
behavior problem. People do not deliberately set out to become addicts.
Rather, for any number of reasons -- like wanting to be part of the crowd or
seeking relief from intense emotional or physical pain -- people may start
using a substance and soon find themselves unable to stop.

Of course, not everyone who smokes a cigarette, takes a drink, snorts
cocaine or self-injects morphine is destined to become an addict.

According to the Institute of Medicine of the National Academy of Science,
32 percent of people who try tobacco become dependent, as do 23 percent of
those who try heroin, 17 percent who try cocaine, 15 percent who try alcohol
and 9 percent who try marijuana.

The Barcelona experts, in discussing the addiction mechanisms, noted,
``Long-term administration of addictive drugs produces alterations in the
brain that increase vulnerability to relapse and facilitate craving even
months or years after successful detoxification.''

Those changes involve cognitive areas and drug-rewarding circuits.

For someone who used drugs to relieve an emotional problem or psychiatric
disorder that was not otherwise treated, the temptation to revert to the
assuaging drug can be irresistible. Without follow-up treatment for both the
addictive disorder and the underlying mental illness, the chances of a
lasting recovery from addiction may be slim.

Because prolonged exposure to abused drugs results in long-lasting changes
in the brain, ``addiction should be considered a chronic medical illness,''
the Barcelona scientists said. As with other chronic illnesses, including
hypertension and diabetes, addiction and its treatment require ``long-term
strategies based on medication, psychological support and continued
monitoring,'' they concluded. Other experts have suggested that treatment of
addiction should be fully insured.