BREAKING ADDICTION CAN BE DONE

Call me a reformed non-believer. For the longest time I had given up
on peoples' ability to change. But new data convinces me substance
abusers can free themselves from addictive and harmful behaviors
(smoking, drinking, drug abuse) in much greater percentages than we
ever imagined.

Researchers have developed mountainous advances in the field of
substance abuse during the last 15 years. We now understand so much
more about how addictive chemicals (alcohol, tobacco, opiates) change
brain function.

Using this newfound knowledge, doctors and treatment experts combine
pharmacological and therapeutic intervention to boost success rates.

On the pharmacological side, methadone and lesser-know drugs such as
buphrenophine ease withdrawal from opiates. Naltrexone ameliorates
alcohol cravings. On the psychological side, researchers have a much
clearer idea of the social and emotional factors that send people down
the long, hard road to substance abuse. This in turn gives people the
tools they need to control and overcome harmful behaviors.

One leading researcher is Dr. James Prochaska, professor of clinical
and health psychology at the University of Rhode Island. Dr. Prochaska
last year won an "Innovator Award" from the Robert Wood Johnson
Foundation for his path-clearing research, revolutionizing the field
of substance abuse treatment and prevention.

What he's done seems simple on the surface, but its impact is nothing
short of amazing. Dr. Prochaska developed a phased-in view of abusers,
recognizing for the first time they are not one indistinguishable mass.

Rather, counselors achieve much higher success rates when they
recognize an addict or abuser's ability and desire to change
progresses in distinct phases, and then tailors an approach to a
particular abuser's situation.

Those stages are:

1. Precontemplation: Abusers have no current intention
of changing. They use hopelessness, denial and
defensiveness to fend off change.

2. Contemplation: Contemplators accept or realize they
have a problem and begin to think seriously about
changing it.

3. Preparation: People in this stage are planning to
take action within a month. Smart preparation includes
a detailed scheme for action.

4. Action: This stage speaks for itself. The person
takes action and makes a commitment.

5. Maintenance: Often more difficult than action,
maintenance can last six months to a lifetime.

6. Termination: The temptation to abuse substances is
gone. Some experts believe termination never occurs,
only that less vigilance is required over time.

Why is this work so important? According to some of Dr.'s Prochaska's
followers, by delineating stages he explains why abstinence-oriented
substance abuse treatment models fail 80 percent of the time and more.
It is too much to expect people to leap from a state of "ignorance
combined with lack of motivation," directly into action. First,
abusers and addicts must recognize they have a problem and then decide
they want to change.

There's another piece we need to address. Society makes it harder to
get treatment than it is to acquire abusive substances -- be they
tobacco, alcohol, prescription drugs or illegal drugs. President Bush
took the unusual step of trying to change this in his State of the
Union address.

He devoted two minutes of the speech (more than any prior president)
to substance abuse treatment. He promised a $200 million boost in
federal spending on treatment. Now he must match his words with deeds.

American taxpayers spend $11 billion per year on treatment already, or
roughly one-third the amount we spend on the war on drugs. That figure
is also less than 1 percent of what we spend on health care overall.
The president's proposed increase, forward-looking as it is,
represents an increase of one-thirtieth of one percent in spending on
treatment.

Throw this information into the mix. We are able to offer treatment to
3.1 million out of 16.6 million Americans who told the 2002 National
Household Survey (a federal survey) they have problems with or are
addicted to alcohol and drugs.

All told, does this mean we are doing enough to change destructive
behaviors? I used to think so. I don't anymore.