AN ADDICTION NEED NOT LAST FOREVER

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:

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

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

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

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

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

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.

Bonnie Erbe, host of PBS' "To the Contrary," writes for Scripps Howard News
Service,