Addiction is a multidimensional process
So, what do we really know about addiction?
Recent neurological and biological studies have defined addiction as: “a disorder of altered cognition from a psychological and neurological perspective.” But what does THAT tell us? We know that addiction affects the brain regions and processes in charge for cognitive functions, such as:
- impulse control
Further, we know that drugs can alter the brain’s normal functioning and structure. Drug abuse produces cognitive shifts that promote continued drug use through maladaptive learning and hinder the acquisition of adaptive behaviors that support abstinence.
However, addiction is a complex disease…to understand and to treat. We at Addiction Blog believe that drug and alcohol problems require a new approach. But what can that look like?
How can integrated treatment help?
We’ve gone to one of the most sought experts for his direct advice. Dr. Howard Wetsman, MD is an addiction psychiatrist who specializes in the outpatient treatment of addiction. He’s on ASAM’s Board of Directors and we are so happy that he has agreed to provide us with a window into new, integrated approaches to addiction treatment today.
In this interview, we’ll talk about the importance of treating BOTH the biological and cognitive aspects of drug addiction. He’ll share with us more about psycho-sociology (offering a model for healthy living) and the biology (sober living/ life without drugs) of addiction recovery. Then, we encourage you to use the section at the end for YOUR questions. We will make sure respond to you or to pass them on personally.
ADDICTION BLOG: In your opinion, is addiction primarily a psychological or a biological disorder? Can it be equally both?
DR. HOWARD WETSMAN, MD: It’s clearly a biological brain disorder, but can it be both? I think that’s a false dichotomy.
Everything is both.
Diabetes is both biological and psychological. So is cancer. There are no biological illnesses that don’t have psychological effects and psychological inputs. Addiction is no different.
ADDICTION BLOG: How did you come up with the idea of combining biological and cognitive treatment? Did you notice a missing gap in the current approaches?
DR. HOWARD WETSMAN, MD: Everything came from our goal of making more recovering people now and in the future. That meant that we had to look at why there weren’t more happening spontaneously.
Basically, we asked ourselves, “What is the treatment industry doing to keep people from coming to treatment?” Everything in our model was designed to decrease barriers that we found in traditional treatment.
For example, one of those barriers was the gulf between those who used medication and didn’t believe in psychosocial treatment and those who did only psychosocial treatment and didn’t believe in medication.
ADDICTION BLOG: Can you please define for us the biological and cognitive treatment approaches for substance addiction? How are they combined?
DR. HOWARD WETSMAN, MD: Well, the first thing to understand is that they work for addiction in total, not just addiction involving substances. Once you understand that addiction is a single biological brain disease, it becomes much less complicated to treat.
The combination of biological and cognitive approaches is directly derived from understanding that in addiction, the illness is there first most of the time. It causes symptoms, and the symptoms cause the drug use. If you just stop the drug use, you’re still left with symptoms and these symptoms get in the way of treatment.
The biological part of the treatment stabilizes the midbrain dopamine tone so that the person can pay attention, remember, attach to others and enjoy the interactions in treatment.
ADDICTION BLOG: What are the limitations of each approach?
DR. HOWARD WETSMAN, MD: Well if you treat only the biology, the person hasn’t learned a way to live, and his previous experience is all geared to the old biology and active using. He may feel better quickly but he’s much less likely to stay that way over time.
If you only take into treatment those that can work on the psychosocial without biological help then you leave a lot of suffering people out there to die of this disease.
We just can’t countenance that.
ADDICTION BLOG: Can you tell us how this new integrated approach has been effective in your experience? In what way is it different from other evidence-based methods?
DR. HOWARD WETSMAN, MD: Everyone in our field is competing for the same 16% of people with addiction who try to get help. We aimed at the other 84%, the people who knew that treatment wouldn’t work, that nothing would work. We offered them something that would work, and it did. This was in keeping with our core goal of creating more recovering people.
ADDICTION BLOG: How long does treatment last?
DR. HOWARD WETSMAN, MD: It’s completely individual, and the longer we do it, and the better we get at it, the faster it will go.
For instance, we’ve been waiting for 4-6 weeks to get genetic testing results back. In about a month we’ll have a 3 day turnaround time. That will make the medical treatment go much faster.
ADDICTION BLOG: Is integrative addiction treatment better incorporated into inpatient or outpatient settings?
DR. HOWARD WETSMAN, MD: Either. It really doesn’t matter.
ADDICTION BLOG: Do you have anything else that you’d like to add about combining the mind and body treatment of addiction for our readers?
DR. HOWARD WETSMAN, MD: No, but thanks for the opportunity to talk about our model. Hopefully everyone can accept and get on board with our goal of more recovering people now and in the future.