Addiction Medicine on Path Toward a New Era

Three of the most visible proponents of developing modern, scientific approaches to the management of addiction received standing ovations from a standing-room-only crowd during the Opening Scientific Plenary of the ASAM Annual Conference Friday.

Discussing government approaches toward a national drug control policy, the reaction of the brain to drug use, and the goals of the Mental Health Parity and Addiction Equity Act were Michael P. Botticelli, George F. Koob, PhD, and Patrick J. Kennedy. Botticelli is the Director of the Office of National Drug Control Policy (ONDCP), Dr. Koob is the Director of the National Institute on Alcohol Abuse and Alcoholism, and Kennedy is a former U.S. Representative and Founder of the Kennedy Forum.

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Michael P. Botticelli

Botticelli reviewed the ONDCP National Drug Control Strategy, which addresses plans to reform the response to substance use, focusing on overdose prevention, medication-assisted treatment, and criminal justice reform.

“There are 23 million people in recovery and we want to support them. This is a disease…a health problem,” he said, adding that the health care community and third-party payers need to recognize the need to transition to a treatment model that sees addiction as a chronic condition.

“We have an obligation to make sure we change our language as it relates to addiction,” Botticelli said, adding that only 19 percent of those with addictions are receiving treatment. “We put the locus on the patient to get treatment. We need to put that responsibility on the system, not the patient.”

In response, government spending on drug control and treatment of addiction is increasing, and the science of addiction treatment is moving into a new era—slowly, he said.

“I wish we did not have a divide between abstinence-based care and medication-assisted care,” Botticelli said. “I hate the terms we use. It undermines treatment in general when we talk along these lines.”

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George F. Koob, PhD

Dr. Koob, former Editor-in-Chief of the Journal of Addiction Medicine, received the R. Brinkley Smithers Distinguished Scientist Award and presented “Reward, Stress and Addiction: Two Faces of Janus.” He discussed how the reward and stress neurocircuitry of the brain changes during the course of the addiction cycle, resulting in compulsive drug-seeking behavior.

The brain goes through three stages in reaction to the use of drugs, he said:

  • The Binge Intoxication Stage is characterized by a compulsion to seek and take drugs, which causes the system to change. This is a time when habits are formed.
  • The Withdrawal/Negative Affect Stage is when there is a loss of control in limiting intake. Researchers have traced this process in the brain and are trying to develop a drug to reverse that process.
  • The Preoccupational/Anticipation (Craving) Stage is a key element of relapse in humans, and it defines addiction as a chronic relapsing disorder. It most strongly affects the frontal cortex, and defects in the frontal cortex may drive addiction problems.

Moving forward, a key part of this ongoing research is to develop a better understanding of how neurotransmitters work, Dr. Koob said.

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Patrick J. Kennedy

Kennedy, who is in long-term recovery from addiction, discussed the importance of the Mental Health Parity Act, how it could be enforced, and the role of addiction medicine in the nation’s health care system.

The son of the late Senator Ted Kennedy, Patrick Kennedy took a much lighter approach toward discussing addiction by joking about his iconic family before moving on to the effects of political assassinations and alcoholism on his upbringing, and his addiction.

That background led Kennedy to be the primary sponsor of the Mental Health Parity Act in Congress, when he was “in and out of treatment,” at a time when addiction was treated as an acute rather than a chronic condition. The Mental Health Parity Act is changing that debate, Kennedy said.

“We are at the most exciting period of time…where we will treat the whole person,” Kennedy said, adding that means better medicines for treatment, improved research, and a stronger addiction community.

“At the end of the day, we all are in this together. Why is addiction treatment not reimbursed by insurance companies? That is something that has to be changed,” he said. “We have to make real the promise of the Parity Act—that we treat addiction and mental health the same way as any other physical illness.”