April 17th, 2009
01:00 PM ET

Is a pill really the right answer for all addicts?

By Caleb Hellerman
CNN Medical Senior Producer

We’ve spent close to a year exploring the twists and turns of addiction and rehab. It stirs up strong emotions – a lot of us have friends or family members who have wrestled with addictions, so it touches close to home. I think that’s why many people see addiction as an issue of morality or basic decency – who are these people to wreak havoc in our lives?

That said, on at least some level addiction is a disease of the brain. I was fascinated to learn about anti-addiction medications and what they might mean for the future of treatment. It was the most e-mailed story on CNN for two days running, and we got hundreds of comments on this report. What many people wanted to know is why these medications are not widely known.

This isn’t an answer, but I’ll lay out a theory: Medications like naltrexone or topiramate don’t fit the current models for treating addiction. This is true, for different reasons, on the high end and the low end, too. The issue in high-end rehabilitation centers is obvious: Why would people or insurers pay tens of thousands of dollars a month, when they could stay home, see their family doctor or therapist and pick up a monthly prescription at the pharmacy? Of course it’s not that simple; even the biggest advocates of medication say that inpatient treatment can be helpful for some addicts, and most inpatient centers do sometimes prescribe these drugs. Still, the business angle can’t be overlooked.

Less obvious but probably bigger is the impact medication could have on outpatient therapy. That’s because a lot more people get treatment in small community centers, or clinics, than go to hospitals like Betty Ford. Even more just go to AA or another 12-step program. In all these settings, many counselors have little or no medical training. Sometimes they just have whatever wisdom they’ve gleaned from their own addiction.

If “medical” outpatient treatment is a lot less expensive than spending a month in rehab, it’s a lot more expensive than hiring lay counselors and organizing AA meetings. Dr. Robert Swift of Brown University and the Providence Veterans Affairs Medical Center, who helped run the federally funded COMBINE study that compared medication with other types of therapy, told me “A lot of these programs go to the lowest bidder. If you can provide, quote, ‘services,’ and one program uses the lowest level of acceptable counselors, and the other provides medical treatment and pharmacotherapy, one of those is going to be substantially more expensive.”

There’s no doubt the struggle over the best addiction treatment has a big component of philosophy: is this a brain disease, or a character flaw? But the issue of cost makes it that much easier to stick with the status quo. In a country of 23 million addicts, where close to 20 million don’t get treatment, that’s not really acceptable.

Has addiction touched your life? What treatment(s) have you seen work?

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