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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soundoff (64 Responses)
  1. Teresa

    I am thrilled that CNN and Dr. Gupta realize how important And desperately neccessary it is to investigate and inform the public about the problems and solutions that surround this DESEASE of alcoholism. Many of us know and love an alcoholic and I will tell you first hand that none of them want this terrible deasese which they have unfortuneatly infherited and/fallen slave to . They feel embarraed, quilty, mortified, alone, scared and ashamed. Like most DESEASEs and I repeat DESEASE, it overcomes them. How many millions of families, friends co-workers etc. have to suffer. This has continued for decaded and our society simply dismisses the alcoholic and a worthless indulging wrech. It's as inaccurate as the century old myths about witches. Alcoholics need help. All!!!alcoholics need help. While AAA has been bennificial to many it is not enough. We need continued reseach and development of more effective drugs to treat this devasting DESEASE. If I knew what I could do to help in the development and research I would do anything in my power to contribute. Please, please KEEP reporting on this topic. If you have any suggestions as to what I could do to help, PLEASE let me know. I thanks you for all you've done to inform the public and pray more will be done to find a cure SOON...."tpanko"

    April 21, 2009 at 22:25 | Report abuse | Reply
  2. Len

    Dr Gupta,
    Please read the book " Alcoholics Anonymous" for yourself. The program of recovery is only the preface, fowards and up to page 164.
    It is also helpful to have a "RECOVERED" alcoholic share with you their experience. The difference is that we have sucessfully worked all 12 step and apply them on a daily basis. AA is not therapy, it is a practical program of action which requirers a consciousness of a power greater then human power and a strenuous effort to help other alcoholics.
    There are a great deal of misconseption in the treatment of alcoholism and addiction, even within AA, thats why it so important to get the facts straight. This will make the difference between life and death for thoses who seek a real solution and they come in quite young now. Most of what I heard on your program could not be reconciled with the 12 step program IN THE BOOK. AA was designed by hopeless alcoholic to treat the worst cases, my experience is that alot of people overlook this especially non alcoholics. Check the CDC website for the annual number of people who drink themselves to death. There is alot of websites now that are devoted to Big book based recovery I can send you, but AA takes no position on these and I do not speak for AA. This is just my experience that all the good intentions and frothy emotional appeals did not help, we must be armed with the fact to be of maximum effectivness. Thanks

    April 21, 2009 at 23:54 | Report abuse | Reply
  3. ann culpepper, MD

    All alcoholics are not alike. I never had any alcohol until age 42. Beginning then, I never had more than 2 glasses of chardonnay qd until I retired. At about age 60 I began to up the level because I could. I have never been tipsy, out of control, or behind the wheel after drinking a bottle per day. I am a day-long sipper. My LFTs are normal. I am the most healthy athletic 70-yr-old I ever met. I am not some 20-30 yr old dr. who is going to lose her career, hurt her 3 grown children, or 4 grandchildren, or anyone. I am happy and have lots of fun. I had a very successful career and am enjoying "golden pond." I will never stop my wine habit. Plz get Dr. Gupta's opinion. Thanks! Dr. Ann Culpepper, Memphis, TN.

    April 22, 2009 at 13:46 | Report abuse | Reply
  4. Mary McConnell

    Biologically is food addiction the same as drug or alcohol addiction in the brain? I feel the same way that Nic did in the story but my drug of choice has been food. Is there something (a pill) that stops the food addiction as well as it did for the alcohol? I'd try it.

    April 22, 2009 at 13:55 | Report abuse | Reply
  5. Rebecca

    I believe that many who have left comments have been touched by addiction or have never been touched at all in any way. First let me tell you that prison is not fun. The food is not good. They provide very little and families who have not yet abandoned their loved ones have to supplement basic needs ( toilet paper, soap, toothpaste, stamps, paper to stay in touch with loved ones. The people who have left comment in their 50's and 60's, why would you want another perpon to go through what you have gone through just to be able to say you did it without help. Crack, cocaine, meth,herion addicts need realistic medical treatment. They probably have issues that need to be addressed, but as long as the drugs are in control, the other issues can't be addressed. A lot of people what to say it's the parents faults. How do you explain on child becomming an addict and the others not. Addiction is a illness and we as a country need to address this problem. There are lots of addicts that would take whatever help they could get to change their lives. I think as a country we are spending billions to prove a point. There are way to many other issues that we could address. When our government has to make a choice to cut our education in order to give a inmate 2 sandwiches and a apple a day, it's time to address to problem.I'm not sure a pill is the answer, but maybe an injection that will stay in their system until their brain can heal and maybe even a booster to keep those cravings in check. I for one would rather have my addict treated with a realistic treatment than for him to spend his life in a prison because he is a nonviolent offender with the disease of addiction or dead. Whatever it take, we need to do something different. Our war on drugs is growing. We're losing it.

    April 22, 2009 at 19:56 | Report abuse | Reply
  6. Mike

    I tried AA i just hope there is something else out there that works just beside talking to them.After hearing other people's problems it just made me drink much worser.A lot of people want to throw off on addiction but I just have one thing to say,till you go one day through it you just dont honestly know what it is like,it is like pure hell.

    April 23, 2009 at 15:43 | Report abuse | Reply
  7. Anthony Ross

    I have been an addiction counselor for 33 years, working 14 years in a Veterans Administration addiction program. Anti-addiction medication is helpful, however are only helpful if the person wants to abstain from all substances. I have noted individuals abstaining from heroin using methadone or naltrexone, smelling of alcohol, testing positive for cocaine, or marijuana. Pharmacology in conjunction with counseling, or therapy is the best answer. Medication only works when taken; many individuals will discontinue the medication once they think they are no longer needed. I have an associate degree in addiction studies and an undergraduate degree.

    April 24, 2009 at 07:04 | Report abuse | Reply
  8. Shannan Matney

    For years I struggled with my addiction with alcohol and pot, I could not function unless I was drunk or high. I had my whole family fooled into thinking I didn't have a problem (and in my mind I was doing nothing wrong). I destroyed my crediability! I was a liar, thief, just the scum of the earth. So three years ago, my husband FORCED me into a rehab. It took me getting sober and unstoned to realize what a joke I was. I done the 12 steps and even had a sponsor, but what really helped me was "THE BIBLE", YES ACCEPTING JESUS CHRIST AS MY SAVIOR. GOD can clean-up the worst of us with our addictions. I understand some people need different kinds of help, because my brother-in-law struggles with drug addiction and he doesn't believe he needs any help. I haved been clean and sober for 3 years and I have never been happier in my life.

    April 25, 2009 at 15:33 | Report abuse | Reply
  9. Norma McGurk

    I don't believe that there is much reasoned debate on disease vs. character flaw, at least not amongst those who follow science. That said, I know from my personal experience that these are neither magic medications nor universally helpful. They may extend some hope to those afflicted, but are not, I repeat NOT, any sort of a cure.

    April 27, 2009 at 18:38 | Report abuse | Reply
  10. Samantha Bury

    I'm married to a recovering heroine addict. He has taken everything, he's gone to rehab 12 times, and been in and out of jail. He is not a horrible, flawed person. He's actually the most caring person I've ever known, and he carries tons of guilt with him. I've been to meetings with him, had to sit through therapy sessions for friends and family, and everything. I've heard it a million times. You can't cure addiction, and an addict has to reach rock bottom. Have you ever read the 12 step books? They're a better guideline for life than the bible. I myself, not an addict, have found help in the books. It depends on the person and how far gone they are when/if they're going to come back. I have plenty of first hand experience watching people crumble and die. My father's a cross addicted cocaine/alcohol. My sister in law is a heroine/crack addict. I've seen people comletely forget their lives and loved ones in selfish pursuits/coping with a disease. It's like a personal cancer you can chose to have and let kill you or you can turn around and fight. Nothing cures it, it's always there. An individual has to change, and has to want to change. Unless a pill can make someone wake up and see the distruction they are causing and the people left in the wake, a pill will do nothing.

    April 28, 2009 at 14:42 | Report abuse | Reply
  11. Ramona H

    Let me begin by saying that I believe in the power of the 12-step program. It has saved countless lives.

    But...I will pose this question for all who lean towards NOT medically treating addiction.

    Will you have people die because you think that someone did not "try" hard enough to work the 12 step program?

    April 28, 2009 at 18:28 | Report abuse | Reply
  12. Julian Milian

    We keep hearing that there are no effective vaccines for Swine Flu and that it is most probable that previous influenza vaccines will not afford protection for this strain of virus. I have not heard anything about whether if anyone in the U.S. gets this mild version of the swine flu, will then be immune to any additional swine flu viruses .

    April 28, 2009 at 23:38 | Report abuse | Reply
  13. Boni Powell

    I live 2.5 miles from the massive Smithfield Circle4Farms.We have suffered respiratory illnesses similiar and the swine workers and now neurological problems.We have tried to tell others about the horrible hog stench daily and looked for help.D.E.Q. who doesn't care.We live in the windiest corridor in Utah and plumes of dust and Volitle organic compounds are a daily imposition.
    Here is my question.
    Can a worker who sneezes and doesn't know he is infected yet spread this back to the pigs so they virus factories> Will it attach to the dust as other viruses do to fly to our home?Know a lawyer to help us get out of this situation?Desperate.

    April 29, 2009 at 02:03 | Report abuse | Reply
  14. spiritual

    Very nice information.

    July 26, 2010 at 08:14 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.