Talking to NIDA about addiction research- Nicotine, cocaine, treatment matching and more

It’s not everyday that I get an invite to speak with NIDA‘s director, Dr. Nora Volkow, and so, even though it required my creative use of some VOIP technology from a living room in Tel-Aviv, I logged onto a conference call led by the leading addiction researcher. When my colleagues, Dirk Hanson and Elizabeth Hartney, were introduced, I knew I was in good company.

Addiction research directions the NIDA way

The call focused on some NIDA interests, including a nicotine vaccine, which Dr. Volkow seemed confident will triumphantly exit phase 3 trials in less than two years and potentially enter the market after FDA approval in three years or less. The vaccine, which seems to significantly and effectively increase the production of nicotine antibodies in approximately 30% of research participants, has shown promise as a tool for smoking cessation in trials showing complete cessation, or significant reduction in smoking among participants that produced sufficient antibodies. Obviously, this leaves a large gap for the 70% of participants for which the vaccine was not effective, but a good treatment for some is much better than no treatment for all. For more on the vaccine, check out Mr. Hanson’s post here.

Aside from the nicotine vaccine (and on a similarly conceived cocaine vaccine), our conversation centered on issues relevant to the suggested new DSM-5 alterations in addiction-related classifications. Dr. Volkow expressed satisfaction at the removal of dependence from the title of addictive disorders, especially as physical dependence is often part of opiate administration for patients (especially pain patients) who are in no way addicted to the drugs. Dr. Volkow also noted that while physical dependence in relatively easy to treat, addiction is not, a matter that was made all the more confusing by the ill-conceived (in her opinion, and in mine) term. Additionally, the inclusion of severity ratings in the new definition, allowing for a more nuanced, spectrum-like, assessment of addiction disorders, seemed to make Dr. Volkow happy in her own, reserved, way.

Treatment matching – rehab search for the 21st century

As most of my readers know, one of my recent interests centers on the application of current technology to the problem of finding appropriate treatment for suffering addicts. I brought the problem up during this talk, and Dr. Volkow seemed to agree with my assessment that the current tools available are nowhere near adequate given our technological advancements. I talked a bit about our upcoming addiction-treatment-matching tool, and I hope that NIDA will join us in testing the utility of the tool once we’re up and running. I truly believe that this tool alone will allow more people to find appropriate treatment increasing the success rate while maximizing our system’s ability to treat addicts.

Involving the greater public in addiction research

It wasn’t until the end of the conversation that I truly understood the reason for the invitation (I’m slow when it comes to promotional issues) – NIDA is looking to move the discussion about it’s goals and directions out of the academic darkness in which they’ve lurked for years, and into the light of online discussion. I’m in no way offended by this, especially since this was exactly my point in starting All About Addiction in the first place. If anything, I’m honored to be included in the select group of people NIDA has chose to carry their message, especially since the conversation was an open, respectful, and data-centered one. I hope more of these will occur in the future.

Resolving confusion about addiction

One of the final points we got to discuss in the too-short hour we had Dr. Volkow on the “phone” had to do with the oft misunderstood concept of physical versus psychological addictions. I’ve written about this misconception in the past, and so I won’t belabor the point here, but it’s time that we gave our brain the respect it deserves by allowing it to join the rank, along with the rest of our body, and the physical realm. We’re no longer ignorant of the fact that our personalities, memories, feelings, and thoughts are driven by nothing more than truly physical, if miniature, happenings in our brains. In the same way that microbe discovery improved our well-being (thank you Pasteur), it’s time the concept of the very physical nature of our psychological-being improves our own conceptualization of our selves.

We are physical, spiritual, and awesome, but only if we recognize what it is that makes “us.”

Creating a better system of addiction treatment: Matching rehabs to patients

I can’t hide it any longer, I just have to confess: I hate the way addiction treatment is managed nowadays. With over 25 million people meeting criteria for addictions in the U.S., only 10% are seeking treatment on a yearly basis. Sure, part of the problem is that others just don’t want it, at least yet, but there’s something else going on and it’s terrible.

The horrible pain of finding addiction treatment

If you, or someone you know, needs help for an addiction, your options aren’t just limited, they’re hard to find and are simply too stressful to deal with. Where do you even start? Most people wouldn’t dare go to their neighbors or family members with something like “Bobby is really struggling with his cocaine problem, do you have an idea of what we should do?” Instead, everyone is left fending for themselves, scared of going to doctors for fear of later insurance trouble, ashamed to admit their difficulties for fear of being stigmatized, and inundated with conflicting information about their chances for recovery if they do seek help.

So people go online, they seek out information, and they call provider after provider, often getting only partial semi-truths. At the end, most are left confused and the rest simply check in to the first place that will take them given their financial reality. Could you imagine if the same were true when someone broke their leg?

But isn’t addiction treatment really useless?

No, it’s not. Treatment works. It’s just that most people don’t get the treatment they need and end up paying the price (literally and figuratively). Well guess what, help is possible, it’s available, and it shouldn’t be this damn hard to find!

I think it’s about time we create a system that makes it easy for those suffering from addiction to find the right treatment for them. Not everyone needs treatment that costs $50,000 a month, and to be perfectly honest, that treatment is rarely better than much cheaper options. Still, no one would know that given bogus advertisements by rich addiction-industry-players that promise cures and fixes. The truth is that recovery is a difficult road and that different individuals may need different treatment.

Still, we know things that work: CBT works, motivational interviewing works, social-support, contingency-management, exercise, meditation, and specific medications work! So why is it that the addiction treatment industry still looks like something put together by a couple of addicts who suffer from too much self-focus and not enough organizational-capacity? Well, probably because that’s exactly our reality at the moment.

How can we make things better? Matching rehabs to patients

I say it’s time for a new age, especially given the passage of mental-health and addiction parity laws and the slow, but eventual inclusion of our most vulnerable citizens in the American health care system. As addiction-treatment becomes (finally) incorporated with medical care, the increased resources are going to mean an increased need for some standardization. It’s time for us to put people in treatment that works, that everyone can afford, and that is easy to find.

We’re currently testing a system that will use some basic, and some a bit more advanced, criteria to help direct addicts towards the right provider for them. Don’t have much money and working full-time? Then residential treatment should probably not be your first choice? Medicated for schizophrenia? You better stay away from providers that don’t offer serious mental health services (though they’ll sure take you if you walk through their doors)

We’re still figuring out the kinks, trying to improve the system even further than its current state, which I think is nothing short of magical. Eventually, I hope that it will be available for everyone, giving people real, reliable, objective access to addiction-treatment providers that do good work across the united States. It’s that easy to find a condo to buy, why shouldn’t it be that easy to find help?

Yes, I have almost 10 years of research experience into what works, but in truth, most of the issues here probably don’t require that at all. What’s needed is a little big-picture thinking and a little less fine-tooth combing. Hospitals can triage people based on a pretty quick, efficient, assessment. We can too.