Addiction: A New Treatment Paradigm

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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In 2010, a comprehensive update on what we have learned about the science of addiction was published in the medical journal Neuropsychopharmacology, authored by experts at the National Institute on Drug Abuse of Bethesda, Maryland, and the Committee on the Neurobiology of Addictive Disorders of The Scripps Research Institute of La Jolla, California, headed by director Dr. Nora D. Volkow M.D. and George F. Koob Ph.D. (doctorate in Behavioral Psychology from Johns Hopkins University). This comprehensive update on scientific research (see link below in Additional Information) reveals that addiction is not an inherited defect in a single area of the human brain, but instead a progressive disruption of normal homeostasis in a broad area of the brain, from the regulatory brainstem to the frontal cortex, called the mesolimbic pathway, which requires a comprehensive and holistic treatment protocol to correct. When this dysfunctional state is corrected, and the whole syndrome of the addiction addressed in a holistic manner, the problem of uncontrolled addiction will be resolved. While Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) does not provide a simple miracle cure, it should be part of the treatment strategy when devising a more comprehensive and holistic protocol to resolve a very difficult health problem.

Addiction is a syndrome or disease that is not just tied to a single substance, but a developing health problem of neuropsychological dysfunction. To date, we have assumed that just stopping the addictive substance or behavior will cure the addiction, and for a great majority of individuals with this health problem, this has not worked.

A growing debate is finally occurring concerning how to treat addiction syndrome, and the growing consensus among experts is that we need to treat the person and the whole dysfunctional disease, not just the craving of a single substance or behavior. The argument against this new protocol of treating the dysfunction rather than just the type of addiction, is complex and backed by an industry that is profitable and needs to fight change to maintain profits. While a debate has been generated stating that if it were indeed true that such treatment for a single substance use addiction would then result in a substitution to a new addiction with successful treatment, in effect treatment generating a failure, we can see that this is not a logical assumption. Instead, if the cycle of dysfunction is truly resolved and homeostatic mechanisms restored, the patient will not be prone to other types of addiction. On the other hand, if the treatment is just limited to a pharmaceutical substitution, as with methodone or 'bupe', and the actual physiological disease is not treated holistically, the cycle of dysfunction will likely extend to other areas of addictive behavior, making life very difficult. For years we have observed this phenomenon, in patients trying to break an addiction to cigarettes who find themselves now with a difficult addiction to sugary foods, and now to e-cigarettes, or to those quitting alcohol and gaining a lot of weight from an addiction to overeating instead. If the treatment involves polypharmacy with other medications that involve addiction, rebound and withdrawal effects of the disease state will not be easily resolved, either. Indeed, most of the serious addiction and withdrawal problems today involve these pharmaceutical drugs. What we need is a way to resolve these dysfunctions and restore health so that the individual can truly choose to stop being addicted.

By 2016, the common tactic in treating drug addiction, just substituting a less harmful drug to decrease craving for the original drug of addiction, has led to an enormous backlash. An article in the May 29, 2016 New York Times, entitled Addicted to a Treatment for Addiction, outlined the problem. Here, we see that law enforcement and the courts are seeing enormous problems with Medication Assisted Treatment, or MAT, as many drug addicts are now committing crimes and resorting to dangerous combinations of drugs to maintain their addiction to treatment drugs such as Suboxone, now called "Box" on the street. While it is true that one cannot get high on Suboxone in its approved form, one can easily just powder the drug to break down the chemicals that decrease its ability to gain a quick high, and it is often then combined with benzodiazepines and other pharmaceuticals to produce euphoria, creating a more dangerous combination. Many judges are now refusing to automatically approve MAT with suboxone for addicts, leading to a federal ruling that these courts may get their funding cut. Many treatment clinics have not succeeded in tapering patients off of the suboxone, and now this synthetic narcotic, like oxycontin and oxycodone, is becoming just another street drug, again produced by pharmaceutical companies. Many communities with high addiction rates are becoming familiar with such terms as "pill mills" and "Box wars" to describe the systemic overprescription and profiteering from these drugs, with a synergy between clinical medicine and street gangs. This is not good. The situation has of course become a binary question, good bad black white, and standard practice just cites the studies that support suboxone and take a hard line approach, not questioning these studies, the data, or the nuances of the problem. In addition, by 2016, the U.S. CDC reported that about a third of the deaths from prescription opioid overdose involved methadone in the drug mix, and that prescriptions for this narcotic in pain relief totaled only about 2 percent of prescriptions. There is a big problem with the opiate substitution strategy to treat addiction, and a continued mindset of pretending that this approach makes sense. The logical solution would be work toward a better addiction treatment protocol, not just substitution and tapering with other drugs. A more holistic and comprehensive protocol would integrate treatment to help stop the cycle of dysfunction in the brain to achieve true relief from addiction. Ignoring this fact has led to a disastrous situation.

This is all now obvious. Integration of restorative medicine into new holistic and individualized multidisciplinary treatment programs will result in remarkable success with this now alarming health problem of addiction. In fact, we are seeing much success with individualized holistic approaches clinically, yet still a resistance to use a restorative medicine model, integrating Complementary Medicine as evidence emerges of the rationale for a variety of nutrient and herbal medicines, acupuncture, and mind-body approaches traditionally used in CIM/TCM. So far, it seems that we have just created a very expensive and ineffective business of dealing with people suffering from addiction. We all would benefit from a more workable protocol, as healthcare costs, government services and law enforcement, costs of prisons, worker unproductivity, and crime related to addiction affects all of us and increases costs of life for everyone, whereas a better treatment protocol and compassionate empathetic approach would cost much less. Today, as the disease of addiction is affecting many people most of us know, we can no longer just vilify individuals with this health problem, and assume that all "addicts" are not worthy.

Much debate and argument still exists in the field of addiction. The Scripps Research Institute cited above is a nonprofit research institution with more than 200 principal investigators, including 3 Nobel laureates and numerous members of the Academy of Sciences, Academy of Arts and Sciences, and American Association for the Advancement of Science, and of course, the National Institute on Drug Abuse is part of the National Institutes of Health (NIH), the primary agency of U.S. biomedical research. What we have learned in the past decade is that addiction is not an easy thing to define biomedically, involving a cascade of events and dysfunctions in numerous areas of the brain that are themselves tied to an array of factors, such as the health of the brain, cognitive patterns, and behavioral habits. While research into addiction in the past was driven mainly by pharmaceutical research seeking to find the key biological mechanism to reverse this disease process, and before this by pure psychological research into the effects of cognitive behavioral psychology and treatment, research in the last decade has focused instead on the obviously complex field of biological events and dysfunctions that define the disease. A link to this article is available below in additional information. The bad news, perhaps, is that addiction is a very complicated pathology, but the good news, according to experts such as Dr. Carl Hart at Columbia University, overcoming addiction may not be as hard as we have been led to believe, and less than 10 percent of users of addictive drugs, foods, and behaviors will have an addiction syndrome. Treatment for addiction needs to be comprehensive, proactive, and holistic, and integration of Complementary Medicine may be essential. Of course, with the scientific research showing us that the syndrome of addiction is a slowly developing set of dysfunctions in a broad area of the brain, this means that we should recognize when a problem with addiction may be starting to develop and treat this early, not wait until it has become devastating to normal functional life.

We have lived with a strong paradigm that defines an addict as a deviant that just took a few hits of a drug and then is "hooked" immediately, and we have defined treatment for these deviant "addicts" as use of a substitute drug to "get off of" the single substance of addiction, use of a quasi-religious 12-step method of redemption that has not ultimately worked for most patients, and use of psych drugs such as antipsychotics, benzodiazepines and anti-depressants that themselves are proven to have a strong potential for addiction, rebound syndromes, and withdrawal problems with chronic use. It is obvious now that research has elucidated the disease that these have not been good approaches, and we need to offer early intervention with safe multidisciplinary treatment protocols to get good results. This means that we need to offer an holistic medical care that is accessible and affordable, not demonize the problem, but rather promote patient understanding and a proactive approach. Complementary and Integrative Medicine and Traditional Chinese Medicine (CIM/TCM) could play an important role in this protocol.

Understanding the pathophysiology of addiction is the first step in taking a step-by-step approach to solving this problem in a proactive manner. These neurobiological experts on addiction mentioned above, at the Scripps Institute and the NIH, stated that drug addiction is a chronic disease involving relapse, and characterized by 3 mental disorders that create a motivational withdrawal syndrome when the drug, food or behavior in question is taken away. These 3 disorders are compulsion, loss of control in limiting intake, and emergence of a negative emotional state involving anxiety, irritability, dsyphoria etc. Dysphoria is a state of emotional and mental discomfort as a symptom of malaise, depression, anxiety, dissatisfaction, restlessness and discontent. Drug addiction is defined as a disorder involving both impulsivity and compulsivity that results in a cycle of dysfunction composed of 3 stages: 1) binge intoxication, 2) withdrawal resulting in a negative affect (emotional state influencing behavior), and 3) preoccupation and anticipation, or craving. While many people in the past have dismissed drug addiction as a psychological defect and perhaps choice of the individual, decades of study have clearly revealed that these same biological mechanisms of dysfunction are found in animals as well as humans.

Much study in recent years, utilizing advanced methods of brain imaging, as well as improved methods of studying active brain chemistry in the laboratory, have linked this sequence of dysfunctions to the dopaminergic pathway, commonly called the reward pathway, from the brainstem and midbrain to the limbic system and prefrontal cortex. The limbic system, comprising the hippocampus, amygdala, anterior thalamus, hypothalamus, and limbic cortex, is known to be the system in our brains that supports emotional memory, behavioral learning, and motivation, and links these to our endocrine and autonomic nervous systems. Repeated hyperstimulation with drugs, or even cognitive and behavioral habits, may alter the expression of neurotransmitter receptors in this limbic system, and lead to a pattern of addiction. As far back as 1954, scientists were able to demonstrate with electrodes placed in the nucleus accumbens, that were repeatedly activated, resulted in uncontrolled binge eating and drinking, as well as drug intake. To effect a return to normal homeostatic controls, the behavior, cognitive habits, and neurochemical balance all need to be normalized for an extended period of time, until the neuroreceptor expression in the limbic system returns to a functional state. While we would like to believe that an individual perhaps could just simply take a drug, or receive a procedure, that would stop this dysfunction, an objective look at the pathology of addiction shows that this is wishful thinking. Such a discovery would result in a large reward for the pharmaceutical industry, or surgical medicine, but realistically, the addicted patient needs to focus on a systematic protocol to restore the function of this dopaminergic pathway. Complementary and Integrative Medicine (CIM/TCM) provides such an holistic treatment protocol. A growing body of scientific evidence shows exactly how acupuncture and electroacupuncture stimulation will affect the key areas of the brain to modulate dysfunctional cross-talk between these areas and restore homeostasis and support homeostatic plasticity, and this research is presented in the section entitled Additional Information at the end of the article. By utilizing this needle stimulation in a holistic protocol, much can be achieved, and integrated with standard medical approaches.

Addiction is not limited to a small percentage of dysfunctional adults in the population, but is a disorder that affects a substantial number of us, and has both a neurobiological and a behavioral aspect, as well as a changing pattern of dysfunction that is measurable within the cycle of binging, withdrawal and craving. Attention to these dysfunctions may help a great percentage of us, not just those whose addiction has now severely ruined their life. An holistic medical approach to addictions is needed to solve this confusing problem.

There is a common biochemical and physiological basis to all addictions, and merely stopping the intake or use of one substance of addiction does not resolve these changes that have occurred in the brain, or in our cognitive and behavior patterns. To truly treat addiction, the patient must take a more proactive and holistic approach to restoration of brain health and function, as well as overall cognitive and behavioral health. By understanding both the biology and psychological aspects of addiction, and the changing nature of the pattern of symptoms and therapeutic needs during the cycle of withdrawal and avoidance, the patient suffering the disease of addiction may adopt an individualized and adaptive therapeutic protocol that intelligently addresses the different needs within this cycle of dysfunction, and proceeds to the healthy restoration of the damage caused by addiction. Complementary and Integrative Medicine (CIM/TCM) provides many tools that can help achieve this outcome and more fully restore neurobiological health to prevent relapse. The question is not which treatment protocol works in addiction, but how to incorporate all of these treatments into an effective and individualized integrated approach. The wide spectrum of addictive syndromes demands such a thoughtful and individualized approach, and the characterization of all patients with addiction as "addicts" has negatively reinforced a general belief in the hopelessness of addiction that is not realistic.

Too much focus on the blame for addiction, rather than the cure, has not helped society deal with the problem. A small percentage of drug users end up with an addiction problem that becomes dysfunctional. While the circumstances in life that create dysphoria, anxiety and depression may lead to drug use, or the drug user may have experienced none of these states, and instead sought to merely have recreational fun with drugs to start, the fact is that with a number of drugs (including alcohol), a medical state of addiction may occur, but not for all individuals taking these drugs. Similarly, with food habits, as well as cognitive and behavioral choices in life, a cycle of pathological addiction occurs in a small percentage of the people engaged in these habits. What we are most concerned about in society is drug addiction, but with the onset of any addiction, other addictions may occur as well. Once science has identified that addiction involves a physiological process, we can no longer assume that the patient is affected by only one substance, but rather by an addiction syndrome. The severity of a drug addiction may vary considerably, depending on the length of time of the drug habit, the type of drug, or the individual. Much emphasis has been placed on blaming either the drug or the individual in drug addiction, some seeking to take the blame off of the individual, or on the other hand, simply denigrating the character of the drug user or abuser, but this has not been helpful in the actual cure of the addiction.

For decades we have associated addiction with one substance, heroin. Heroin was a substance created from morphine to provide a better type of pain medication, but was abused as a street drug in the 1960s and then demonized to counter the rising social movements of the political youth and black power movements. In 2016, Harper's Bazaar printed a previously unpublished interview with the famed John Ehrlichman, top advisor to President Richard Nixon for almost two decades, and creator of the infamous "Plumbers" that instigated the Watergate scandal, and who later was convicted to 2-8 years in federal prison. Ehrlichman was quoted as stating that he engineered the "war on drugs" using obvious lies about heroin, to be able to legally harass 'blacks and hippies' involved in political work. In this extensive interview in 1974 Ehrlichman claims that the dangers and addictive harm to the public were greatly exaggerated to turn public opinion against the political threats to Nixon and the Republican Party. The result was the complete removal of any natural narcotic pharmaceutical from use in the clinical setting, and the development of synthetic narcotics that were much more profitable, but came with an array of adverse health effects and perhaps even more addictive potential. In 2014, a study at the University of Michigan School of Medicine, in the United States, showed indeed that oxycodone produced dramatically more robust and continued increase in the neurotransmitter dopamine in the brain than morphine, which evoked a dopamine increase phase of less than a minute that quickly returned to baseline levels. Since sustained dopamine release from synthetic opiates such as Oxycodone in key centers of the brain, such as the nucleus accumbens and mesolimbic pathway, is the key to the addiction syndrome, it is obvious that these synthetic opioid pain medications were designed to be much more addictive than more natural opiates. To see a summary of this study, just click here: http://onlinelibrary.wiley.com/doi/10.1111/ejn.12709/abstract . It is time that we quit pretending that profit motivation is not involved in our crisis of addiction.

The fact is that from a very early point in human history, the use of drugs has been common, although until recently these drugs were derived from natural substances, not chemically created. The incidence of drug abuse, or uncontrolled craving and compulsive taking of a drug or drugs beyond what is reasonable, has also always been seen in human culture. In recent decades, though, the incidence of drug abuse and addiction has accelerated, probably due to the use of pharmacological drugs, some of which may have been designed to create addiction, to promote sales. The public perception of addiction has changed as well in recent decades, with a widespread belief that anyone who takes these illegal drugs will become addicted. The emergence of drug addiction to pharmaceutical drugs, though, poses a problem to this equation, as these drugs are also widely prescribed by medical doctors. The belief that drugs are bad, and that anyone foolish enough to use them recreationally is going to be addicted does not equate to the belief that the same drugs prescribed by doctors are good, and will not lead to addiction. In fact, these mistaken concepts may have added to the factors that create the addiction cycle, as the drug user and abuser may have a belief that the drug being taken is addictive, and that there is no choice but to be addicted. On the other hand, the patient prescribed addictive drugs, or even abusing prescription drugs, may be unaware of the risks of addiction until it is too late. Interviews with many young drug addicts reveal that they believed that because they were abusing pharmaceutical drugs recreationally, that they did not think that they could become addicted. The sad fact is that rates of addiction for Oxy, Adderall, and other commonly abused pharmaceuticals is at least as high as that for heroin, methamphetamine, crank, crack cocaine and other non-pharmaceuticals, which hovers around 10 percent of users. No, using these drugs does not doom 100 percent of users to addiction, a widely accepted belief in society, but does involve about 1 in 10 involved in an addictive problem. The real problem may be, though, the addictive physiology and cognitive and behavioral aspect of the patient, not the drug itself. A more holistic plan allows these patients with addictive problems to better understand and resolve their problem.

The truth of the matter is that a percentage of people that take drugs, whether they be derived from plants or pharmacologically created, or whether they were taken for recreation or prescribed by their doctor, will eventually develop a medical addiction that needs to be treated. Many of these people will be able to treat their addiction simply, using an understanding of addiction and a host of treatment protocols, while others will have a difficult time with the cycle of addiction and need medical help. Early intervention may be the key to success. Many of us will find ourselves addicted to rather benign substances and activities, such as alcohol, cigarettes, marijuana, sugar, fast food, risky behavior, gambling, sex, pornography, etc. These too can have devastating effects on life, though, when abused, or overused, and lead to a cycle of dysfunction in the dopaminergic pathway that makes drug addiction easier to create biologically. Some people may arrive at a realization that they are addicted to other compulsions, such as obsession with political or religious zealotry, and may seek to understand their biological compulsions and impulses, and see if they can normalize these. A healthy society may depend on healthy brain function, just as a healthy brain function may depend on a healthy society. By integrating Complementary Medicine into the treatment scheme for any type of addiction, the problem can be resolved faster, and restoration of homeostatic health and function may be accomplished as well. Complementary Medicine isn't a cure for addiction, but is a very useful tool in the comprehensive treatment protocol. The actual cure for any degree of addiction or type is you. Complementary Medicine, in the form of treatment from a Licensed Acupuncturist and herbalist with experience, helps you to achieve this cure, and can be utilized to any extent you choose.

A September 17, 2013 article in the New York Times Science Times, entitled Tracing Addiction Outside the Brain, quotes Dr. Carl Hart Ph.D., an associate professor of psychology at Columbia University, New York, New York, U.S.A., an expert on addiction. Dr. Hart states: "80 to 90 percent people who use crack (cocaine) and methamphetamine don't get addicted, and the small number that do are nothing like the popular caricatures. 80 to 90 percent of the people are not negatively affected by the drugs, but in the scientific literature nearly 100 percent of the reports are negative. There's a skewed focus on pathology. We scientists know that we get more money if we keep telling Congress that we're solving this terrible problem. We've played a less than honorable role in the war on drugs."

The ironic fact that Dr. Hart points out is that scientists appear to be addicted to the money they get if they continue to emphasize the mistruths about drug addiction, and can't apparently stop their behavior, despite a wealth of research showing that they are wrong. The biology of addiction is true, but the belief that addiction is purely a biochemical imperative is not. For instance, Dr. Hart points out in his experiments that rats confined in small solitary cages continually press a lever to get more drugs, while rats put into a larger and more natural communal environment stop pressing the lever. He suggests that we try placing addicts in a better environment, instead of prison, or in a poor, hopeless and jobless situation, where many become addicted, and see if the addiction is reduced. His own experiments with humans show that even with patients with strong addictions, if these individuals were given a strong enough economic incentive, they freely chose cash over the drug, despite their addiction. Carl Hart is upsetting the scientific cart, but coming from a background of poverty where drug addiction was rampant, and earning a doctoral degree in neuropsychological research from the University of Wyoming, he has the credentials and experience to be believed. While the attitudes and beliefs concerning addiction will be slow to change, even among the experts in the field, hopefully we will see an open-minded attitude to looking at this new evidence of the pathology and make positive changes to help the many individuals now addicted to so many substances and activities.

This emphasis on incentives and disincentives (punishment) to stop addiction has led to much research on this subject as well. As usual, we still are trying to decide which method we should use, rather than assessing the benefits and drawbacks of all methods and sensibly combining them in a more holistic and individualized protocol. In 2016, experts at the University of Cambridge School of Medicine, in the United Kingdom, reported that: "Our findings illustrate the ineffectiveness of punitive approaches and highlight the potential for interventions that focus on improving the goal-directed behavior and implementing more desirable habits to replace habitual drug-taking" (PMID: 27313048). These experts emphasize that there are no medically proven pharmacological treatments and interventions to change maladaptive behavior in addiction, and that leaves us with psychosocial approaches. To make this work, though, we need to integrate an array of therapeutic protocols in a more proactive manner, educating patients to the benefits of various therapies to encourage better compliance and motivation. Only in this way will the 'carrots over sticks' approach work.

As the problem of addiction expands in the United States, mainly driven by the widespread and easy access to pharmaceutical drugs for recreational purposes as well as pain relief, and treatment of anxiety and mood disorders, the need for a more effective treatment protocol is urgent. A one-size-fits-all approach and simple labeling of all addicts as a single type of person, a deviant, is no longer acceptable, and the simplistic quasi-religious 12-step approach most widely used, and proven ineffective in the long run for decades, can no longer be the answer. Modern medicine is developing a more individualized and holistic approach to treatment, integrating many treatment methods, but there is still the primary emphasis on using pharmaceuticals to treat addiction. Two approaches seem to be most prevalent, pharmaceutical substitution, providing the substance of addiction in another form, and the use of broader antipsychotic medications, as well as benzodiazepines and anti-depressants. The problem is that all of these pharmaceutical drugs are addictive, and using an addictive drug to resolve the pathophysiology of addiction is obviously not a good biological approach. It is almost unheard of to publish or even design studies that look for proof of negative effects with pharmaceutical treatment, but even studies trying to prove efficacy have found that these drugs actually often attenuate the addiction pathology rather than relieve it. For instance, a 2013 randomized controlled study at the University of California San Francisco (UCSF) found that the antipsychotic medication Abilify, or Aripiprazole, "did not significantly reduce methamphetamine use among actively-using dependent adults" (Addiction, 2013 Apr. 108(4): 751-761). While the study also did not find that Abilify increased methamphetamine use or amplified its effects, it was noted that other studies have found that antipsychotic medications could amplify and exacerbate the effects of methamphetamines (Newton et al 2008 in the official journal of th Collegium Internationale Neuropsychopharmacologes), and Tihonen et al, in the American Journal of Psychiatry, 2007).

Indeed, it is now well known that the practice of combining antipsychotics with drugs such as methamphetamine in recreational drug use is now widespread. In 2013, Dr. Deborah L. Haller of the Columbia University College of Physicians, in New York, director of psychiatric research at St. Luke's and Roosevelt Hospitals in New York City, U.S.A. called for physicians to start screening patients for substance abuse before prescribing atypical antipyschotics due to the now common knowledge of the popularity of such combinations to enhance drug effects. One study led by Dr. Haller found that of 429 patients studied in detox and rehab units of the Addiction Institute of New York, that 17 percent reported recreational use of combinations of antipsychotic drugs with other drugs of abuse and addiction, such as meth, cocaine, opioids and alcohol. This problem surfaced many years ago with the too easy prescription of atypical antipsychotics, as seen with a 2008 study by Dr. MJ Hanley of the University College of Pharmacy, in Kingston, Rhode Island, U.S.A., where Dr. Hanley noted that evidence of the use of atypical antipsychotics in drug combinations with addicts was mounting, especially in studies with incarcerated addicts (PMID: 18359967). Surely, such drug cocktails would not be popular if antipsychotics did not enhance the effects of other drugs. The increased use of atypical antipsychotics and other pharmaceuticals noted in addiction and rebound withdrawal syndromes has stubbornly been ignored in the standard treatment of addiction. What is also not emphasized is the many adverse health effects of these treatment protocols with pharmaceuticals in addiction therapy, as well as the studies of problematic rebound and withdrawal effects from antipsychotic, antidepressant and benzodiazepine medications. Studies with laboratory animals found that Aripiprazole, or Abilify, had some effect on animals on cocaine seeking behavior, attributed to affects on the dopamine mesocorticolimbic pathway, but negative effects on methamphetamine behavior, increasing desire, as well as apparent stimulant and euphoric enhancement of methamphetamine. Simplistic summaries of such studies are used to justify the use of the antipsychotics in treatment of cocaine addiction, and if there is no other alternative, this may be justified, but if there is a healthy and safe protocol to restore this neurohormonal pathway with holistic medicine, why not try this first?

The subject of addiction is thus broad, and the levels of addiction are many, creating a subject composed of many shades of grey, not a black and white situation, as we have been led to believe. Many critics and condemners of 'addicts' are themselves facing an addiction syndrome. What we all need to focus on is realization of what addiction is and how to go about fixing the problem in a systematic manner. Each case needs to be handled individually, and a general realization that most of the addiction problem is a biological disorder that can be fixed with intelligent and persistent work, performed mostly by the individual with the addiction, not by other people, but that changes in cognitive habits, the environment, and behavioral habits must accompany improvements in neurobiological health, is the key to curing addiction. The addicted individual must not just want to break their addiction and have someone do this for them, but must actually understand what is involved and intelligently direct the process, seeking help, not someone to exert control over their lives. The old adage that you can't help someone who won't help themselves may strongly apply in addiction. This process should utilize both internal and external processes to actually change the way the brain works. Seeking the right medical help is important, and this process may involve any number of medical professionals, depending upon the circumstances. As Dr. Carl Hart points out, it will take more than a pill to cure addiction, and a holistic protocol is needed. Dr. Hart started out believing in an allopathic cure for addiction, but after 20 years of research in this field, he now realizes that a broader approach is absolutely necessary, and that the dysfunctions seen in addiction are not as hard to break as he had been told. As with any medical problem, first trying a conservative approach to treatment and seeing what can be accomplished is the correct choice. Delaying treatment until the condition is severe, and then jumping into expensive drug rehabilitation clinics, or taking harsh pharmaceutical drugs, is not a good idea. This article presents scientific information that can help individuals with addiction tackle the problem early and hopefully reverse the dysfunctions that define the disease.