WBUR

With New Research, More Doctors Treat Addiction As A Chronic Disease

BOSTON — Often, people with drug or alcohol problems don’t get help until they end up in the emergency room or in their doctor’s office for another issue.

Many doctors are not trained in how to identify or treat addiction. But with new research into how it affects the brain, and with new drugs to treat it, more doctors are handling addiction as a medical problem and managing it like a chronic disease.

Addiction As A Chronic Disease

In a sparse exam room at Boston Medical Center, Dr. Christine Pace examined a patient and spoke with him about his kidney stones.

“Are you taking the Oxycodone right when you get the pain?” Pace asked her patient.

The patient, Paul B., does not want to be fully identified because he is recovering from heroin addiction.

“Tell me about how about the rest of your recovery program,” Pace said. “Are you doing counseling? Going to meetings?”

Asking patients whether they are attending 12-step meetings is not the norm in American medicine, but Pace just got out of medical school and is the very first resident at Boston Medical Center in a new sub-specialty called addiction medicine.

“This approach, being a medical patient and not being judged, it’s like I’m actually treated as if this is disease not a morality problem.”
– Paul B., patient

“Medicine has been to slow to embrace what we’ve known for a long time, which is that addiction is a chronic disease,” Pace said. “We don’t in medical school or in residency, no matter what the specialty, get a whole lot of training… in diagnosis and treatment of addiction. I think as a result of that, physicians — like many people in this country — continue to stigmatize [addiction] and continue to not really see it as a disease.”

Doctors now have a better understanding of the biology of addiction and the changes that take place in the brain. That has led to more forms of treatment.

One of those treatments is a highly regulated drug called Suboxone. Paul B. has been using the drug for years.

“I’ve been in recovery for almost 10 years and I’m on Suboxone,” Paul B. said. “I was a former methadone patient, a former IV drug user. I’ve used heroin, OxyContin, Dilantin, medications like that. I’m really lucky to be alive because a lot of my friends aren’t alive.”

Even though there is more acceptance of treating addiction in mainstream medicine, he says there is still a lot of ignorance.

“A lot of doctors don’t want addicts in their waiting room,” Paul B. said, “they don’t even want to draw that clientele to their establishment. … This approach, being a medical patient and not being judged, it’s like I’m actually treated as if this is disease not a morality problem.”

Paul B. was one of the first patients to be given Suboxone at BMC when the medication was approved in 2003. Today, the hospital and its clinics use the drug to treat 500 patients with opioid addiction.

Colleen Labelle, an RN who runs the Suboxone program at BMC, says there’s a growing demand from doctors who need help in treating patients with addiction.

“You know, throwing their arms up not knowing what to do,” Labelle said. “‘This patient comes in and they’re on Percocet and OxyContin and Ativan and Xanax and what do I do with this person?’ And having no clue where to start and what questions to ask.”

So far, 20 medical residents are training in hospitals nationwide to become experts in this new field of addiction medicine — that number is expected to grow next year.

Doctors at Boston Medical Center hope that the training will eventually lead to an established medical specialty so more patients with addiction problems can find help in their own doctor’s office.

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  • Anonymous

    Thank you for writing this article and helping to disseminate  accurate information about advancements in addiction medicine.  Too often the media focuses on hype and the typical inaccurate stigmatized views which unfortunately causes patients to shy away from effective lifesaving treatments like this. People with loved ones who are addicted need this kind of accurate information so they can proactively help their loved one get the proper treatment in a timely manner. 
    NAABT 

  • Philip Paris

    No question, Suboxone (buprenorphine) has made treatment for
    opioid addiction available to thousands of people previously untreated.  These new patients are able to make the
    transition from addiction to a more normal life.  Still, we should not forget the 250,000 who
    are currently being treated in methadone based addiction treatment
    centers.  In spite of their success, these
    patients bear the burden of a stigma against methadone that encourages them to
    hide their treatment.  Their methadone treatment
    may be kept secret from their spouse and even more frequently, a secret from
    their children.   Their successes did not
    come easily.  Instead of feeling the
    stigma, it is possible for each one of them to feel pride in having overcome
    the life threatening disease of opioid addiction.

  • Blueshale

    What a breath of fresh air to see that the Doctors are learning to treat people with chronic addictions as patients and not criminals.
    Thank you AMA.

  • Patricia Koren

    This article gives me some hope for the future of Opiate addicted patients. I am the Program Director for an Intensive Out Patient Program for Opiate addiction called Viatas Center in Greenwood Village, Co. I hope that moe Physicians start recognizing that addiction is a chronic disease and just like other diseases needs to be treated with proper education, treatment and protocols. 
    Patti Koren, MA, LAC

  • French_squaw

    What a wonderful and long awaited idea…..Thank you to the doctors who are beginning to study addiciton and ask the hard questions.  I could not be happier. 

  • CHUCK11432

    AS AN ADDICTIONOLOGIST (MD) FOR THE PAST 23 YEARS, I AM SO THRILLED THAT SOME OR ONE MEDICAL SCHOOL AT LEAST , HAS HAD THE FORESIGHT TO REALIZE THAT DOCTORS (ALL  DOCTORS) NEED TRAINING IN ADDICTION MEDICINE. I HAVE VOLUNTERED TO TEACH INTERNS FOR NO COMPENSATION AT ALL—REFUSED BY OU MED SCHOOL.  I DO FEEL EMPATHY FOR THE YOUNG DOCS PUSHED OUT INTO THE REAL WORLD  WHERE ADDICTION HIDES ITS FACE–AND THEY ARE SUPPOSED TO COPE WITH IT,   AGAIN CONGRATULATIONS !!!!                          

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