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One Nut Wonder the First |
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Monday, October 13, 2003 at 1:07 PM http://www.cnn.com/2003/SHOWBIZ/10/10/cnna.pinsky/index.html Pinsky: A hijacking of the survival system
Friday, October 10, 2003 Posted: 8:33 PM EDT (0033 GMT)
Dr. Drew Pinsky is a specialist in treating addiction. (CNN) -- In a statement during his nationally syndicated radio show Friday, Rush Limbaugh acknowledged an addiction to prescription pain medication. The conservative commentator also said, "I am checking myself into a treatment center for the next 30 days to once and for all break the hold this highly addictive medication has on me." Dr. Drew Pinsky, an addiction specialist, spoke with CNN anchor Miles O'Brien about what Limbaugh is facing in terms of the drug, OxyContin, and beating addiction. O'BRIEN: They call it "Hillbilly Heroin" in some parts of the country. [Abuse of] OxyContin is a real problem. Just give us a sense, though, from your perspective as somebody who deals with people who are addicted to these kinds of things, how big an uphill battle does Rush Limbaugh face right now? PINSKY: Well we're really talking about opiate addiction. And it doesn't matter if you're taking OxyContin, Vicodin, Lortab, heroin or codeine. It's all the same disease and it has basically the same biology. It is the form of addiction with the highest recidivism. The biology, the biological grip of the disease, is profound. The withdrawal is miserable and painful. And it takes a long time to recover. Treatments are drawn out. [Addicts] need to stay engaged in intensive, highly structured treatment. In my opinion, it's unrealistic to expect somebody to get significant recovery or a high probability of success from opiate addiction without three to six months of intensive treatment. The 30 days is really just getting things started. I think we should wish [Limbaugh] well. Who wants this disease? It's the disease that comes upon [people] often accidentally. These are common medications that are prescribed. If you have a history of alcoholism or addiction in your family and you're prescribed that for a period of time, eventually that switch gets thrown in this disease, and you're off to the races. O'BRIEN: Is it a physical addiction, a mental addiction or a little bit of both? PINSKY: Addiction is addiction is addiction. You can either stop or you cannot. ... There's an activation of a 'reward system' in the genetically prone individual that alters permanently the motivational priorities of the brain. It is literally a hijacking of the survival system, whereby the brain begins confusing the actuality of survival with the chemical message of the drug. So people with this disease ... will literally die to get the drug, do anything to get the drug without really consciously realizing this is what's behind the behaviors. There's a lot of controversy in my field about how to treat opiate addicts because it is such a profoundly powerful disease that's there's a school of thought we shouldn't even try to treat them. We should just put people on methadone or buphrenorphine or one of these replacement chemicals and just call it a life; just put them on chronic replacement. I don't think somebody like a high-level, high-functioning professional would take that option. I hope to hell he doesn't. ... That's committing to somebody to really, in my opinion, chronic disease. I suspect this will -- [his] coming forward with his disease -- create dialogue about what kinds of treatments are appropriate. I've seen miracle recoveries. I've seen people become better than they ever knew they could be after having suffered this disease. And I have no doubt that he could achieve the same. I think putting him on methadone, which is a very difficult drug to stop using, would be a travesty. O'BRIEN: Let's talk a little bit about OxyContin. We've been talking about [OxyContin addiction] being an emerging problem. Can you give us a sense of how big a problem it is nationwide? PINSKY: It is exceedingly common. Vicodin, hydrocodone, this has been a longstanding problem for those of us who work in the field of addiction. OxyContin is basically just a way of giving a more powerful, high dose of the chemical -- the same kind of opiate chemicals. O'BRIEN: You know there has been some criticism of the company that makes this, Purdue Pharma. PINSKY: It's a mistake to blame the product, because it's an excellent product. If you're a cancer patient, you're thanking God it's available. O'BRIEN: You've referred to this earlier: The rate of failure in attempts to break oneself of this is very high. PINSKY: Opiates, specially, very high. ... The first step is to keep them abstinent from these substances so the brain mechanisms themselves can heal. There's literally a sort of a settling down of this process. Then we engage them in an emotional dialogue with other of their peers that helps them, again, slowly, in an experience-by-experience basis, rewire some of these mechanisms that allows their brain to integrate better. It's a complex process, and that's about the simplest way to explain to it you. But the first thing is really getting off the drug and letting the biology settle down.
—One Nut Wonder |
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Harry Ballzack |
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Monday, October 13, 2003 at 8:31 PM Adam!!! ADAM!!! ADAM!!! Love, JIMMY!!!! JIMMY!!! JIMMY!!! You two are the next Ben and Matt! —Harry Ballzack |
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ZT Spice |
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Friday, August 3, 2007 at 10:10 AM Junkies and victims: addiction and the disease debate: Slate has an article by a psychologist and a psychiatrist who argue that addiction is not a 'brain disease', contrary to much of the recent rhetoric about drug abuse. This is one side of the debate that is driving our attempts to understand addiction. The 'brain disease' concept (also known as the 'disease model') is one that is often thrown around in debates about mental distress or behavioural problems, but it is far from the neutral, scientific term that many of its supporters might believe. In a sense, every problem of mind and behaviour is a 'brain disease', because we've identified it as a problem and it involves the brain, as does everything else related to thought or action. However, a comprehensive explanation requires not only neuroscience, but also psychology and social factors to make it complete and meaningful. Calling a mental problem a 'brain disease' often implies that these other factors aren't important, and, most tellingly, suggests that the person isn't responsible for the effects of the disorder, and, consequently, their actions. The level of personal influence varies by condition, but, importantly, psychologists now know that the effects of all illnesses, from Alzheimer's disease to the common cold, can be influenced by how we understand them and what we believe about our own ability to influence the effects. There is no doubt that genetics and the development of nervous system significantly influence the risk of becoming an addict, but addiction, perhaps more than many other disorders, is amenable to personal choice, albeit to varying degrees at various stages of its course. Theodore Dalrymple (the pen name of psychiatrist Anthony Daniels) noted in The Wall Street Journal that many people are quite able to choose to give up their addiction when sufficiently motivated and argues, in his usual provocative style, against the excess medicalisation of substance abuse: It is not true either that addicts cannot give up without the help of an apparatus of medical and paramedical care. Thousands of American servicemen returning from Vietnam, where they had addicted themselves to heroin, gave up on their return home without any assistance whatsoever. And in China, millions of Chinese addicts gave up with only minimal help: Mao Tse-Tung's credible offer to shoot them if they did not. There is thus no question that Mao was the greatest drug-addiction therapist in history. However, we shouldn't forget that there is now a large body of evidence highlighting the importance of inheriting a vulnerability to become addicted, and the most addictive drugs tend to modify exactly the bits of the brain that are involved in desire and wanting, making them less amenable to 'will power'. This research was recently highlighted by a Time magazine article on the neurobiology of addiction and Dr Nora Volkow's recent radio interview on the drugs and the brain. Both spin the 'brain disease' angle, and many argue that this reduces stigma. The trouble is, research has found that purely biological explanations of mental problems tend encourage stigma in the public, patients and mental health professionals. One of the key findings of these studies is that purely biological explanations of mental disorders imply that people are less in control of their actions. Psychological therapies are known to be effective treatments for drug addiction and one of the key components is to boost the patients 'self-efficacy' - that is, their belief that they can take control of their life. We know that self-efficacy, essentially a scientific term for a sense of personal responsibility and control, is one of the most important predictors of recovery from addiction. Genetic research has shown us that some people, through no fault of their own, have inherited an increased risk for addiction. Neurobiology has shown us that drug use modifies the brain to make resisting temptation harder. Nevertheless, describing addiction as purely a 'brain disease' is neither useful nor meaningful, and may actually reduce the likelihood that someone will overcome their difficulties. We need to understand addiction as a problem of mind, brain and society, and make sure everyone knows they play an important role in overcoming problem drug use, whether it occurs in each of us individually, or in the neighbourhood that we live in.
Anti 'disease model':
Link to Slate article on addiction.
Link to Theodore Dalrymple article in WSJ.
Pro 'disease model':
Link to Time article 'The neurobiology of addiction'.
Link to Dr Nora Volkow radio interview
—ZT Spice |
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cmg2571 |
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Friday, August 3, 2007 at 6:16 PM As someone whos listened to hundreds of hours of loveline I notice that there seems to be a large gap between what Drew says every night and whats talked about in the public. Mostly about the genetic aspect of addiction. Drew says that if one of your parents has the addiction biology then you have 50% chance of inheriting it. I believe what he says and because neither of my parents are addicts and my childhood was normal im pretty confident im safe. I honestly feel that i could go out tommarow and start shooting heroin for a few months or even years and then just stop cold turkey. I'd obviously withdraw and be miserable for a while but smooth sailing after that. I've mentioned this to friends before and they say i could never quit just like that. There seems to be this theory that everyone in the world is one snort of coke away from becoming a homeless crack whore. I find it weird that in the media they're going on about Linsey Lohan, Britany Spears and Paris Hilton battles with addiction and they never mention if any of their parents are addicts and if they even have the addiction gene. Anyway I'm glad I dont have the gene so bring on the meth, coke and heroin. —cmg2571 |
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plurry |
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Friday, August 3, 2007 at 6:35 PM
Edited Friday, August 3, 2007 at 6:36 PM the problem is that you don't know how your brain will react after you stop. non addicts will not preoccupy after withdrawal, addicts will forever. you have no way of knowing which way you'll fall until you've been down that road. you can only guess the outcome based on your genes. —plurry |
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Dark Laith |
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Friday, August 3, 2007 at 6:38 PM
Edited Friday, August 3, 2007 at 6:39 PM AI've mentioned this to friends before and they say i could never quit just like that. There seems to be this theory that everyone in the world is one snort of coke away from becoming a homeless crack whore. I find it weird that in the media they're going on about Linsey Lohan, Britany Spears and Paris Hilton battles with addiction and they never mention if any of their parents are addicts and if they even have the addiction gene. —cmg2571 The public has all kinds of misunderstandings about medical stuff, though. Even basic stuff. Anyone remember the whole "humans only use 10% of their brain" thing that was going around several years back? It was 100% incorrect, but it was treated as some kind of common knowledge. I'm not surprised that the scientific aspects of addiction that are apparent to the medical community are so unknown to everyone else. —Dark Laith |
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anobody |
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Saturday, August 4, 2007 at 8:36 AM Drew says that if one of your parents has the addiction biology then you have 50% chance of inheriting it. Actually he says that if one or both of your parents have it, then you've got a 50% chance of getting it. The non-Mendelian genetics of that always feels wrong to me (at the very least, I'd like to see some studies). Not that I'm bringing into question the substance of what he's saying - just that one little detail feels like inserting the pipe-cleaner sponge. you have no way of knowing which way you'll fall until you've been down that road. you can only guess the outcome based on your genes. If you take Drew's telling as he presents it, being an addictive person really means that you're a risk-taker / thrill seeker. Presumably, if you paid attention, you would know that you have that thrill-seeking aspect before trying drugs, so you could use that as a guide to suggest that maybe it's not a great plan for you* (in addition to looking at your parents and relatives). *Disclaimer: I'm not advocating that and I'm sure it's not a great plan on the chance that it doesn't work out. Also, I don't picture Plurry being driven to jump out of airplanes or drive insanely fast, so there's obviously (at least) some small crack in that theory. Anyone remember the whole "humans only use 10% of their brain" thing that was going around several years back? I still hear that from time to time :-( —anobody |
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plurry |
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Saturday, August 4, 2007 at 6:20 PM i'm cutting back to 8% to save energy. —plurry |
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TortillaFactory |
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Saturday, August 4, 2007 at 6:38 PM Some genius Asian kid debunked that myth on Ellen one time. I wanted to hug him. He earned like a six-year degree in one year. —TortillaFactory |
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catloaf |
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Saturday, August 4, 2007 at 8:58 PM Isn't "genius Asian" redundant? Like "AIDS-riddled Assyrian?" —catloaf |
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Dark Laith |
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Sunday, August 5, 2007 at 8:43 AM
Edited Sunday, August 5, 2007 at 8:44 AM An astute analogy. —Dark Laith |
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