Mon, Jul 18, 2011 - Page 9 News List

Addiction’s roots, and its treatment undergo a rethink

By Douglas Quenqua  /  NY Times News Service, NEW YORK

There is an age-old debate over alcoholism: Is the problem in the sufferer’s head — something that can be overcome through willpower, spirituality or talk therapy, perhaps — or is it a physical disease, one that needs continuing medical treatment in much the same way as, say, diabetes or epilepsy?

Increasingly, the medical establishment is putting its weight behind the latter diagnosis. In the latest evidence, 10 medical schools have just introduced the first accredited residency programs in addiction medicine, where doctors who have completed medical school and a primary residency will be able to spend a year studying the relationship between addiction and brain chemistry.

“This is a first step toward bringing recognition, respectability and rigor to addiction medicine,” said David Withers, who oversees the new residency program at the Marworth Alcohol and Chemical Dependency Treatment Center in Waverly, Pennsylvania.

The goal of the residency programs, which started on July 1 with 20 students at the various schools, is to establish addiction medicine as a standard specialty along the lines of pediatrics, oncology or dermatology. The residents will treat patients with a range of addictions — to alcohol, drugs, prescription medicines, nicotine and more — and study the brain chemistry involved as well as the role of heredity.

“In the past, the specialty was very much targeted toward psychiatrists,” said Nora Volkow, the neuroscientist in charge of the National Institute on Drug Abuse. “It’s a gap in our training program.”

She said the lack of substance-abuse education among general practitioners was “a very serious problem.”

Schools offering the one-year residency are St Luke’s-Roosevelt Hospital in New York, the University of Maryland Medical System, the University at Buffalo School of Medicine, the University of Cincinnati College of Medicine, the University of Minnesota Medical School, the University of Florida College of Medicine, the John A. Burns School of Medicine at the University of Hawaii, the University of Wisconsin School of Medicine and Public Health, Marworth and Boston University Medical Center. Some, like Marworth, have been offering programs in addiction medicine for years, simply without accreditation.

The new accreditation comes courtesy of the American Board of Addiction Medicine (ABAM), which was founded in 2007 to help promote the medical treatment of addiction. The group aims to get the program accredited by the Accreditation Council for Graduate Medical Education, a step that requires, among other things, establishing the program at a minimum of 20 schools.

However, it would mean that the addictions specialty would qualify as a “primary” residency, one that a newly minted doctor could take right out of school.

Richard Blondell, the chairman of the training committee at the ABAM, said the group expected to accredit an additional 10 to 15 schools this year.

The rethinking of addiction as a medical disease rather than a strictly psychological one began about 15 years ago, when researchers discovered through high-resonance imaging that drug addiction resulted in actual physical changes to the brain.

Armed with that understanding, “the management of folks with addiction becomes very much like the management of other chronic diseases, such as asthma, hypertension or diabetes,” said Daniel Alford, who oversees the program at Boston University Medical Center.

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