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Friday, 24.03.2017

Martin, Weinberg, Bealer: Healing Addiction

Peter R. Martin, Bennett A. Weinberg, and Bonnie K. Bealer: Healing Addiction: an Integrated Pharmacopsychosocial Approach to Treatment. John Wiley & Sons Inc., Hoboken, New Jersey, 2007 (248 pages).

INFORMATION ON CONTENTS: “Healing Addiction: an Integrated Pharmacopsychosocial Approach to Treatment” is divided into five parts, complemented by a “Foreword” (writtenby Patrick J. Carnes) and “Prefaces” by the authors: Part1, entitled “Out of Control: The Biopsychosocial Model of the Causes of Addiction ”deals with various clinical presentations and the progression of addictive disorders, epidemiology and changing attitudes about these disorders, brain changes and complications associated with drug use, and biopsychosocial underpinnings of addiction; Part 2,“The IntegratedApproach: Pharmacopsychosocial Treatment of Addiction as a Bona Fide MentalIllness”, with identification, diagnosis, and the treatment process; Part3, “Gaining Understanding: Treating Drug Addictions ”with different drug use disorders, including alcohol, opioids, central nervous system depressants, stimulants, and marijuana and tobacco; Part 4, “Gaining Understanding: Treating Behavioral Addictions ”with the neurobiological mechanisms of behavioral addictions, such as problematic hypersexuality, pathological gambling, food-related disorders, and the fundamental role of learning in these behaviors; and Part 5, “Recovery as an Ongoing Process: Controlls Never Complete”, with definition softreatment success and strategies for managing recovery over a lifetime. The volume is complemented by a “Glossary of Terms”, “Helpful Websites”, “Epidemiological Tables”, “Pharmacological Treatment of Withdrawal Syndromes”, “Pharmacological Maintenance Strategies for Substance Dependence after Detoxification Is Completed”, and a “Bibliography”.

AUTHOR’S STATETEMENT: The central concept of this book is the “Pharmacopsychosocial Treatment Triangle ”which represents the integrated delivery to the addicted patient of treatment which includes (A) pharmaceutical therapies for primary addictive disorders and co-occurring other psychiatric conditions, as indicated; (B)psychological therapy and counseling specifically adapted to substance use and/or behavioral addiction disorders; and (C) social support incorporating a network of the patient’s family, friends, and members of the appropriate mutual support groups, e.g., 12-Step programs.

If appropriately delivered, the pharmacopsychosocial treatment of addictive disorders resonates with, and specifically addresses, each of the elements of the biopsychosocial model of drug use disorders and behavioral addictions. This book underlines that thes eare bone fide mental illnesses whose treatment outcomes equal those of other chronic illnesses encountered in medical practice and present similar challenges to the treating physician. The greatest obstacle to success is recognizing that drug use and other addictive disorders may masquerade as other psychiatric and medical conditions, which in fact, are not the underlying problem, but rather represent clinical complications of the primary disorder.

There as on that drug use and other addictive disorders are so often not correctly identified by psychiatrists has to do with limited training received in residency, the associated stigma, and therapeutic nihilism, the belief that not much can be done for these patients.  Thus, it seems easier to label the patient’s signs and symptoms as an affective or thought disorder, for which the psychiatrist has many psychopharmacologic tools in his armamentarium.  However, these tools are mostly ineffective if the appropriate diagnosis is not made. Rather, theproblem that must be addressed is the addictive process, not simply its complications. Recent advances in developing pharmacologic strategies for treatment of the addiction per se is a major conceptual advance that has become a major component of the Pharmacopsychosocial Treatment Triangle and is discussed in this book.

Another theme in the book is that some of the same neurobiological mechanisms involved in drug use disorders come into play in repetitive and out-of-control behaviors that are self-destructive, e.g. problematic hypersexuality, gambling, and over-eating associated obesity or food restriction.  An especially important implication of this notion is that it might be feasible to utilize the Pharmacopsychosocial Treatment Triangle in management of disorders, heretofore considered “medical” in nature, such as obesity-induced type 2 diabetes mellitus. Individuals with this form of diabetes, which constitutes a major health care challenge in the developed world, might well benefit from focusing on the behavior of over-eating, much as the treatment approach for addictive disorders. This would be a significant advance over simply controlling blood glucose or addressing insulin resistance, the currently-practiced and mostly ineffective approach to treatment (unless of course lifestyle change is also achieved).

The major points in the book are underlined using relevant case studies, which provide an integrative guide to understanding and treating addiction that draws on advances in neuroscience, pharmacology, social sciences, and psychological research. It presents a model of addiction as a mental illness involving physiological changes in the brain, and addiction treatment as requiring both medical and psychosocial components. It is intended as a resource for physicians, professionals in the addiction community, for social scholars and policy makers, and for the interested general reader.


Peter R. Martin

February13, 2014