David Kipper - The Addiction Solution: Unraveling the Mysteries of Addiction Through Cutting-Edge Brain Science

To Sam, Chanel, and Jessi...
our reward pathways

T wo decades agoabout the time my son Sam was borndoctors were limited in what we understood and could do for many diseases, especially the disease of addiction. Back then, there wasn't even a valid medical approach to addiction. Campaigns like Just Say No and the government's costly but ineffective War on Drugs were all we had.

But during Sam's lifetime we have seen an explosion in medical research and technology that has led to new and successful treatments for chronic conditions like heart disease, cancer, andyesaddiction.

An avalanche of informationmuch of it coming from cracking open the long-hidden code of human genetic makeuphas revealed the true origins of addiction. Previously mistaken as a behavioral problem, addiction has been proven to be a chronic disease. This knowledge has opened the floodgates to new, smart-targeted, and successful medical treatments that no longer depend on the failed behavioral approach.

Like Sam, the field of addiction medicine has grown up. His generation has the opportunity to understand the science behind addiction and to manage it, much in the same way that my generation learned to better manage diabetes, heart disease, and cancer.

Indeed, diagnostic and treatment breakthroughs are revolutionizing the entire world of addiction.

The Human Genome Project has identified specific genes and biomarkers that allow doctors to chart the origins of addiction and to predict those people most at risk for this disease. (Even Your Addiction Prediction on page can readily and simplistically identify who is at risk and the specific substances they are most likely to abuse.)

We now have the ability to create an addiction blood panel much like the blood tests for cholesterol, arthritis, and liver disease that allow us to detect, evaluate, and monitor these problems.

Imaging techniques such as functional MRIs allow us to go beyond external behaviors and glimpse the areas of the brain responsible for addictive behaviors. With a new technology called brain mapping, we can actually see the brain as it heals from addiction. Having clear pictures that show the progressive stages of recovery encourages patients to maintain their commitment to therapy.

A close corollary to these advances were the heart scans developed in the 1980s that allowed patients who were vulnerable to coronary artery disease to see their own heart arteriesfor the first time enabling them to know if they were truly at risk. These simple, noninvasive 10-minute tests became the gold standard for diagnosing heart disease and quickly rendered the less-sensitive electrocardiograms, treadmills, and blood tests obsolete. Those with a family history of heart attacks could take this scan, identify their impending risks with their own eyes, and intervene long before the disease progressed to an irreversible situation.

Indeed, the discovery that addiction originates in brain chemistry brings a new era of successful medical treatment of addiction. This is the new paradigm, the cornerstone of The Addiction Solution.

Under the new paradigm, addiction treatment succeeds only when it becomes more personalized, replacing cookie-cutter behavioral therapies that have not worked on their own with customized treatments that relate to individual chemical imbalances in our brains. The clues to solving the medical causes of addiction are found in family trees and in the contributing factors of genetic imprinting and environment.

Medicine is doing all that right now. And by continuing to address the real scientific and medical issues, it spells just the beginning of an amazingly successful turnabout in treating addiction.

Within the next few years, as the success of the new paradigm settles in, Sam's generation will witness a total makeover in the ways addiction is viewed and treated.

• The new paradigm will universally establish addiction as a medical disease, not a behavioral malfunction.
• With this new understanding, the negative connotations of addiction and of being an addict will largely vanish.
• Punitive attitudes toward addicts will be replaced by positive and healing support systems.
• Dual diagnosis will become the essential tool of addiction therapy, with medical treatment seen as primary and behavioral methods viewed as secondary and supportive.
• Medical treatment in the new paradigm will rely primarily on pharmacologic breakthroughs that target neurotransmitter imbalances.
• Vaccines are being developed to target cocaine and other abused substances.
• Every advance in the addiction solution will come from science and not from the exhausted behavioral model.
• Patients will be given new tools to better manage their stress and to address associated medical issues like sleep disorders and chronic pain syndromes.
• The revolution in awareness will inspire a greater number of professionals to dedicate themselves to the field of addiction medicine.
• Along with doctors, other professionalsincluding neuropharmacologists, psychologists, nutritionists, physical trainers, homeopaths, and pain management specialistswill collaborate as teams to integrate the medical and behavioral aspects of dual diagnosis.
• Exclusive 28-day inpatient treatment programs will be replaced by comprehensive and personalized outpatient programs with long-term agendas.
• By personalizing addiction therapies, medical treatment will reverse the 90-plus percent failure rate of the outmoded, stand-alone behavioral treatment to a 90 percent success rate nationwide.
• Addiction will be a manageable and preventable disease controlled with the smarter-targeted diagnostics and therapeutics that are even now in development.
• These advances will allow health care professionals to target adolescentsthe greatest at-risk populationwith insight, counseling, and (when necessary) medications, so that treatment will finally become preventive and proactive rather than after the fact and reactive.

Addiction is not a disease limited to any one population or demographic. It doesn't attack by class, income, religion, IQ, race, or culture. Addiction is and always has been an equal opportunity epidemic.

To deny anyone the basic right to medical treatment is immoral and a type of malpractice. Victims of addiction need access to doctors, medications, counselors, a wide assortment of psychological and behavioral therapies, pain management courses, and sleep and eating disorder programs.

Health care reform must recognize and support this new paradigm. Insurance carriers and Big Pharma must not discriminate against any chronic disease that negatively impacts our national health, including addictive disorders. The very best care must be provided whenever and wherever it is needed; it must be accessible to all, not just the privileged few, now and in the future.

And what a future that could bea bold new era of addiction vaccines, in vitro genetic engineering, and other miracles of medical science hardly imaginable today.

By the time Sam is my age, it is my beliefand a real possibilitythat there will be no further need for The Addiction Solution... because the addiction puzzle will already be solved.

David Kipper, MD
Beverly Hills, California

C hange is always in the wind.