Notable Report Findings
Recommendations
The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches, and to bring practice into line with the scientific evidence and with the standard of care for other public health and medical conditions. “It is time for healthcare practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars,” noted Foster.
For this study, CASA Columbia conducted a thorough review of more than 7,000 publications; in-depth analysis of five national data sets; focus groups and a nationally representative survey of 1,303 adults; statewide surveys of addiction treatment directors and staff providers in New York State; an online survey of 1,142 members of professional treatment associations involved in addiction care; an online survey of 360 individuals with a history of addiction who are managing the disease; and an in-depth analysis of state and federal governments’ and professional associations’ licensing, certification, and accreditation requirements. CASA Columbia also obtained comments and suggestions from 176 leading experts in a broad range of fields relevant to the report.
Founded in 1992 by former US Secretary of Health, Education, and Welfare Joseph A. Califano Jr., CASA Columbia is a science-based, multidisciplinary organization focused on transforming society’s understanding of and response to the disease of addiction. CASA Columbia conducts research and utilizes the scientific findings of others to inform Americans of the economic and social costs of substance use and addiction and evaluates addiction treatment and prevention programs to determine what treatment models work best, while seeking to reduce the stigma attached to this disease by replacing shame with hope and giving people the tools to prevent and treat addiction.
It is my sincere hope that this book will provide both the medical and the counseling professions with a viable tool to help them understand the problems of addiction, as well as the full range of information and resources that is available to assist us in the fight against all forms of addictive behavior.
Of course, my wonderful parents, who showered me with love and encouraged me (and paid for my college and medical school education); my teachers at the State University of New York and Yale University, who inspired me toward academic pursuits; Dr. George Wayne, who first recruited me to work at Edgemont Hospital in Los Angeles; Dr. Anthony Radcliffe, who brought me to SCPMG Kaiser Permanente; Dr. Rochelle Sechooler, who asked me to join the teaching faculty at Los Angeles City College; and more recently, Dr. Krista Gilbert, who invited me to join the treatment team at Michael’s House in Palm Springs, California. I also want to thank Dan Mager of Central Recovery Press and Mike Rounds for their invaluable assistance in putting this book together.
Merriam-Webster defines addiction as “a compulsive need for and use of a habit-forming substance (as heroin, nicotine, or alcohol) characterized by tolerance and by well-defined physiological symptoms upon withdrawal” or in a broader definition, “the persistent compulsive use of a substance known by the user to be harmful.”1
Historically, addiction has been defined as physical and psychological dependence on psychoactive substances (for example alcohol, tobacco, heroin, caffeine, and other drugs) that cross the blood-brain barrier, and once ingested, temporarily alter the chemical milieu of the brain. Addiction can also be viewed as a continued involvement with a substance or activity despite the negative consequences associated with it.
Addiction begins as a pursuit of pleasure, enjoyment, or relief from actual or perceived ailments; however, over a period of time more involvement with the substance or activity (such as gambling, eating, or sex) is needed to feel normal. In other words, a person starts doing it to feel good and then has to continue doing it to keep from feeling bad.
However we define it, humankind has been experimenting with mind-altering substances ever since we first discovered that grapes would ferment into wine. Since then, we’ve used our intellect, imagination, and ability to create myriad new ways to alter our consciousness through the use of addictive drugs and behaviors. Unfortunately, some people go on to develop serious problems when they go down this road. It has often been said that in the beginning of this deterioration, the use of drugs sometimes “gets in the way of the person’s life.” Later on, “life gets in the way of the person’s drug use.”
This is not a book about counseling or therapy. We already have more than enough books that deal with that subject area. This is a book about the essential biological and medical knowledge that a therapist or counselor should have if he or she desires to work effectively with addicts (including alcoholics). Throughout my many years as a physician working in this field it has been disappointing to observe that so many well-meaning therapists and counselors seem to know relatively little about the biological and medical aspects of addiction. The consequences of this lack of knowledge lead to suboptimal care and treatment for this very vulnerable patient population.
I hope that in some small way this book will lead to improved integration of the medical and counseling fields. The Therapist’s Guide to Addiction Medicine has been written as a basic guide to assist counselors and therapists in helping their clients recover from the disease of addiction. Although The Therapist’s Guide to Addiction Medicine was envisioned as a handbook for addiction counselors and therapists, I have tried to make it easy to understand so that it can be used as an educational and self-awareness resource for anyone who struggles with addiction or is living with or caring for someone who suffers from this disease.
INTRODUCTION NOTES
1 By permission. From Merriam-Webster’s Collegiate® Dictionary, 11th Edition, ©2013 Merriam-Webster. Inc. (www.Merriam-Webster.com).
“I’m Not an Addict; I Can Stop Anytime I Want!”
There are any number of reasons why people use and end up becoming addicted to alcohol and other drugs: to change the way they feel—for euphoria, sedation, and anesthesia; to self-medicate depression, anxiety, insomnia,
