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Dr. Podesta on Hooked and How to Fix The Addiction Epidemic

I recently interviewed addiction expert and psychiatrist Dr. Arwen Podesta to discuss her new book Hooked and explain common misconceptions, how to help families, how to fix the addiction epidemic and how to handle relapse. Here's what she had to say...

Why did people need another book on addiction--what's different about yours?

There are many great books on addiction, from anecdotes and personal journeys, to textbooks, and anywhere in between. Often patients and colleagues ask me to help them navigate the treatment and reason for treatment types. I have never had a good, concise and clear, non-judgmental book to refer them to. So I wrote one. In HOOKED, I delve into the underpinnings and causes of addiction, levels of treatment and care for addiction, and even why some people respond to a treatment and others don't. This book is short and just the tip of the iceberg, as the longer, deeper investigative books are already on the market.

What misunderstandings about addiction do you most commonly encounter?

Among professionals and patients alike, there are biases and misunderstandings about addiction. Some question whether it is indeed a brain disease. Many suggest it is a disease of character and moral failings. Many believe that if you change the environment and stress, than the addiction can go away. Many people are opposed to taking medications to treat the disease of addiction, and feel that someone on a medication is not truly sober and therefore not in recovery. To some degree, all of these ideas can be correct (depending on the individual) and all can also be dispelled as misconceptions. BIOLOGY+STRESS+DRUG=risk for ADDICTION. Like any additive equation, if you decrease the addends, then you decrease the sum; in this case the sum is the risk of addiction.

What are the key ingredients to fixing the growing crisis of addiction in America?

We have a devastating crisis on our hands. I heard an estimate that, if the current trend continues, we would quadruple the number of opioid related deaths in 2017. About 33,000 people died of this in 2015, so imagine! But we can treat addiction at any stage, except death. We can prevent it with education, pre-screening, preemptive treatment, public health and rational prescribing. We can treat active addiction with many effective evidence based modalities. We can even rescue overdoses, but we must have those tools available and spread throughout the communities. I think the Surgeon General putting out a report was a good step to getting this knowledge into the public eye. It would be useful now to have more physicians trained and able to be incentivized to do good, rational, whole treatment for this disease. Our treatment system is not well prepared to address this epidemic, and although there are more doctors getting licensed to use buprenorphine for treatment, many are not well trained to treat the whole disease of addiction, much less have access to wrap around services to meet all the needs. And when doctors do prescribe, there are barriers within the health plans to cover the lifesaving medications. Organizations like ASAM (American Society of Addiction Medicine) are doing great work in these arenas, but we need more. I concur with a position many colleagues take, that if we liken the treatment of this crisis to the AIDS Drug Assistant Program, which helped millions of people get the price-prohibitive medication, we could have quite a reversal of the estimated death toll.

What advice do you have for a family member or loved one of someone who is struggling?

For families or loved ones of someone struggling with addiction, I sincerely empathize. The first thing to note is that you are not alone. Almost everyone knows someone struggling with addiction (even though you may not know it). In HOOKED, I have a short chapter entitled "Loved Ones Roles and Expectations." A few pearls from that chapter include:

-creating a role of love and support, but with strong boundaries

-give guidance and recommendations when the addict wants help getting on track

-pull back when relapse occurs; seek support for yourself during that time

- understand that addiction is a disease

What do we know about relapse--why it happens and what to do if it does?

Addiction is a relapsing illness. Just like diabetes. Many, once treated, with lifestyle change, intake change, and medication, will never relapse. But many will. Relapse is expected, and it a pleasant surprise when it does not occur. When a patient relapses, treatment providers and families must tighten the parameters, have more accountability, perhaps adjust medications, and increase the level of care. For family members, the most important thing is to know that the loved one could relapse, and have a plan in place- not just a plan for the person with addiction, but a plan for added support for the family.

Several times a week, I am approached by friends, colleagues, family or patients to help them figure out how/where/if to refer someone they know to treatment. It is tough to navigate the system, and with so many for profit companies ready and willing to take you call, it is difficult to know where to turn. In the back of HOOKED, I include some non-biased resources and "Quick Guide- What to Ask a Rehab."

I am humbled to learn from all of my patients and experiences. I wrote HOOKED to be able to help those I may not get to meet.

Thanks Dr. Podesta!

Thanks, Omar, for the great questions!

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