Theories of Addiction Treatment

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The treatment of addiction has grown beyond just alcohol and drugs.

In the early days of addiction treatment, the focus was on alcohol and drugs. The theories about what was going on with the patient and why, focused on the specifics of physical craving for the addictive ingredient and treatment was primarily an outgrowth of the 12 step concepts of Bill W. What we had learned was that you had to continue to absorb more and more of a substance to which you were addicted in order to try to achieve the same level of pay off from the substance.

Today there are two major focal points for dealing with addiction. They both recognize and validate the role of the other in understanding and treating addiction. One is the medical doctor and the medical approach. This approach involves utilizing new powerful tools like MRI’s and Cat or Pet scans to find out where in the brain the issue resides. These new technologies have enabled us to learn more about what is going on in the brain of the addict. In the old days, if you were addicted and you stopped taking the drug to which you were enslaved, you would have physical and visible symptoms like delirium tremens or the shakes, or nausea because your body was going through chemical adjustments from withdrawal symptoms.  Now we recognize so many other things as being addictive such as video games, porn, sugar cravings, sex, etc., these things do not trigger the same physiological and visible responses within your body. You do not go into DT’s when you stop playing a video game or stop watching porn.  But what we can see with the technology that is available today is what is going on in your brain. We can identify the dopamine and norepinephrine balances in the brain and where the location of the trigger points involved in the arousal state are located. Our problem right now is figuring out how to moderate those neurotransmitter balances from the outside with treatment of some kind. The medicines we use to try to impact those sites have to find a way through the blood brain barrier and we do not yet have a way to do that that works as well as we need it to.

There are medicines that work, but they come with baggage that we can not afford. There are side effects that are not worth the gain.

The other pillar of treatment is the psychological and emotional pillar. We are looking at the reward system and the way it works in the brain. We all seek out rewards of some kind in order to gratify our needs. One of the questions that we have to ask is what is your pay off for this behavior. A lot of what we do in therapy today is emotional economics. We ask, “is the cost of the choice you are making now worth the payoff you get from the behavior?” If we begin to approach treatment from this perspective, we have to also look at behaviors that support our access to the addictive substance. An instance is the presence of technology in our lives. Our cell phones in our hands are always available. Internet based video games are always out there, and you can play them anywhere anytime, or even all the time. Those cause a level of stress and the desire to check our emails is intrusive and becomes classifiable as an addiction.

How do we identify these hungers as reward-based behaviors? Can we track them with technology? Yes, we can see where they are in the brain and we can see when they get triggered. But behaviorally we have to use other approaches. How do we identify the hunger that drives the trigger and moderate the behavior we develop in response to the hunger? Can we modify it or train it to some other response? These are some of the elements of addiction that we have to discuss this week on our podcast.

There are new strategies and new technologies that put new tools in our treatment basket. Listen to this week’s podcast and hear our discussion of these new ingredients for identifying and treating addictions.


This Health cast was written and presented by Dr. Kathy Maupin, M.D., Bio-identical Hormone Replacement Expert and Author, with Brett Newcomb, MA., LPC., Family Counselor, Presenter and Author.

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