Thanksgiving Thoughts

Posted on November 25, 2011 by admin

The blog is updating a little late this week because of the holiday. I hope that you all had wonderful Thanksgivings, and that you got the opportunity to spend time with your families and think about the things in life you’re thankful for. Though eating and shopping have become large traditional parts of this weekend, it’s always worthwhile to stop and reflect on what we are grateful for in our lives.

It’s always difficult to feel thankful when you’re suffering from a long-term illness, and the disease of addiction has a uniquely destructive effect on the lives of those it afflicts. The behavioral and psychological aspects of the disease often lead to broken families, as theft, lies, and betrayal take their toll on relationships with parents, spouses, and children. The financial drain of drugs and treatment can prevent addiction patients from being able to provide a large Thanksgiving feast. It’s a long, hard road to emerge from this disease, and it’s difficult at any point to feel particularly thankful for the troubles it brings.

But there are still reasons to be grateful. We now live in one of the few decades in history where an effective treatment for addiction is generally available. That treatment is not a cure, and it is not as widely available as I would like, but there is more hope of a normal life for addicted patients than there has ever been before. With more understanding of and education about this disease, the family members of addicted patients can learn to help their suffering loved ones and make treatment easier. And it is my sincere hope that understanding and treatment will only continue to improve.

Thanksgiving is now over, but I think it is worthwhile to remember what we have to be thankful for every day of the year. I am thankful for the ability to help my patients, and I will continue to reflect on that opportunity on Monday. Until then, I wish you all happy holidays.

Good Drugs and Bad

Posted on October 25, 2011 by admin

I’ve talked before on this blog about the fear patients and physicians often have that treating addiction with buprenorphine is “only trading one addiction for another”. While this might technically be true, it’s a phrase that ignores the huge material and medical improvements to patients’ lives that buprenorphine gives by eliminating the high-withdrawal cycle of active drug abuse. (Not to mention putting a stop to the destruction of the brain and other organs by toxic substances.)

The problem here is that there are a lot of fine distinctions between the normal course of the disease of addiction and the controlled, symptomless “addiction” of buprenorphine, but people who don’t know a lot about the field of addiction medicine aren’t likely to see that. And it’s mostly people who don’t know about addiction medicine — voters, lobbyists, abstinence care providers — who control the way it is seen by the public and dealt with by the law.

There is a similar confusion I often hear about “prescription drugs”. Lots of people know that misuse and overdose on prescription narcotics cause a huge number of deaths every year. There’s a general sense that we have to reduce the number of drugs being prescribed, because more drugs leads to more death. So when physicians like me who realize the need for medication treatment of addiction try to push for the power to prescribe more medication, we are met with resistance from the belief that prescription drugs kill people, and are bad.

While this is an understandable response to the amount of drug deaths we see yearly in the U.S., it is also an overgeneralization that actually does a great deal of harm to everyone involved. It’s true that many kinds of prescription medication, especially narcotics, can be and are abused. It’s true that patients often scam multiple doctors to get prescriptions for these kinds of medications, and that the best way to cut down on their abuse would be to keep a stricter watch on prescriptions and reduce the number of prescriptions given out. So how can I advocate for wider prescription?

There are several very important distinctions that “prescription drugs” fails to acknowledge. The first, and maybe most important, is that it’s virtually impossible for a patient who is already addicted to opiates to lethally overdose on buprenorphine. Once the opiate receptors are fully saturated, taking more buprenorphine will have no appreciable effect. So while it can certainly be diverted to the street and shouldn’t be given out indiscriminately, buprenorphine is infinitely less dangerous than ordinary prescription narcotics and benzodiazepenes. It also carries fewer health risks in and of itself than many stronger opiates.

Secondly, buprenorphine by definition is a medication used to treat addiction, and therefore would only be prescribed by physicians who are knowledgeable about treating the disease of addiction. It’s my opinion that the root of our prescription painkiller problem today is physicians who don’t know or don’t understand the addictive effects of the medications they prescribe, and aren’t willing to deal with the addictions of their patients. Over-prescribing of opiates and narcotics has led to a rise in the incidence of the disease of addiction, and now new, different medications are required to treat this disease that we created.

A good way to think about this problem is by analogy to viruses and vaccines. It seems non-intuitive at first that exposure to a virus could help you avoid the problems caused by that virus, but that’s exactly how vaccines work. It’s also how buprenorphine works; by introducing a safer, more predictable, more controllable version of the problematic prescription drugs, we can prevent and alleviate the problems they cause, from crime rate spikes to the deaths of celebrities.

There is no such thing as a “good drug” or a “bad drug” — all drugs can be good when they’re given and taken in the right circumstances, and all drugs can be bad when they’re abused. Saying that all prescription drugs are bad is a shortsighted assumption that can do long-lasting damage to patients and physicians alike.

Simple Truths

Posted on October 11, 2011 by admin

The truth is never simple.

This week, I discovered that one of the patients in my office is a drug dealer. While she is seeing me for her opioid addiction and getting buprenorphine prescriptions, she continues to see her regular doctor to get prescriptions for her narcotic pain pills. She then sells the narcotics on the street. She is defrauding her insurance company, lying to multiple doctors, and enabling other addicts by illegally making prescription narcotics available to them.

She is also a 76-year-old grandmother, widowed, and barely able to walk due to scoliosis — the reason she was taking addictive prescription narcotics in the first place. She lives with her son, who helps to take care of her. Both this woman and her son are on Medicare and disability, and her profits from selling narcotics are a significant part of their income and is absolutely essential for them to make ends meet.

Selling drugs is criminal and morally wrong; in addition to harming those who buy the drugs, it has long-lasting consequences on the entire healthcare system. “Diversion” — when prescription drugs are sold on the street rather than being taken as prescribed — is a major issue in pain management and addiction right now, and it’s one of the reasons that many physicians are so reluctant to treat addicted patients.

The selling of drugs illegally also reinforces the connection between substance addiction and crime; it familiarizes younger addicts with criminal behaviors, but also casts undeserved shame on people who have never committed a crime but are addicted to prescription narcotics due to illness and injury, like this woman herself.

Clearly what my patient is doing is wrong — but saying she is “weak”, or a bad person, becomes difficult. Here we have a woman who is desperate and disabled, just trying to survive. The Occupy Wall Street movement which has recently spread throughout the country is teaching us just how much desperation and anger exists among people trapped in poverty and unemployment, and how desperate situations can lead to desperate acts. The Occupy movement has been ridiculed for not having a clear agenda or offering solutions to America’s financial problems, but this is foolish, and it’s a distraction from the really important thing; that it doesn’t matter whether Occupy Wall Street has a clear agenda. What matters is that it is happening. People are spontaneously gathering all over the country to express their frustration with the economy. That this is happening at all is a clear sign that this country’s social, economic, and medical systems are massively, disastrously broken.

My patient is not connected to the Occupy Wall Street movement, except for the fact that her situation is a symptom of a massively broken system. Just the fact that she is forced to sell her pain pills in order to make ends meet is a sign that something has gone terribly wrong in the Social Security systems meant to keep her out of poverty, and the medical systems that are meant to effectively manage her treatment.

Her terrible situation does not excuse her from the responsibility of the harm she’s caused by selling illegal drugs. All talking about it can do is help others understand the root of the problem, which is the only way we as a society might have a hope of solving it. And if nothing else, this goes to show just one more way in which the public, “commonsense” perception of drugs, drug addicts, and even drug dealers is far too simple, divided, and prejudiced to approach the deeply complicated truth.

Self-esteem and Treatment

Posted on October 4, 2011 by admin

Addiction treatment is often a very turbulent and even painful period in a patient’s life, for reasons that may or may not be directly connected to their treatment. Often patients are driven to seek treatment by a traumatic event in their lives — the death of a loved one, the “intervention” of friends and family, or legal troubles that require them to get “clean”. This
is one reason why my office will recommend counseling to those who want it, since pure medical treatment of the disease sometimes leaves behind emotional and interpersonal issues in a patient’s life that should be addressed.

Every patient’s life is different, but one problem that I see many of my patients wrestling with a lack of self-esteem. If it seems odd that self-esteem should be an issue in addiction treatment, keep in mind that, no matter what kind of treatment is used, overcoming addiction is often a long and arduous process. Even with medication — the kind of treatment that causes the least physical suffering — an addiction patient often has to
adjust their life in major ways; whether it’s finding a new drug-free social circle or dealing with the effects their illness and treatment are having on friends and family, the challenges of addiction treatment can be ongoing and severe. Without some belief in their own strength and ability to cope, some patients can find it next to impossible.

Unlike removing their cravings for addictive drugs, this isn’t a problem I can easily solve for my patients. But it’s clear to me that something needs to be done to help give addiction patients more faith in their own ability to manage their health and cope with the hardships of treatment, they need to be empowered — the same sort of general encouragement that is often available for people recovering from other diseases, like cancer, or from major surgery. It is recognized in these areas of medicine that optimism and self-esteem are valuable tools in recovery, and they are encouraged by medical personnel and by friends and family. In addiction this, like so many other aspects of care, is largely ignored, and many treatment providers still try to shame patients out of their desire to use, which only makes things worse. A person suffering from addiction will most likely try to eliminate feelings of shame and guilt by relapsing to their drug of choice, not by pulling themselves up by their bootstraps to do a better job.
Building self-esteem and self-empowerment in this patient population is a complicated and delicate process. It is best accomplished after patient’s cravings and withdrawal symptoms have been treated with medications as the relief of these symptoms will at least give patient the ability to refrain from using. Expecting patients to refrain from using in the face of intolerable withdrawal symptoms will only expose them to another potential
failed attempt at changing their lives and will continue to pile on the shame, guilt, and feelings of helplessness and worthlessness. The current most commonly relayed message to those suffering from the disease of addiction by most treatments based on 12 step phiolosphy is still shame, guilt, and helplessness. These messages to those who are addicted must stop before we can make significant progress in treatment. As I’ve said a thousand times before, addicts are sick, not evil; and sick people deserve
treatment, not punishment.

As a physician, I sometimes find it difficult to walk the thin line between encouraging my patients to think positively about the future and giving them false hopes about what addiction treatment is currently capable of. I am also mostly powerless to help them with the consequences of bad decisions in their lives, and the patterns of bad decision-making that may have accumulated over the years of their addiction. Nonetheless, as people with a serious medical condition, addiction patients deserve the same encouragement that cancer patients routinely receive; that they are stronger than their illness, that they can beat their condition and return to their normal, healthy lives.

Addictive Personalities

Posted on September 27, 2011 by admin

We used to think of addiction as a moral sin — something that happened to people who were weak, or sinful, or broken in some way. Over time, this view grew into the perception of addiction as a moral failing, or some type of personal deficit that made some people become addicts and others not. The first few haphazard attempts to medically describe the disease of addiction still held onto this viewpoint, that addiction was caused by an inborn character weakness; eventually this gave rise to the idea of an “addictive personality”, a vague series of personality traits thought to cause addiction.

The concept of an “addictive personality” as a cause of addiction has been discredited for years, ever since physicians have begun to think of addiction as a physical disease and not an inbred moral issue. It became clear that certain chemicals had the potential to addict anyone, regardless of personality, and before long most serious medical discussions had abandoned the concept of an addictive personality altogether.

Now, as we struggle with the concept of addiction as disease of the brain, those who work with addicts still have to deal with the many “bad” behaviors that those with addiction display. We have also started to realize that to some extent many people with addiction display many of the same characteristics — poor judgement, poor evaluation of risk/benefit analysis, impulsevenss, easy boredom, craving for excitement, difficulty learning new
behaviors, lying, and others. These clusters of behaviors seem to be common to many suffering with addiction; in other words, they appear to form a pattern of behavioral symptoms that are linked to the physical disease.

Do these behaviors arise because of the addiction and the neural damage it can cause, which would make them a set of acquired cognitive deficits secondary to the development of addiction? Or are they a set of dormant, inborn characteristics that exist in our patients that are pre-disposed to developing addictions (which we know have a genetic component)? We don’t know the answers to these questions, and they will be very difficult to study, partly due to the complexity and misunderstood nature of addiction, and partly because it develops at a very early period of life when a person’s full personality is not yet formed. If, at some point, it can be proven that these behavioral traits come before addiction and contribute to its development, then perhaps there is a definition for an addictive personality disorder after all.

The discussion of a possible “addictive personality disorder” is not about developing a new way to label addicts, or trying to go back to the concept of addiction being some type of inbred defect. If there were a cluster of personality traits that we could recognize as being suggestive of the development of an addictive disorder, then perhaps it would lead to early
recognition of a “pre-addiction” condition that might be amenable to early recognition, intervention, and prevention. Even if we can prove that an “addictive personality” exists, it should still not be seen as a defect or a moral failing; like other potential personality disorders, it is due to factors beyond a person’s control and merits treatment, not punishment.

The brain is such a complex system that there are certainly undiscovered connections between chemicals and behavior still waiting to be uncovered. I am looking forward to physicians and patients moving forward together to advance treatment and prevention of this disease.

Anecdotes and Data

Posted on September 5, 2011 by admin

Of all the people offering addiction treatment, those who are not trained professionals tend to be laypeople who have struggled with addiction problems in their own past. They may describe themselves as “ex-addicts” or still in recovery, but they offer a common reassurance: that they have experienced all the troubles that addiction brings, and they understand what their clients are going through. Often, they market their particular
treatment as something that worked for them personally, which they
want to share with others.

The desire to share something that helped you, so that it can also help others in your situation, is a good and noble impulse. But it often happens that the results of that impulse do more harm than good. Brain chemistry and behavior are complex, finicky things, so much so that even our oldest and best-tested methods of treatment often have wide margins of error. In this field, moreso than any other, what works for one person may do no good, or even harm, to someone else. In this field more than any other, we need large
studies and statistics to collect data on huge amounts of people and categorize it so that we can filter out individual eccentricities and find strategies that will help almost everyone.

Anecdotes, personal stories, and testimonials can sometimes be helpful, but they are not medical data. They are often incomplete, exaggerated, or inaccurate, disregarding the people who have strong financial motives to outright lie. People suffering from addiction are often desperate, frightened, and may be functioning at less than their full mental capacity, which makes them perfect prey for unscrupulous con-men selling a style
that they claimed worked for them. Even those run by honest people who truly were helped by them are often grossly unsuited to help others. Stories and anecdotes tend to be more compelling than statistics, because it is easy to relate to someone telling their story, and the emotional impact of a person standing in front of you telling you about their life is very hard to ignore. But for those same reasons, anecdotes are incredibly unreliable as the basis for seeking medical treatment. Many people distrust statistics, thinking that they might be fabricated or biased, but the fact is that medical statistics from credible sources (such as the CDC or ASAM) go through a much more rigorous fact-checking process than the founding myth of any nonmedical treatment ever will. It is the stories of such that are more likely to mislead their clients or put them in harm’s way.

This is only one more way in which we need to bring the field of addiction up to the same scientific standard as other fields, such as dentistry and cardiology. Very few people would, say, switch to an all-banana diet because they heard a story from a neighbor’s friend who said it had cured his cavities. Yet people routinely pay tens of thousands of dollars for the promise of a nebulous “spiritual transformation”, or for a bizarre regime
of vitamins, horses, sauna treatments, and other provisions that have nothing to do with addiction, all because they have been fed bad information through “patient testimonials” and other stories.

Healthcare and medicine are based on truth; on what, in reality, actually can be proven to help people. I have seen many peoples’ lives improve after they come through Bel Air Center for Addictions, but I won’t ask that people come to my office just because I say that. I prescribe opioid maintenance treatment because its use has been continuously and irrefutably supported by the scientific study of brain chemistry and how it can be altered to improve the lives of people suffering from this disease.

Hurricane Withdrawal

Posted on August 29, 2011 by admin

This weekend, the East Coast was shocked and frightened by the approach of hurricane Irene. Though the hurricane didn’t do as much damage as the news media had forecast, people from North Carolina to Maine feared for their lives and property, and rushed to gather emergency supplies and find somewhere safe to wait as the storm approached.

The hurricane was highly unusual, but the fear and panic that came before it were things I had seen before. For someone suffering from addiction, every day can be like the day before a hurricane. They are constantly living in fear of withdrawal, to the point where every minor headache, cold, or stomach pain is seen as a sign that the storm is about to break, and the wretched withdrawal symptoms are about to hit them with the force of hurricane winds. People who haven’t experienced addiction tend to think of withdrawal as being similar to the flu; it’s uncomfortable, but after a while it goes away and you’re no worse for wear. They don’t realize that one of the symptoms of the disease of addiction is heightened sensitivity to the kind of pain and discomfort that withdrawal brings, to the point where it becomes completely crippling. I’ve had many patients who relapsed because they were unable to ‘wait out’ the withdrawal symptoms, which they say felt worse than a non-addicted person could imagine.

It’s understandable that addicted patients start to panic if they think they are about to experience withdrawal, and that will cause many of them to use. But it extends beyond the panic of a single moment. For addicted patients, withdrawal is always looming on the horizon, and they constantly have to take steps to ensure that they don’t suffer from it. As soon as they get one fix, they have to be looking for the next one. If they have to change cities, or take a trip on business, or deal with some big event like a wedding, they have to ensure that they’ll have an adequate supply of their substance if they don’t want withdrawal to overtake them. The frenzied planning and desperation many patients feel under the threat of withdrawal is similar to what East Coast residents experienced under the threat of hurricane Irene.

Those who say that addicts are ‘dirty’, that relapsing makes them ‘weak’, should consider that perspective before they make their judgements. It is possible for some people to wait out withdrawal symptoms, just as some people were better able to handle the fear and uncertainty produced by the weather predictions last week. But the desire to protect ourselves against perceived future threats is a deeply human trait, and no addiction treatment can be complete without taking it into account. Physicians in addiction treatment must be aware of what the world looks like to their patients, and they must be willing and able to reassure their patients that the storm of withdrawal isn’t a problem. 12-step detox programs attempt to just get their patients through the storm, patching up damage as it occurs and making no attempt to prevent further damage. Wouldn’t it be better to keep the storm from hitting at all?

Philosophy and Hedonic Tone

Posted on August 15, 2011 by admin

During the years I’ve spent in the field of addiction medicine, I’ve heard a lot of non-medical explanations for the symptoms and behaviors of people who suffer from addiction. One explanation that keeps recurring in different forms is the idea that all human beings are somehow born with a capacity for “something higher”. This is often described as “enlightenment” or a “higher plane of consciousness”; one Internet commenter recently described it to me as “sparkles and comfort”. The idea is that a normal, healthy human being is somehow lacking in some mysterious key to happiness, and it is this being destined for “more” that drives addicts to their substance of choice to try and find it.

We can also describe this idea using the more scientific concept of hedonic tone. The hedonic tone is a way of measuring the happiness or contentment a person feels or is capable of feeling. Each person has a unique base hedonic tone — that is, each person has a baseline level of happiness that they return to when their lives are free from great stress or achievement. Anhedonia is a condition in which someone’s hedonic tone is unusually low, so they are incapable of feeling pleasure.

People who argue for the “destined for more” model of addiction seem to be saying that we are all born with a certain hedonic tone — let’s say 50% — which is much lower than our maximum, and that this is something wrong with us. They see this unnaturally low hedonic tone as the real problem, while addiction is just a misguided attempt to self-medicate for the real problem. They therefore suggest that by fixing the real problem, you fix the addiction, which is only a symptom. The same commenter I mentioned earlier insisted that if patients could get their “sparkles and comfort” elsewhere, like from a spiritual or religion, their addiction would no longer be a problem.

The fact is that while we do naturally have a hedonic tone that is less than our maximum, this is normal. By having a hedonic tone lower than the maximum, the brain leaves itself room to increase it in order to reward us for doing things that help us survive. If we were born with a maximum hedonic tone, we wouldn’t respond to any rewards, and we would have no motivation for even keeping ourselves alive.

We can physically see this in action when we study happiness and how the brain responds to it. The brain wants to stay at that ideal 50% hedonic sweet spot over the long run, so while it will reward you with endorphins that raise your hedonic tone, it will eventually return to baseline when they wear off. We see this in people who have achieved some goal that makes them happy, say by buying a new car they really wanted. At first, their hedonic tone is higher, but after some time the brain adjusts the baseline upwards, so that what was once 75% becomes 50% again. This is a way of preventing us from stagnating, and keeping us moving on to the next goal.

We see the same pattern when we look at chemical receptors in the brains of people who suffer from addiction. Normally receptors are active at a baseline level — again, say 50%. Drugs raise the saturation and the hedonic tone, mimicking the feeling of the brain’s reward; it feels good, so the addict continues to do it. The brain wants to be at 50%, so it will eventually adjust the receptor levels, producing more, until what used to stimulate 100% now only stimulates 50%, and to get to 100% requires a greater amount of drugs. This is called “tolerance”, and it’s a phenomenon that many addicts are intimately familiar with. If escalated too long, it can lead to severe brain malfunction, and eventual overdose from the ever-increasing amount of substance needed to reach that 100%.

We can see from this that the “destined for more” model is actually a very distorted way of interpreting real data. It’s true that doing drugs raises the hedonic tone towards the maximum, and that this is the reason addicts first seek it out. Where the “destined for more” model goes wrong is in thinking that humans are supposed to be at 100%, that we are meant to be there, and that being at our natural state of 50% means we are somehow “broken”. It puts a mystical and philosophical distortion over a very real biochemical phenomenon.

Addiction has been around for a very long time, and like any scientifically classifiable disease, it often follows predictable patterns. People with ulterior motives or a lack of medical training have come up with all sorts of theories that claim to explain the nature of addiction, but ultimately fail to hold up under the evidence. It is imperative that all research and treatment of addiction be based on sound science, instead of mysticism, if we are ever to make progress against this disease.

‘Medical’ Marijuana

Posted on August 8, 2011 by admin

In September of 2010, ASAM released a statement expressing what many people considered to be a surprising opinion about the legalization of medical marijuana. The document, The Role of the Physician in “Medical” Marijuana, came down largely against the legalization of ‘medical’ marijuana that have been enacted by several states. This seems surprising, since many professionals have expressed the opinion that, while it is mildly addictive, marijuana is safer to use than other common, legal recreational drugs like alcohol and nicotine. In fact, it’s not the legalization of marijuana itself that ASAM and other professionals are objecting to; it’s merely the haphazard way in which the ‘medical marijuana’ system is constructed.

According to this article from Time magazine, only about 10% of those who use marijuana become addicted, as compared to 25% of heroin users and 15% of alcohol users. The overwhelming majority of marijuana use is recreational, and occurs in people who are not (or are not primarily) addicted to it. To this population, marijuana is still illegal, but is also desirable, and they will try to obtain it through the ‘medical’ system where such a system is in place. This leads to the main point of the ASAM paper; though marijuana is supposed to be dispensed in a medical capacity, it isn’t regulated like an ordinary medicine. It hasn’t been tested thoroughly by the FDA; there is a lack of real dosing guidelines, especially for smoked marijuana, where the amount administered is less easy to control; and the potency, usually measured by THC content, can vary widely, making proper dosing even more difficult. There are no specific illnesses which marijuana has been proven to effectively treat. In short, the ‘medical marijuana’ system is not very medically sound.

It seems that the ‘medical’ system is designed largely to exclude the ‘potheads’, those who are addicted to marijuana or only use it recreationally, from obtaining it. As I’ve written previously, patients who are addicted or have a history of addiction act very differently from other patients, and by making a prescription necessary to obtain this drug, the system gives these patients a strong incentive to lie to their physicians, who may not be prepared for this behavior. Physicians untrained in the field of addiction are now having to deal with people who might be suffering from addiction, instead of whichever disease marijuana is meant to cure. This will lead largely to misdiagnoses and over-prescribing of the drug.

This has also shifted some of the focus of the marijuana legalization debate to physicians, who are in no position to deal with it. Since there are no real protocols or procedures for the administration of marijuana in a medical capacity, physicians are being forced to make decisions about its use based on little or no scientific information. They have been made unwilling gatekeepers, which brings with it a great deal of responsibility and liability.

I am not opposed to the federal legalization of marijuana for recreational use; as I mentioned earlier, marijuana is no more dangerous than alcohol or nicotine. With proper regulation, and age-limit laws like those in place for alcohol, I see no particular reason why it shouldn’t be legal. If we’re going to make it legal, though, widespread regulation is absolutely essential. The ‘medical marijuana’ system is largely uncontrolled, ineffective, and full of loopholes which are ripe for abuse.

Buyer Beware

Posted on August 2, 2011 by admin

I recently heard the story of a woman in California who was lied to by a Scientology-based addiction treatment facility, Narconon, and is now suing them to try and regain some of her lost money.

I went to investigate the website of the facility in question, the Narconon facility in Vista Bay, CA. The website is impressive and appears very professional, and uses many of the buzzwords common to nonscientific treatments, including vague promises of “lifelong recovery”, warnings against medication, and an unspecific list of treatments including “vitamins, exercise, and… our sauna”. They claim several times that their method is “proven”, but nowhere on the site do they offer any scientific journals, papers, or research studies that support this claim, and a few of the statements about addiction supposedly made by M.D.s on the Narconon staff are dubious at best. One of many opposing sites, Narconon Exposed, makes an attempt to catalog the problems with Narconon, especially those relating to the organization’s supposed ties to Scientology.

The suffering of those who have been misled by Narconon’s advertising is cause for outrage, but Narconon is also merely a symptom of larger problems in the addiction-care system. I’ve written previously on this blog about the lack of standardization in addiction care, and the tragic consequences it can have for underinformed addicts and their families. The sad fact is that Narconon is licensed by the state of California to adminster addiction treatment, a fact which is flaunted at great length on the website, which includes scans of many impressive-looking official documents. It would be very, very easy for someone who wasn’t aware of the many problems to be taken in by Narconon’s marketing, and sign themselves up for treatment that is not only ineffective, but potentially harmful.

The licensing of Narconon has been blamed on the understaffing and low budget of the California government offices responsible for vetting and approving treatment facilities, and it is likely that as our nation faces growing cuts to public services in the face of the recent budget crisis, such oversights will only grow more common. It is more vital now than ever before for people suffering from any illness to inform themselves on all their treatment options, and carefully investigate any facility before they pay for what may be fraudulent care. Snake oil salesmen thrive in times of uncertainty, and decades of misinformation have made people suffering from addiction prime targets.

Narconon is unusually harmful, even cruel, but there are many, many more centers out there that claim to treat addiction with regimens that are stunningly ineffective. I’ve written a great deal about various 12-step programs on this blog, and I am sad to see that Narconon displays many of the same traits that 12-step programs use to market themselves; a warning against all medications, an emphasis on permanent recovery and “cure”, and affiliation with a religion or “spiritual” approach. It just happens that Narconon is affiliated with the Scientologist religious model instead of the vaguely Judeo-Christian one that most 12-step programs are based on.

Snake oil salesmen of this type have been around as long as humanity, and the only way to weed them out is to combat their misinformation with proven medicine, sound science, and rigorous oversight. It has happened in other fields of medicine, and it will undoubtedly happen in the field of addiction, though it may take several years. I am confident that, if we continue to move ahead with research and treatment using medicine to treat the disease of addiction, that the patients who are being taken in by these scams now will be among the last to be fooled.