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Dependence vs. abuse: more than semantics

June 22, 2010
by Gary A. Enos, Editor
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A keynote presenter at NCAD will reinforce the call for more tailored treatment

Carlton K. Erickson, PhD, ac-knowledges that today's conference attendees in the addiction professional community respond more positively to neurobiological clues about addiction than they did a generation ago, when his lectures tended to provoke arguments. Still, he wonders whether clinicians who today will nod their heads when presented with scientific data are effectively applying that knowledge in their everyday work with patients.

“Most catch on quickly now, but whether they actually practice it, I don't know, because no one has measured this,” says Erickson, director of the Addiction Science Research and Education Center at the University of Texas College of Pharmacy.

Erickson will devote his keynote address at this September's inaugural National Conference on Addiction Disorders (NCAD) to a discussion of neurobiological factors that can inform excellent treatment. Part of the talk will focus on the clinical criteria for a diagnosis of substance dependence vs. a diagnosis of substance abuse, as Erickson believes this important distinction must continue to be reinforced in the field.

“It's extremely important to talk about this difference, because one's a brain disease and one is not,” Erickson says. “We know that the good centers are assessing for this difference and are generally admitting people who are dependent. They want their treatment to focus on the people who are the most ill-they feel that's the best use of their limited resources.”

NCAD, to be held Sept. 8-11 in Washington, D.C., is being produced by Vendome Group, publisher of Addiction Professional, as an event combining treatment, administration, design, technology and other information for the addiction treatment community. Vendome has founded the event in conjunction with NAADAC, the Association for Addiction Professionals and the National Association of Addiction Treatment Providers (NAATP).

NAADAC's annual meeting now will be held under the NCAD title going forward. Also participating as an organizer of this year's conference is the International Coalition for Addiction Studies Education (INCASE). Targeted audiences for the conference include counselors, physicians, nurses and addiction treatment program executives.

Erickson concerned

Erickson believes many treatment programs might be treating a large number of individuals who do not meet clinical criteria for the disease of addiction (i.e., for dependence). “All they see is this general sense that a person has a drug problem, and all they want to do is help,” he says.

Erickson thinks others might actually target non-dependent individuals. He believes, for instance, that treatment centers that emphasize to potential clients their spa-like services have to be treating a non-addicted population if they are showing much success. “You can't change a brain disease with better food and more relaxation,” he says.

He is particularly troubled by the removal of the specific distinction between dependence and abuse in the draft of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The draft's combining of the DSM-IV categories of substance dependence and substance abuse into a “substance use disorder” category is being seen by some as easing insurance requirements for providers, but Erickson thinks it will complicate the case for convincing the public that addiction is a disease.

“I happen to think this is a horribly egregious mistake,” Erickson says of the proposed change. “The public won't understand that you don't treat every person the same.”

During his NCAD address, Erickson will convey his enthusiasm for neurobiological research during what he considers an exciting time for the addiction profession. He sees important developments on the horizon, from genetic validations for the disease of addiction to the development of a generation of more effective medications.

While Erickson sees the time gap between addiction research discoveries and their application in practice as shortening, he still believes there are deficiencies in this regard. And he lays at least part of the responsibility on a research community that has not fully appreciated how the end user of services can benefit from its discoveries.

“I think that in cancer research, when researchers are looking for a particular gene, they already will have a vision of what this will mean for treatment,” Erickson says. “In the alcohol and drug area, a scientist may never have talked to a person with a drug problem.”

He adds that many of these scientists possibly are motivated more by intellectual curiosity alone than about what the discoveries will actually accomplish for the person with a substance use problem. “A lot still believe that this problem is a willpower problem,” Erickson says.

Erickson has authored and edited several books, including the acclaimed 2007 title The Science of Addiction: From Neurobiology to Treatment, and was a regular contributor of commentaries in Addiction Professional. He is an associate editor of the journal Alcoholism: Clinical and Experimental Research.

Other presenters

As this issue of Addiction Professional was going to press, another confirmed keynote speaker for the NCAD meeting was David E. Smith, MD, FASAM, a leading national figure in addiction treatment since his founding of the Haight Ashbury Free Clinics in the 1960s. Smith is medical director of Center Point in San Rafael, Calif., as well as chair of adolescent addiction treatment at Newport Academy in Newport Beach, Calif.

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