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The  Addicted  Brain  Transcripts  –  Week  7  
Video  7.1  
Now  we  come  to  one  of  the  most  important  topics  in  drug  abuse  and  drug  addiction.  
That  topic  is  treatment.  
 
Drug  abuse  can  be  very  difficult  to  stop,  and  relapsing  is  highly  probable.  Also,  the  
disease  itself  impairs  the  ability  to  make  judgments  and  reduces  the  ability  to  make  
free  decisions.  Treatment  is  essential.  
Treatment  is  a  lifeline  to  those  who  are  experiencing  the  negative  consequences  of  
this  disease  and  who  are  having  difficulty  stopping.  
 
It’s  been  shown  in  many  studies  that  treatment  can  cut  drug  use  in  half.  It  can  
reduce  criminal  behavior  up  to  80%,  it  can  reduce  arrests  up  to  64%,  and  it  reduces  
the  cost  of  drug-­‐related  crime.  Treatment  is  proven  to  be  effective  and  is  not  a  waste  
of  time.    In  fact,  for  a  drug  user,  it  can  be  the  very  best  possible  use  of  time.  
 
How  would  you  define  treatment?  Treatment  is  a  set  of  activities  such  as  taking  
medications  or  changing  behaviors  with  the  goal  of  reducing  or  eliminating  drug  
use.  It  can  be  as  broad  and  varied  as  the  drug  problem  itself.  
Addiction  is  a  very  complex  disorder,  and  treatment  must  address  these  
complexities.  Treatment  is  not  threatening.  Those  seeking  treatment  will  not  be  put  
in  jail;  they  will  not  be  restrained  and  forced  to  undergo  a  painful  withdrawal.    The  
individual,  and  their  wishes  and  goals  are  respected  in  treatment.  
 
The  Addicted  Brain  Transcripts  -­‐  Week  6  
A  major  concern  about  someone  entering  treatment  has  to  do  with  confidentiality.  
They  may  have  concerns  like:  “Who  will  know?  I  don’t  want  to  be  known  as  an  
addict.  I’ll  lose  my  job.”  Treatment  is  confidential  and  what  happens  in  treatment  is  
private.  
 
Sometimes  we  encounter  very  surprising  attitudes  about  addicts.  Some  people  
might  say:  “Why  bother  with  treating  them?  They’re  only  addicts.”  
 
This  attitude  is  without  compassion,  without  the  knowledge  that  addiction  is  a  brain  
disorder  or  disease,  and  without  the  realization  that  treatment  exists  and  works.  
Also,  those  with  this  attitude  lack  an  appreciation  of  the  many  benefits  of  treatment,  
such  as  savings  in  money  and  misery.  Further,  this  attitude  reflects  the  stigma  of  
addiction.  Addiction  is  not  a  moral  failing,  but  one  of  many  complex  physiologic  
disorders  that  must  be  treated.  
 
Let’s  talk  more  about  the  stigma  of  drug  addiction.  Stigma  is  very  important  in  this  
field.  Stigma  is  an  attitude  of  disgust  associated  with  addicts,  and  it  often  turns  out  
to  be  a  cruel  attitude.  It’s  due  mainly  to  a  lack  of  information  and  rationality.  
Importantly,  stigma  prevents  us  from  providing  treatment  because  we  want  to  
avoid  the  topic  and  ignore  the  problem.  
 
Another  important  part  of  the  problem  of  stigma  is  that  it  prevents  an  addict  from  
coming  forward  to  get  treatment.  They  are  afraid  and  in  denial  of  their  own  
The  Addicted  Brain  Transcripts  -­‐  Week  6  
problem.  Therefore,  overcoming  and  reducing  the  stigma  around  addiction  is  a  
major  goal  in  public  health.  
 
Some  are  very  surprised  that  addiction  can  be  compared  to  other  chronic  diseases  
that  have  little  stigma.  These  include  cardiovascular  disease,  asthma,  diabetes,  and  
others.  Let’s  compare  addiction  to  one  of  the  cardiovascular  diseases,  
atherosclerosis.  Both  addiction  and  atherosclerosis  are  serious  health  problems.  
Both  kinds  of  patients  can  be  at  least  partly  blamed  for  their  own  role  in  the  disease,  
in  their  own  decisions  and  actions.  Both  have  a  likely  biologic/genetic  vulnerability  
to  the  disease.  Both  diseases  can  be  slowly  progressing  and  are  chronic.  Relapses  
occur  in  both.  And  dealing  with  both  can  require  a  change  in  lifestyle.  
 
Let’s  continue  this  comparison.  The  table  uses  examples  to  compare  the  two  
diseases  on  the  basis  of  medications,  changed  behaviors,  and  new  behaviors.  The  
cardiovascular  disease  finds  medications  very  useful  to  lower  cholesterol,  for  
example.  In  addiction,  medications  are  helpful  to  reduce  cravings.  In  one  you  have  to  
change  your  behavior  to  avoid  fatty  foods  and  control  your  weight.  In  the  other  you  
have  to  avoid  drugs  and  drug  users.  New  behaviors  are  needed.  In  one  you  have  to  
start  exercising  and  dieting,  in  the  other  you  have  to  attend  to  coexisting  health  
problems.  And  it’s  clear  that  treatment,  while  different,  helps  both  diseases.  
 
So  let  me  briefly  summarize.  Addiction  is  a  brain  disorder  or  disease  like  many  other  
diseases  associated  with  other  organs.  Addiction  compares  in  many  ways  to  
The  Addicted  Brain  Transcripts  -­‐  Week  6  
atherosclerosis,  for  example,  and  other  chronic,  relapsing  diseases.  There’s  no  
inherent  reason  for  addiction  to  have  any  stigma.  Stigma  itself  is  a  problem  that  
should  be  overcome.  I  will  continue  these  topics  in  the  next  lectures.  Please  don’t  
forget  to  examine  the  review  questions  for  this  lecture.  
 
Video  7.2  
Let’s  continue  to  talk  about  treatment.  Treatment  for  drug  abuse  and  addiction  is  
critical,  and  even  if  someone  is  convinced  that  he  or  she  can  walk  away  from  drugs,  
it  can’t  hurt  to  get  some  guidance  from  a  professional.  Because  treatment  so  
essential,  many  people  have  done  a  lot  of  thinking  about  it.  There  are  a  number  of  
principles  that  are  related  to  effective  treatment,  so  let’s  go  over  those  in  more  
detail.  The  first  thing  to  realize  is  that  professionals  are  available  and  facilities  exist  
to  help  those  people  who  can’t  seem  to  get  away  from  drugs  by  themselves.  
Individuals  vary  in  age,  in  severity  of  addiction,  and  in  having  coexisting  problems.  
Treatment  must  be  flexible  enough  to  effectively  deal  with  the  various  kinds  of  
individuals.  Drug  abuse  is  complex.  As  I  have  said  before,  treatment  must  address  
this  complexity.  Treatment  certainly  should  be  available  to  those  that  need  it,  and  
making  sure  that  enough  money  has  been  invested  by  society  to  make  it  available  is  
of  utmost  importance.  As  treatment  progresses,  the  needs  of  the  patient  may  
change.  They  may  go  from  emergency  and  intensive  care,  to  dealing  with  a  sustained  
level  of  drug  use.  Or,  once  someone  gets  the  drug  use  under  control,  they  may  need  
job  training  or  other  kinds  of  activities  to  improve  their  lives.  Thus,  treatment  may  
need  to  change  and  evolve  as  the  process  of  recovery  changes  and  evolves.  
The  Addicted  Brain  Transcripts  -­‐  Week  6  
 
Subjects  need  to  remain  in  treatment  for  an  adequate  period  of  time.  In  general,  
treatment  works,  and  the  chances  that  it  will  work  with  a  specific  person  can  
depend  on  how  much  time  is  spent  in  treatment.  Some  studies  suggest  that  perhaps  
more  than  three  months  in  treatment  is  needed  to  get  control  of  drug  taking.  
Counseling  can  also  help  produce  needed  behavioral  changes.  The  individual  may  
have  to  eliminate  something  they  are  doing,  such  as  hanging  out  around  people  that  
use  drugs;  or  they  may  have  to  add  some  things  that  they  aren’t  doing,  such  as  
finding  rewards  and  fun  without  bad  consequences.  Medications  must  be  
considered.  It  is  clear  that  medications  can  help  deal  with  the  complexity  of  drug  
abuse.  Medications  can  be  especially  useful  in  reducing  craving.  
Coexisting  or  what  we  referred  to  as  comorbid  problems  have  to  be  addressed.  
Frequently,  problems  other  than  drug  use  exist  that  enhance  drug  use.  The  co-­‐
existence  of  such  a  problem  with  the  drug  problem  may  make  both  problems  worse.  
 
Sometimes  people  think  that  they  only  need  to  go  through  distressing  withdrawal  to  
stop  the  craving  and  the  grip  of  drugs.  Going  through  withdrawal  is  referred  to  as  
detoxification.  It  is  important  to  know  that  detoxification  is  a  good  start  in  
treatment,  but  it  is  only  a  start.  As  you  know,  brain  imaging  has  shown  that  the  brain  
is  changed  for  a  long  time  and  that  the  healing  process  is  slow.  To  avoid  relapse,  
treatment  must  be  extended  and  included  in  life  after  detoxification.  
Some  people  say  that  you  have  to  want  to  get  off  of  drugs  to  get  off  drugs;  you  need  
to  want  to  get  clean  for  treatment  to  work.  However,  this  seems  to  be  an  urban  

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