A double-board certified addiction medicine physician believes that 12-step programs are a critical part of recovery.
Russell Surasky, MD, who is board-certified in Neurology as well as in Addiction Medicine, is certainly well-versed in the pharmacologic treatment of addiction. And yet he is also a passionate believer in 12-step programs for his patients, calling them the “gold standard” when it comes to achieving stable recovery. For more on his treatment approach and philosophy, see below.
Richard Juman: It’s interesting that a double-board-certified addiction medicine physician, who is obviously well-versed in the role that Medication-Assisted Treatment now plays in many treatment episodes, is also passionate about the role of 12-step programs in a recovery plan. Can you describe your general theory about the development of addiction and your philosophy of treatment?
Russell Surasky, MD: Individuals often seek drugs to escape from their underlying psychological and emotional conflicts. When this behavior occurs enough times, then significant neurological changes occur in key regions in the brain, causing addiction to set in. Once addiction begins, the brain prioritizes the importance of using drugs at the same level as survival behaviors including eating food and drinking water. This is why those suffering from addiction will often keep using drugs despite the continuous and horrendous consequences that they face. Left untreated, many will use drugs until death.
These brain changes are not permanent but rather can be reversed with the proper treatment. The ability for the brain to reorganize itself by forming new neural connections is called neuro-plasticity. A person’s genetics determines how much exposure to the drug needs to occur before addiction takes hold.
RJ: What would you say are the most significant recent pharmacologic and medical advances for treating the brain changes in addiction, and how do you incorporate them into your practice?
RS: The biggest changes have come in the treatment of opioids, as we respond to the opioid epidemic. After as little as a few weeks of use, opiates “hijack” the limbic system of the brain to the point that it needs the drug for survival, and the compulsion to continue taking the drug becomes overwhelming. Withdrawal and counseling aren’t enough. Unless the neurological changes to the brain can be reversed, those cravings may persist for a lifetime. One of the newer and most effective treatments is Vivitrol, an extended-release medication that is injected once a month and immediately stops cravings.
Vivitrol is a safe medication that helps the brain to heal from the changes that have occurred during the drug use. Vivitrol itself is not an opioid, is not addictive and does not cause dependence. Vivitrol is an “opioid antagonist,” meaning it binds to the receptors in the brain and prevents opioids from acting on the receptors. By blocking that attachment, Vivitrol prevents the pleasurable opioid effect and reduces cravings for the drug. A patient on Vivitrol who does take opioids does not get high, does not get sick, and does not crave drugs. Treatment is individualized for each patient to ensure that the psychological and behavioral aspects of the disease have been adequately addressed and the individual has developed the life skills needed to remain drug free. Drug addiction destroys lives and families. Medication-assisted treatment can heal the brain by undoing the neurological damage opioids have inflicted, and along with ongoing behavioral therapy offers patients a lifeline and the hope of a permanent recovery. I believe that Vivitrol represents a giant leap forward in helping those suffering with addiction. By any measure by which you could measure recovery, the results that I have seen in practice have been incredible. However, medication by itself without counseling, is very often a failure.
For more answers on why Dr. Russell Surasky believes 12-Step programs are the “gold standard” for achieving a stable recovery, head over to the original feature interview Medication-Assisted Treatment is Not Enough at The Fix.