Why Should We Use Genetic Testing in Addiction Treatment?
Feb16

Why Should We Use Genetic Testing in Addiction Treatment?

I’m sorry that I have to use an almost clichéd literary trick to explain this. First, let’s explain why not to use genetic testing. If you believe addiction is caused by a weak will, a spiritual emptiness or a moral problem, there’s really no point in doing genetic testing. But on the other hand, there’d also be no reason for doing addiction treatment. Spiritual guidance is free and freely available to all. The law of the land should promote good behavior and lead people willing to change to the great number of spiritual teachers around, so there’s no reason to spend money on addiction treatment. Just keep up the war on drugs, and this will all sort itself out. The insurance companies love this explanation. On the other hand, if you believe that drugs are the only cause for addiction, there’s really no point in doing genetic testing. Under that assumption we’re all the same, and, through bad decisions or poor social policy, some of us will get exposed to addictive drugs, which change our brains and cause addiction. But on the other hand, if drugs were THE cause of addiction, we’d have no explanation for compulsive gambling, compulsive overeating, sex addiction, etc. We’d have to limit our understanding of the problem of addiction to drugs, and as that focused understanding has not led to a solution for the last 100 years, we’d have to wonder if it’s the correct understanding. Again, we would need to focus on the war on drugs, prevent addiction by preventing exposure to drugs, and keep people with addiction drug free until their brains go back to normal. If you believe that, the answer to addiction lies not in medical or psychological treatment, but in living in a monastery for about 3 years, free of charge. The insurance companies love this explanation too. Now if you don’t believe that addiction is a moral problem and you don’t believe it’s caused by drugs, then you’re left with a real conundrum. What the hell causes addiction? Well to answer that we’d have to first define what addiction is. The American Society of Addiction Medicine has published a definition of addiction, which can be summarized in its short form: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors. Notice that addiction isn’t limited to drugs, and that the illness comes first; it causes symptoms; and it’s the symptoms that cause the characteristic...

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The Kissinger Cross and Beginner’s Mind
Jul22

The Kissinger Cross and Beginner’s Mind

The Kissinger Cross I learned about the Kissinger cross from an economist named Jim Rickards (twitter: @JamesGRickards). You may have guessed that the Kissinger Cross was named after former Secretary of State Henry Kissinger, but you might be struggling to figure out what it has to do with addiction. No, it isn’t that it’s his cross to bear. It’s something else all together. Kissinger said that when we enter a new situation we have all the options that exist but we don’t have any information on which option is best. As we learn more about a situation our knowledge rises, but with that knowledge comes a decrease in the options available. Some just don’t look good with that new knowledge. So he said there are two lines to be drawn as time moves on, the down sloping line of options and the up sloping line of information. The more we learn, the fewer options we have, so in the end, we know everything but can’t do anything. What the Kissinger Cross is, is the point at which the two lines cross. We no longer have all the options but we still have a lot, and we don’t know enough, but we know a good bit. It’s a chancy thing making decisions with incomplete information, but life is a chancy thing. What Secretary Kissinger gave us was a system with which to figure out when to act that is graphical, at least somewhat objective, and can be put on paper for clarity of thought. It’s a good idea, but what does it have to do with addiction? Well, it has to do with everything, but that’s not the point of your question, is it? You want to know what the Kissinger Cross has to do with the problem of addiction in our society. Well, it can provide us with a solution, but only if we use it correctly. To illustrate that, you’ll have to come with me on a little thought experiment. A World Without Addiction So imagine that we live in a world with no addiction, or, since you won’t be able to imagine that, just imagine that we’re not from this world. We arrive here and see addiction for the first time. We don’t know anything about it; it’s a completely new situation. We can do anything about it we want. We can shoot people, give them lemonade, pet the dog, or go home. We have all the options in the world, but we don’t know what to do. We’ve never seen addiction before. We don’t know what it is, what causes it, what it costs. We just know we’re...

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You’re Sick and You Almost Died, So Don’t Come to my Wedding
Jul09

You’re Sick and You Almost Died, So Don’t Come to my Wedding

The other day I heard from a friend about his son who has addiction. There was a recent overdose on opioids in which he almost died. Luckily there was someone with him to get him help, and he survived. He’s now in treatment and doing well. I was glad to hear he was doing well, but what really struck me in the conversation was that after word of his overdose had gotten around the extended family, my friend’s son was uninvited to his cousin’s wedding. You’re probably asking why, and I’d love to tell you. I don’t know why. My friend didn’t know why. Were they afraid he’d make a scene and stop breathing during the reception? Where they afraid he’d vomit on the wedding cake? Where they ashamed he was a person with addiction? I have no idea. But the first thought I had when I heard the story was the title of this article: “You’re sick and you almost died, so don’t come to my wedding.” That’s what overdose in someone with addiction means. It means they are ill, and now they almost died, if they’re lucky. Of course a lot, and increasingly so, aren’t so lucky and do die. Would we ever call up Aunt Sally during her breast cancer chemo and tell her not to come to the wedding? Would we call up cousin Sal and tell him that after his recent near death experience with diabetic ketoacidosis, we’d rather he stay home? No, we would not. In every other case, where a relative was potentially terminally ill, we’d welcome the chance for just one more family memory. Not so with addiction. I wrote recently about what people with addiction die of, the disease, ignorance, or cruelty. Too many have to live that way too. Hopefully, one day, we will be able to say that more and more people with addiction live with health and hope and love. Until then social isolation will continue to make the illness worse (the biology of this is described in my book) and we’ll continue to wonder why these addicts don’t just learn from their isolation. “After all, if we were snubbed, we’d change, right?” So we try to stem that ignorance every day. Just keep telling people you know the truth about addiction. It’s just an illness. It’s just biology. It’s just an act of nature. It just happens. If enough people understood, perhaps we could get to health, and hope and love.   Copyright 2016 Howard C Wetsman...

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The Big Short
Jun06

The Big Short

By now, most American’s have heard of the book, The Big Short by Michael Lewis, and the movie of the same name. (To short is to sell something you don’t own because you believe it will go down in price or value a great deal) Most people know that the book is about people who saw the collapse in the housing market before it happened and made money from it. That’s not really what the book’s about. The book is about how hubris and cluelessness of government officials and establishment organizations allowed imbalances to get so great that when they finally balanced (as imbalances always do) the entire financial system was at risk. The fact that individual traders saw the imbalances and acted on them should be no surprise. What is a surprise is that those very traders tried to tell people something was wrong. They went to the rating agencies and told them they were wrong; they went to the big banks and told them they were wrong; they went to the government and told them they were wrong. The reaction of all these people was that the traders didn’t know what they were talking about. “How could they know?” the establishment seemed to say. “The system had worked just fine all these years. Who are they to tell us that there are hidden costs that we don’t see?” Well history has decided who was right and who was wrong on that score, and it was an expensive lesson for all of us. The problem behind the Big Short was the assumption that housing in America could never go down across the country at the same time. It hadn’t happened for over 70 years, so it couldn’t happen, right? As long as it didn’t happen, even the crappiest sub-prime mortgage bond would be good. Turns out the assumption wasn’t true, the bonds were worthless, and the pyramid of derivatives built on them were as well. Is there a “big short” in addiction today? Is there a situation in which entrenched establishment groups or regulators are so sure they are right that they can’t see the hidden costs of their system? Is there a situation based on an assumption so old that no one today can question it? I think there is, and it’s also about 70 years old, but that’s long enough for generations of academics and clinicians to have been trained by people who were trained by people who were trained by people who assumed that this was the truth. The Big Short was a best selling book with hundreds of thousands of copies in print. There’s another bestseller that is...

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The ICU
Feb28

The ICU

The young woman walked out of the ICU knowing she’d never see her friend again. At age 26, this was the second time she’s said good-bye to a childhood playmate in this ICU.  When the first of her friends to die was lying there with a machine breathing for her, there was a constant stream of friends and family coming to say good-bye. Now that her second friend was dead but for the machine pumping air into his lungs, there was the same stream of loving people to say good-bye. Both of her friends had struggled with genetic illnesses all their lives, both had done their best to stay alive, both succumbed. The first one died of cystic fibrosis; the second, of addiction. The friend with CF did everything she knew how to do. Took all the medication her doctors told her to take, ate only the foods her doctors told her to eat, exercised, stayed fit, everything. She had a loving family that got her to the best doctors who gave her the best care. But CF doesn’t have a cure, and it doesn’t have a treatment that does more than extend life into the 20’s. It’s genetic, and it’s unfair, but so is every illness you’re born with. The friend with addiction was really no different except for one thing. When his loving family took him to the best care, he heard that medication wouldn’t help. He heard that he should be able to “recover naturally,” that he didn’t need medication. The best doctors that his family sought out didn’t tell him about evidence based medical treatments for his genetic illness. Instead they told him his illness was caused by drugs and would go away if he just stayed clean and became spiritually fit. So in his 4th or 5th rehab he went to a religious based program to get that spiritual fitness. I don’t know his spiritual status when he died, but I know he couldn’t breathe on his own. I wrote a piece recently about what we die of when we die of something that has a treatment we aren’t offered. The young woman’s first friend died of cystic fibrosis and our inability to treat the illness better. Everyone did everything they could. It’s just beyond us at this point in time. But I’m not sure that the second friend died of addiction. There is a treatment available that has been shown to improve survival rates, but he was told it’s a bad thing to be on. There’s a known neurobiology of his illness, but his treaters were willfully ignorant and disdainful of that knowledge, believing that their spiritual superiority was enough...

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Disease, Ignorance, and Cruelty
Feb19

Disease, Ignorance, and Cruelty

I want to tell you a story about disease, ignorance, and cruelty. To make it interesting, we’ll make you the protagonist. The year is 1665, and you live in London. You’re trying to stay away from people because plague is sweeping through the country, and more than a quarter of the people you know have already died. In spite of your efforts, you wake up one morning feeling weak. Your body hurts. It’s hard to move. You know immediately what’s wrong, or fear you do, and you know there’s no hope. You don’t know anyone who has become symptomatic who has survived though you’ve heard a few rumors that there are such people. You’re eventually able to get up to void your bladder and notice large swollen masses in your groin. You throw up, and the effort has worn you out. You crawl back in bed, and later that day, you die. But what did you die of? I am confident in saying that you died of disease. In this case the disease was bubonic plague, a very virulent illness caused by a bacteria called Yersinia pestis. Now the year is 2000 and you live alone in Arizona about 2 hours from the nearest town. You’re out in your garden digging and you find the skeletal remains of an animal. You think nothing of it. A few days later you wake up feeling weak and feverish. You think it must be the flu because your body hurts and you have a terrible headache. You get out of bed and when you get to the bathroom you throw up, confirming for yourself that it’s the flu. You have a lot of survival gear in the house because you live far away from help. This includes antibiotics like doxycycline, but you know that they don’t help the flu, so you just go back to bed. You try to stay hydrated but it doesn’t work out. By the time you start considering this might be more than the flu you can’t get out of bed. After falling into unconsciousness later that day, you die. But what did you die of? I’d say you died of ignorance; you died of a lack of information. You didn’t know plague bacteria can live in the ground. You didn’t know it could be found in your area. You didn’t know you had plague. You didn’t know you had the cure 20 feet away. You died not knowing that you died of ignorance. Now the year is 2016 and you aren’t living alone. You’re a microbiologist living in a group of other scientists in Arizona. You go out...

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