Monday, August 11, 2008

Review of heroin dependence

JAMA has a Clinician's Corner review on heroin dependence. It's a chatty, narrative review which covers the history of heroin abuse in the US, its epidemiology, the history of and research supporting methadone therapy, buprenorphine and naltrexone treatment, as well as a Q&A at the end which addresses some of the language used:

When I was on the American Psychiatric Association DSM III-R...committee, the problem that we had when we were designing a diagnostic classification scheme was that we were trying to come up with a scheme that applied to all drugs of abuse. So that meant nicotine, alcohol, cocaine, heroin, and so forth. People who work primarily with alcoholics don't like to use the word "addiction" regarding alcohol. But it absolutely fits. All of the drugs of abuse activate the reward system, but through different mechanisms. The reward activation produces learning, which results in long-term behavioral effects that increase the probability of relapse. The major problem with terminology is the tendency to stigmatize. However, as more public figures have admitted to addiction problems, we see that it can happen to anyone. I think it is better if addiction is dealt with as an illness instead of as something that implies bad character. Addiction is just another medical problem. I think the stigma is a holdover from the time when addiction was thought of as weakness of will or bad character or criminal activity. Addiction is a chronic disease of the brain with strong heredity components, and it ought to be approached as a medical illness.

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