How Personalized Medicine Can Revolutionize Addiction Treatment

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How Personalized Medicine Can Revolutionize Addiction Treatment

By Temma Ehrenfeld 08/30/16

Do you like spicy foods? That means you might respond better to naltrexone.

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How Personalized Medicine Can Revolutionize Addiction Treatment
Your genes could write your prescriptions.

“Personalized medicine,” also known as “precision medicine,” grew out of the success of the Human Genome Project in 2003. It’s possible now to map an individual’s DNA, and researchers are looking for genetic markers linked to addictions. One day, a genetic profile could provide a warning system—you might get an assessment, let’s say, of your teen’s chance of kicking off schizophrenia early by smoking pot. Or your DNA could suggest you’re a good candidate for a particular medication to fight cravings. 

Truly personalized, precise medicine will go beyond medication, giving professionals a bigger set of tools, including support groups, talk therapy, and other services, to offer. Let’s not forget that other goal—treating “the whole person.” No one wants to be “Jack Addict” who needs the med of the day that matches his genetic profile. You also don’t want to be automatically ferried into a 12-step group or motivational counseling.

“It would be a miracle if standardized treatment strategies would work for everyone at every stage and that patients with the same diagnosis would respond in the same way," observes Jaap van der Stel, a professor of mental health at the University of Applied Sciences in Leiden, Germany, in his 2015 overview, Precision in Addiction Care: Does It Make a Difference? He goes on to say that addiction care could benefit greatly from more precision, offering a “targeted focus on the patient’s individual characteristics and a better selection of treatment strategies.”

At the moment, people struggling with addictions tend to steer clear of official help altogether. Personalized medicine may make a big difference in two ways. It could be more effective and it seems inherently more respectful.  

If you’re opting out of medical treatment, you’ve probably heard that you’re in denial or afraid of stigma. I believe there’s much more to say. We need to better address the truths behind “resistance.” 

Among the reasons people give for declining addiction treatment are these three:

1. I don’t need help. I can do this on my own. 

2. I don’t want a support group. I’m not like other addicts. 

3. Meds are a crutch. 

These all may be true—for you. 

Let's take point number 1. It’s a big myth that you’re doomed if you don’t get treated. Many—some say most—people get better on their own, over time. They recover when they’re motivated and find strategies that help. You might have to say goodbye to an old friend or a spouse who bonds with you through a drug. You might need to leave a job you hate. You might have a crisis—or slowly escape bad circumstances or grow into other coping methods.

Telling people they can’t do it alone is arrogant. Telling people that a med or some other package could speed things up is respectful. Call that personalized medicine.  

As for point number 2. Of course, saying “I’m different. I don’t belong with that group of losers” smells strongly of arrogance and denial. Any group of people with addictions will be a varied bunch, possibly more so than other bunches. As Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction, has pointed out, “The whole range of human character can be found among people with addictions, despite the cruel stereotypes that are typically presented.” Be aware of two ubiquitous phenomenons: “selective attention” and “confirmation bias.” You may go into a group thinking “Addicts are selfish and manipulative” and hear about some selfish behavior and think “I’m not selfish, so I don’t belong here.” You’re seeing what you’re looking for—selective attention—and confirming your bias. People with addictions aren’t especially selfish or manipulative. You might walk in thinking everyone with an addiction was abused as a child, or that every drunk drinks alone at night—and you weren’t and don’t, so a group isn’t “for you.”   

There are good reasons to join support groups. If you feel isolated with your problem, you’ll be less alone. You may get accountability with a sponsor. Most likely you’ll meet people who are ahead of you with recovery, which can be inspiring, or people who are doing worse than you are, which tells you that you’re not the greatest wretch of all time, as we so often feel. You may enjoy helping others. You can get information and the benefit of wisdom acquired with experience.

But if public confession makes you cringe, you hate Higher-Power talk, or no group you try gives you a sense of belonging or feels useful, or (your answer here)—walk away from anyone who says you must go to a 12-step group or you’re toast. That’s not personalized medicine.

You (or your child) might need a kind of therapy, but it should be targeted. As just one example, early research suggests that younger teens with a rebellious streak and a marijuana issue do better with family therapy than cognitive behavioral therapy (CBT), which teaches people to think more rationally. On the other hand, 17- and 18-year-olds may do better with CBT. Maybe what you really need is career counseling. 

Point number 3: “Meds are a crutch.” Think about that metaphor. What’s so bad about a crutch, i.e. cane? You use it so you can get around while you’re limping. If you don’t need it anymore, you can put it aside. Does it make sense to choose to stay home instead of using a cane?   

Genetic testing could make the current choices among medications more attractive. Naltrexone is a powerful tool against alcoholism, preventing relapses for up to 75 percent. Do you like spicy foods? That makes you a better candidate, some research suggests. Other signs are strong alcohol cravings and a family history of alcoholism.

Pushing off a drinking relapse with acamprosate may have something to do with your genes, according to a 3-month American study with 225 alcohol-dependent subjects in 2014. The anti-smoking drug Chantix (varenicline) may also work for drinkers, and scientists are looking for associated genetic markers.

The list of drugs that potentially can reduce cravings is promising, but none of them will work for each person. They include Topamax (topiramate), Antabuse (disulfiram), Lioresal (baclofen), N-acetylcysteine, and Wellbutrin (bupropion).

The pharmacology industry is also hot on the trail of effective meds for behavioral addictions, since so many people have habits that might be deemed addictive. Those meds could easily become the new anti-depressants. Let’s hope we also get precise information on the best candidates, genetic or otherwise.  

In a beautiful world—and I do think the world is beautiful on a good day—the extra step of DNA tests would be preceded or accompanied by medical cocktails that work. People with addictions who seek medical treatment are more likely to have other psychiatric issues than all addicts or the population at large. Ugly feedback loops abound—between depression and drinking, or schizophrenia and marijuana. Precise medicine would interrupt the loop in more than one way. Antidepressants alone don’t stop substance abuse and anti-craving drugs probably won’t overcome serious depression. In one early study, depressed drinkers who received both Zoloft (sertraline) and naltrexone did better than those treated with either drug alone or a placebo. 

Let’s say you’re addicted to opioids. You might get a script for Zubsolv, which is similar to Suboxone, or an implant releasing buprenorphine. Maybe your genetic makeup will help determine which med or the dose. If you’re in pain, I’d also hope you are offered a choice of seeing a cognitive behavioral therapist, or working with a biofeedback machine. You might explore a kind of therapy called “GMI” for graded motor imagery. There’s some evidence that combining GMI with a form of electrical stimulation is successful at reducing pain in some people. In a treatment called neuromodulation, an embedded device sends electrical pulses that interrupt or mask pain signals that travel to and from the brain.

Insist that the people working for you see you as an individual. In the end, anyone fighting an addiction needs to find ways to avoid relapses, which may require both persistence and experimentation. Personalize your own medicine.

Temma Ehrenfeld is a ghostwriter and journalist in New York. Her journalism has appeared in The New York Times, Newsweek, Reuters and Fortune and her literary work in Michigan Quarterly Review, The Hudson Review, Chicago Literary Quarterly, Catamaran Literary Reader and Prism International. She blogs at Psychology Today and is shopping her first novel, The Wizard of Kew Gardens.

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