Can drugs effectively treat add.

Byline: STRAIGHT STUFF By Jerry Gjesvold For The Register-Guard

For years, treatment centers such as Serenity Lane have asked this question: Should we give medications - drugs, in other words - to a person in treatment for chemical dependency?

Some people think not. They think that abstinence is the only way that works and that "No mood-altering substances" means just that: none. Their position is clear and easy to understand. It's one that many policy-makers seem to prefer.

We often encounter this belief in 12-step programs, where people generally recover through a belief in total abstinence. It's easy to see why they would be suspicious of any approach that might "replace one addiction with another."

But, like many public health issues, the reality of treatment for chemical dependency is never best addressed by simple answers. Fortunately, during the past couple of decades, many physicians, treatment professionals and people in recovery programs have grown more sophisticated concerning medications that help in the healing process.

Antidepressants are one example of this trend. At one time, depression carried a powerful stigma. It was seen as a moral failing - much like addiction to alcohol and other drugs. Today, we understand it is created by a chemical imbalance. These days, you might even overhear one recovering alcoholic talking to another about taking an antidepressant, comparing it to taking insulin for diabetes. That's progress.

Dr. Richard Caesar, co-medical director at Serenity Lane, explains that two categories of medications are used in treatment: those applied on a "tapering schedule" during detox and inpatient treatment and others that are used on an ongoing basis.

For example, Librium might be prescribed to stabilize someone in alcohol withdrawal - but only for a few days, in decreasing, "tapered" dosages. Or, anti-seizure medications might be administered for about a week to reduce the potentially serious consequences of withdrawal from certain prescription or over-the-counter medications, or alcohol.

In the case of opiate addiction - from street heroin to OxyContin - treatment professionals can look to a new drug such as Buprenorphine to ease the difficulty of withdrawal. Caesar notes that when Buprenorphine is used, symptoms of opiate withdrawal essentially disappear, but with no euphoria. Because Buprenorphine prevents opiates from working in the body (by blocking the nerve receptors that opiates affect) it can also be used on an ongoing basis.

"Our overall philosophy," he explains, "is that we begin a medication in treatment only if it addresses a risk or problem that is interfering with treatment. And if patients are currently taking a non-addictive medication, they will be left on the drug unless there is an urgent or immediate need to stop it."

Ultimately, the use of drugs in treatment for chemical dependency reflects a debate that's gone on for years about the nature of addiction: Is recovery a moral issue or an illness? Now that addiction is medically classified as a disease, we can treat it like one, using medications known to reduce risk, alleviate suffering and increase the probability of a successful outcome.

We do so carefully, of course, as our patients are here because they abuse drugs and alcohol. But we always want to remain open to treatment approaches shown to work - even if that means challenging ourselves, policy-makers or the 12-step community to accepting new ways of doing things.

The opinions expressed in this column are those of the writer. As Serenity Lane's statewide coordinator of employer services, Jerry Gjesvold helps companies across Oregon create and manage their drug-free workplace policies and programs. More information is available on the Serenity Lane Web site at www.serenitylane.org.