But fate — and inebriated Web browsing — gave her another option. When she woke up from a three-day bender last year, she saw that somehow in her fog she had pulled up the website of Enterhealth, a residential treatment center outside of Dallas. “It was on my computer screen, and I don’t remember clicking on it,” she says. “I saw that the program was in Texas, and I’m from Texas. I thought, ‘Ooh, that’s a sign.’ ”
Within days, Sheila (who didn’t want her last name used for this story) had driven herself from her home in Missouri to Enterhealth’s ranch and checked in for one more try at sobriety.
Whatever you want to call the process that brought Sheila to Enterhealth — coincidence? kismet? — once she got there, she became the beneficiary of a much more deliberate program, one that looks to harness a surprisingly overlooked tool in the war against addiction: science.
More than 75 years since Bill W. became the world’s most famous recovering addict, the Alcoholics Anonymous co-founder’s mix of group therapy reinforced by mentoring relationships remains the most common treatment for alcoholism and drug addiction. But Dr. Harold C. Urschel III, the co-founder of Enterhealth, thinks that although AA’s famous 12-step program is a valuable piece of the puzzle, its famously low success rates (which are almost impossible to verify but have been pegged at 30 percent by one multi-study report) can be vastly improved using breakthroughs in medicinal and behavioral research from the past two decades.
“Think about it,” says Urschel. “The CT scan came around in the 1970s, the MRI in the ’80s. There’s been a lot of great research since then, but nobody’s using it.”
There’s an unexpected engine driving the majority of this new research into addiction: the federal government. Specifically, the National Institute on Drug Abuse (NIDA), which, with almost 400 full-time employees and an annual budget of more than $1 billion, has been funding almost all the major research into what makes addicts tick. “NIDA supports something like 85 percent of the world’s addiction research,” says Keith Humphreys, a professor of psychiatry and behavioral sciences, and an addiction specialist at Stanford University. “Everyone knows it’s the best resource out there.”
The NIDA research works, broadly speaking, in two directions: They fund medicines that help addicts break the physical cycle of addiction, and they explore the behavioral side, or how an addict’s brain influences his or her disease. On the medication side, drugs like buprenorphine (an improved replacement for methadone) and Vivitrol (which reduces cravings for alcohol) have been important. So, too, have behavioral strategies such as “contingency management,” a program that incentivizes addicts to meet short-term goals, since the mind of an addict is extraordinarily biased toward instant rewards rather than delayed gratification.
But it’s this word disease that may be the major contribution of NIDA’s research. Since long before Prohibition, alcoholism and drug addiction have been viewed as a moral failure as much as anything. What science has taught us, in part by documenting the distinct physical changes in the brain of addicts, is that addiction is not a matter of diminished willpower. It is a chronic disease in the same way that diabetes and high blood pressure are.
“This question of why [addicts] can’t stop taking drugs, even though they want to, is a bit of a mystery,” says David Anderson, editor of NIDA’s Journal of Addiction Science & Clinical Practice. “But basic research has been solving it. We know now that it’s a brain disease.”
Humphreys, the Stanford professor, recently returned to campus after a year working as senior policy adviser at the White House Office of National Drug Control Policy. In that time, he helped ensure that drug-abuse disorders were included in health-care reform — there are more than 50 mentions of it in the legislation, he says. It was an important step toward “medicalizing” addiction, as he puts it, and will help not just to expand access to addiction treatment, but also to make people understand that it’s an illness that should be covered, like any other.