That understanding — addiction as disease — should also inspire hope, says Urschel, because if diabetes can be controlled about 90 percent of the time thanks to advances in medicine, then addiction should be the same. That’s the source for Urschel’s claim — trumpeted on the back cover of his book Healing the Addicted Brain: The Revolutionary, Science-Based Alcoholism and Addiction Recovery Program — that up to 90 percent of patients can have success with his program. In reality, Enterhealth’s ranch hasn’t yet been around for two years (it opened in December 2008), the interval at which patient success rates can be measured. But Urschel is right to say that the disease model for addiction shows just how outdated an AA-only approach is.
“I like to use an analogy,” he says. “If you were diabetic, would you go to meetings to talk for an hour a day about how not to eat sugar? People chuckle, but that’s essentially what we’re doing now.”
If addiction is a disease, then managing the illness requires a more comprehensive and easily understood approach. In his book and at his clinic, Urschel keeps things simple, translating medical-science jargon into “layspeak” for affected patients and their families.
“The wonderful thing about Enterhealth is that they hit it from all different sides,” says Jonathan (who also didn’t want his last name used in this story), who has been off of heroin since he first came to Enterhealth in April. In addition to 12-step programs, “[Enterhealth] worked on my health, fitness, nutrition. They have massage therapists, acupuncture, whatever you need.”
So why has AA-only remained the dominant model? In part, it’s because NIDA hasn’t had enough success in translating its research findings into clinical practice. So NIDA has been launching an information offensive, of which Anderson’s Journal of Addiction Science & Clinical Practice is one part. The journal only comes out twice a year, but it has a unique mission to bring clinicians and researchers together. People from both camps write articles for the journal, and there’s usually an answer or rebuttal attached to it from the other side. “We try to make the journal appealing to both sides,” says Anderson, “and then to have a discussion.”
NIDA’s outreach extends far beyond the journal. The NIDAMED program provides physicians and nurses with screening tools, and it has created an addiction curriculum for medical students and residents. Even more important is the Clinical Trials Network, which pairs 16 research institutions around the country with community drug-abuse centers in their local area. The drug-abuse centers provide insight, recruit patients for clinical trials, and help finetune practical applications of the scientifi c findings.
Urschel says health-care professionals are getting the message but not at the right pace. “More and more centers are slowly adopting this,” he says. But he points to the continuing lack of addiction psychiatrists (Enterhealth has one on their full-time staff) as an example of misplaced priorities. “There are maybe 60 to 80 new addiction psychiatrists coming out of residency programs a year,” he says. “For the whole country. That’s not enough.”
The sense of urgency is understandable. Alcohol is the third leading cause of death in the United States, Urschel says, behind cancer and heart disease. Humphreys says there are more than 10 million people in recovery right now. Drug and alcohol addiction is a national crisis, and it makes sense to bring every weapon to bear in combating it.
For Sheila, this approach has paid off. After 16 months of sobriety, she is back in college and during two semesters had a 4.0 grade-point average and now is getting a 3.8 GPA as she pursues what she hopes will be a new career as a social worker. “I don’t know how to describe it except that there’s a wonderful life out there,” she says. “Without Enterhealth, I don’t think I’d be here.”
For more information on Dr. Harold C. Urschel III and his work on addiction, visit www.enterhealth.com.
NATHAN THORNBURGH is a New York–based writer and a former senior editor for Time. This is his first article for American Way.