Dr. Joseph Matta, medical director of the Psychosomatic & Addiction Medicine Program at Addiction Recovery Resources Inc. (4836 Wabash St., Suite 100, Metairie, 780-2766; www.arrno.org) and assistant clinical professor of psychiatry at Tulane Medical School discusses addiction and what to do about it.
Q: How big a problem is addiction in the New Orleans area?
A: Because it is the Big Easy, [alcohol is] part of the culture, whether it's celebrating Jazz Fest, Mardi Gras or something else. It's not only alcohol use, but the amount of alcohol. Binge drinking is more common here than in other places. You see things here — like drive-thru daiquiri shops — that you don't see other places, and people don't blink an eye.
In terms of substance abuse, what we're seeing now is a lot of prescription opiate abuse. That's a huge problem. ... The access to prescriptions prescribed to someone else or available on the street is really high. You also have prescription stimulants: speed, amphetamines, Adderall, Ritalin. People in college are using that a lot to get a bit of an edge on other people, and they don't realize how addictive they are. Women will often use the stimulants to lose weight and don't realize how addictive they are.
Q: Are there identifiable causes of addiction?
A: It's a combination of things. There are certain aspects of alcoholism that can be genetic. Typically, male alcoholics who have a history of early addiction have a greater chance of having a son who is addicted. Then, just being in an environment where there is a lot of alcohol, they may be more inclined to become addicted.
It all boils down to the brain reward pathways. There are these very old centers of the brain; they are here for pleasure, and they release dopamine (part of the brain's reward system). It's the same area of the brain that's involved in sex, food, gambling, drugs, alcohol, food. If it's something as important as eating, it's a very strong pathway. If it's activated, you are going to be set up to want to do [the activity that produces the dopamine] over and over again.
Q: What types of addiction does ARR treat?
A: We do not only addiction but also psychosomatic medicine, which is the link of psychological and surgical and medical problems. With intravenous heroin use, you might end up with a patient with hepatitis C. HIV might have combination drug therapy to keep HIV under control, but you need to know how the HIV medication is metabolized in the body to know which psychiatric medication should be prescribed. You can also see cognitive problems, problems with memory in people who have hepatitis C. You need to know how to treat that so they are able to function better.
Q: When it comes to drugs, what are the most addictive?
A: Nicotine is one that is often overlooked and probably the most common. Heroin is the other one; it's back and it's better is what they say. With the opium poppies in Afghanistan, it's not only back, it's more pure. We've also seen cocaine that is painted with an anti-worm medication that can cause death. It causes the brain to release more dopamine, so you get higher.
The biggest advance is Suboxone, used for opiate dependence. Methadone has been around since the 1970s, is highly controlled in how you get access to it, and you have to go to a government clinic so you don't get sick from opiate withdrawal. Suboxone has allowed people (to get off opiates) without withdrawals, and (patients don't have to go to a government clinic for a daily dose, so) it allows people to go back to work without relapsing. The medication blocks the high if you try to shoot up again. It's really been a lifesaver for people who are motivated to take it.
Q: What does addiction do to a person?
A: It causes pathology of motivation and choice so that what people become motivated for is the drug rather than anything else in life. Choice ends up getting taken away. ... They are using (drugs) so they can feel normal. When they don't take the drug, they feel sick. There's a dissociation between the actual value or "high" of the drug. ... The problem is motivation and choice, but what perpetuates it is the craving (the lack of dopamine).
Q: How long does an addiction recovery program normally take?
A: Treatment is very individual. Generally it involves an evaluation looking at all spheres of function from work, support systems, the severity of the addiction, whether they have a medical problem as well. It's then determined what level of care, whether they are ambulatory, whether they need inpatient or outpatient care, whether they've been in treatment before and failed. It's thought of as a chronic relapsing illness, just like high blood pressure and diabetes. The difference is there seems to be a moralistic view toward it: that they should just be able to get over it. Once you understand it is a disease, an illness, you have to go forward and make sure you get the right treatment. We never think of it as being cured; they can be in remission or they can be sober and clean, but they need to continue going to meetings, follow-up and treatment. Just as if you have cancer removed, you would still want to follow up with your oncologist.
Q: What are the normal age ranges?
A: Most of it does start in adolescence, early adulthood. [After that], developing a new addiction or dependence issues typically doesn't happen unless they are exposed to it.
Q: Do you also have to treat psychological effects on family members?
A: We do have counselors that are available for family members as well as the patient. That is typically part of any assessment, including effects on relationships, whether it is a spouse, mother or father. Often family members come with the patients. There is an increased risk if you have a family history. If you have a problem with abuse, whether it is a problem with DUI or possession of marijuana, even if you don't have a full-blown addiction, there is a risk of developing a full-blown addiction in the future. That is an area where the National Institute on Drug Abuse and the National Institutes of Health are developing programs of brief intervention and providing [patients] with counseling that may decrease the risk.