Petros Levounis, MD, MA
President, New York County District Branch
Addiction treatment in the 20th century essentially revolved around three efforts: (a) facilitating the engagement of the patient with mutual-help groups, mostly Alcoholics Anonymous, (b) confronting the patient’s denial and dysfunctional defenses, and (c) providing methadone for heroin addiction. Addiction Psychiatry in the 21st century has kept (a), discarded (b), and greatly improved on (c).
Many of us in the field of Addiction Psychiatry firmly believe that Alcoholics Anonymous and other mutual-help groups offer a tremendous—but not sole—vehicle to recovery; in fact, millions of people around the world have found support and healing trough 12-step programs. When it comes to providing psychotherapy and counseling, our field has moved from confrontation to motivation, the latter method being best exemplified by the Motivational Interviewing approach. Along with cognitive-behavioral techniques, motivational enhancement therapy is more focused on working with ambivalence and fostering self-efficacy than on breaking down defenses. Finally, while methadone clinics continue to provide invaluable treatment to heroin addicts, there is now a powerful alternative to methadone: buprenorphine is a partial agonist to the mu opioid receptor, with superior safety and tolerability profile and can be prescribed on an outpatient basis in a physician’s private office.
Twenty-first century Addiction Psychiatry has added two more elements to our work with the addicted person: (a) treating co-occurring psychiatric disorders, and (b) using an ever-expanding list of medications that directly address substance dependence.
We now appreciate that approximately one-third to two-thirds of all patients who suffer from addictive disorders also suffer from co-occurring unipolar or bipolar depression, anxiety, attention-deficit, psychosis, and/or severe personality disorders; treating both the addiction and the other psychiatric disorder(s) simultaneously—and hopefully under one roof—has proven to be the most effective way to heal the whole person. Furthermore, the explosion of addiction psychopharmacology over the past 10 years has armed us with more weapons against the addictive illnesses than we could have imagined in the previous century. In particular, the partial agonists buprenorphine, as mentioned above, and varenicline, which acts on the nicotine receptor, have revolutionized addiction treatment of opioid and nicotine dependence respectively. Who knows, possibly before the end of this decade, we may even see the Food and Drug Administration approving a medication (or would it be a vaccine?) for cocaine dependence—considered the holy grail of addiction psychopharmacology research.
On April 17, the Committee on Addiction Psychiatry of the New York County District Branch of the American Psychiatric Association will present a symposium entitled “Addiction Psychiatry in the 21st Century” during our organization’s Annual Meeting. Evaristo O. Akerele, MD, MPH, president of the Addiction Psychiatry Committee, and Petros Levounis, MD, MA, president of the District Branch, will co-chair the symposium (please see schedule of events listed in the event calendar section of our website at www.nycodbapa.org or contact the DB office at 212-685-9633 for additional information). Six New York addiction psychiatrists will present short updates in their areas of special interest. Dr. Akerele will open the symposium with a discussion of performance enhancing drugs in professional sports, a topic which keeps attracting great interest and controversy from the media. Drawing from recent national epidemiological studies and his own research over the past two decades, Dr. Richard Rosenthal will update us on the most recent recommendations for the treatment of dually diagnosed patients. Dr. Andrew Kolodny will discuss the alarming increase in prescription opioid abuse and dependence and suggest interventions both from the standpoint of the individual practitioner and the public health perspective. Dr. Jose Vito will help us understand the complex world of substance abusing teenagers and its many microenvironments and subcultures. Dr. Marianne Guschwan will discuss the latest ideas on spirituality and the 12-step approach to recovery and healing. Finally, Dr. Levounis will close the symposium with a look at the emergence of both clinical and research interest in the behavioral addictions, especially the compulsive use of the Internet.
We hope to see you on April 17 at the New York Academy of Medicine. |
