Hooked: A concise guide to the underlying mechanics of addiction and treatment for patients, families, and providers
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Addiction is a complex problem, with social, psychological, and biological underpinnings. The scope of the problem is at epidemic proportions. Thanks to decades of scientific research, we are better equipped than ever to comprehend the causes, complications, and effective social and medical treatments for addiction.
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Hooked - Arwen Podesta MD
© 2021 Arwen Podesta, MD
Additional editing by Joshua Podesta
All Rights Reserved.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the written permission of the author.
Each example of a patient is an amalgamation of many stories of patients with whom I have worked. No names, identifying information, or story details is about a true specific patient.
ISBN 978-1-952481-31-4
ISBN 978-1-952481-32-1 (e-book)
Library of Congress Control Number: 2021911785
Printed in the United States of America
Published in Hellertown, PA
For information or to purchase bulk copies, contact the publisher at
Jennifer@BrightCommunications.net
www.BrightCommunications.net
CONTENTS
Foreword
Author’s Note
OVERVIEW
Why Am I Writing This Book?
Why Do We As a Society Need to Care about Addiction?
How Can a Loved One Help?
What Is Addiction?
What Do We Do?
BIOLOGY OF ADDICTION
Neurochemistry Basics
Neurobiology of Addiction
Primer on Genetics and Epigenetics
Why Do People Have a Drug of Choice?
Why Isn’t Everyone Who Tries Drugs Addicted?
TREATMENTS FOR ADDICTION
Overview of Treatment
Is Medication Necessary?
Types of Treatment Levels and Facilities
Finding the Right Treatment Program
MEDICATIONS FOR ADDICTION
Medications for Nicotine Dependence
Medications for Alcohol Dependence
Medications for Opioid Dependence
Medications for Cocaine, Amphetamines, and Other Drugs
When and Why Medications Might Be Used in Treatment
Detoxification and Withdrawal
Early Recovery and Maintenance
Cravings and Relapse Prevention
Recovery Maintenance
Harm Reduction
BUILDING THE FOUNDATION
Gut
Neurogenesis
Hormones
Nutritional Supplementation for Methylation
Increase Glutathione
Healthy Relationships
Therapy
Sleep
Exercise
IV NAD+ Therapy
Summary: A Basic Regimen
PAIN AND ADDICTION
PREGNANCY AND ADDICTION
LOVED ONES’ ROLES AND EXPECTATIONS
Relapse—What Does the Family Do?
Trust
EXPERIMENTATION VERSUS ADDICTION
INTERVENTIONS
Conclusion
References
Quick Guides and Resources
About the Author
Contributors
Endorsements
Index
FOREWORD
Dr. Arwen Podesta is a rare breed of addiction psychiatrist: Not only is she one of the few US psychiatrists to be board certified in addiction medicine (with extensive practical experience working in one of the most difficult and prevalent areas of addiction in the US) but also she is one of the very few addiction psychiatrists to take a fully integrative approach, which is essential to sustainable sobriety and healing.
Hooked is concise and easy to read, while being full of helpful scientific and practical advice for those with addiction, their families, their friends, and health practitioners. In it, Dr. Podesta deconstructs the disease of addiction, explaining its genetic, neurological, biochemical, psychological, and lifestyle contributors, and how they all interact to create the perfect storm.
She offers us a comprehensive set of biochemical and psychological treatment options and the various schools of thought around them. She shares her own philosophy, which is to treat the whole person, using temporary medication-assisted treatment, if necessary, while she and her team support the biochemical, psychological, and lifestyle interventions which take time but address the root cause of addiction, therefore allowing for long-term sobriety and healing.
With her team at Podesta Wellness, Dr. Podesta treats addiction by working with the patient’s biochemistry (genetics and how they affect brain chemistry; epigenetic factors such as nutritional imbalances, gut issues, toxic load, and hormone imbalances; and medication-assisted treatment, when necessary) as well as psycho-spiritual factors (such as stress and trauma) and lifestyle habits and circumstances (such as lack of sleep and inappropriate exercise, but also poverty and incarceration, which are prevalent factors in addiction).
This is reflected in the formula she coined (see opposite page):
Biology + Stress + Drug = Addiction
The prevalence of addiction combined with poor treatment outcomes, makes addiction one of the most pressing public and private health issues. Indeed, since 2009, there has been a 30-percent increase in worldwide drug use, to 269 million drug users in 2018, of which 35 million, or 13 percent, suffer from the disease of addiction. Drug overdose deaths have more than tripled since 1990. And in the US, almost 130 people a day die of an opioid overdose.
The disease of addiction has shown itself to be an intractable one, with relapse rates for most addiction treatment hovering at around 60 to 70 percent. This is perhaps because most addiction treatment does not cover the full spectrum of biochemical, psychological, and lifestyle diagnoses and treatments. Indeed, too few addiction psychiatrists or rehab clinics diagnose and treat an addict’s underlying biochemistry in combination with their psychological issues, lifestyle habits, and life circumstances.
Dr. Podesta’s approach, outlined in this brilliant book, takes all these into account and demonstrates that the chance of recovery is significantly higher with an integrative approach combining biochemical treatments (natural supplements, medications, diet) with psychotherapy and other somatic therapies, with lifestyle habits and circumstance changes.
Hers is a rare combination of scientific understanding and analysis, extensive medical and practical experience, and compassion wrapped in an accessible, non-judgemental tone, which make this book an absolute gem for addicts, their families, and health practitioners.
Hooked should be required reading for anyone who struggles with addiction or is trying to help those who do.
—Kirkland Newman Smulders
Founder and editor, mindhealth360.com
Host, The MindHealth360 Show
AUTHOR’S NOTE
For many years, addiction has been seen and treated as a social disease. Punishment and social treatment were the tenets of treatment. President Nixon started the war on drugs in 1971. With more enforcement, we had more prisoners in jail because of drug addiction, but they were not receiving treatment.
In recent years, the pendulum has started swinging the other way— toward understanding that addiction is indeed a disease of the brain. Furthermore, medical treatment of addiction is effective and preferable to social stigmatization and incarceration.
Many articles and books have been published stating that addiction is not a disease at all, but that it is caused only by severe stress and sometimes childhood problems. Once the stress is dealt with or removed, it is suggested that addiction is gone. This is interesting and, in fact, true for some people. A common story often told is about Vietnam veterans returning from war with addiction. During the Vietnam War, those serving were often offered amphetamines and opioids with the intent of helping soldiers do their jobs, numb them out, and keep them awake during stressful wartimes. Among those Vietnam veterans who returned and self-reported as having addiction problems, about three-quarters of them got better once life, lifestyle, and stressors improved. The conclusion was that if the stressors are removed, then the