Bankole A. Johnson, a neuroscientist at the University of Maryland School of Medicine in Baltimore, illustrates the difficulty of breaking a heroin habit by comparing the craving for opioids with desires for food and sex.
“Drinking alcohol, in the brain of someone who is addicted, is about 10 times better than food and sex,” he says. “Think about giving up something that is 10 times better than food or sex. It’s tough. When you start getting to cocaine, it’s about a hundred times more. And when you start getting to opiates, it’s about a couple of hundred.”
The point is critical to Johnson’s case for expanding the use of medication-assisted drug addiction therapy. Advances in neuroscience have shown that “addiction is a disorder of the brain,” Johnson said, and that medicines have been developed to genetically target and effectively treat substance abuse.
Nevertheless, skepticism about using drugs to treat drug addiction runs high. The use of naltrexone, methadone and buprenorphine to block the effects of opioids remains controversial.
A Maryland task force report on heroin and opioid usage, released earlier this month, recounted the concerns that residents expressed at regional summits on heroin addiction.
“Some local parent coalitions were disturbed that medication usage during treatment has seemingly emerged as the sole option to address heroin and opioid dependency and that long-term abstinence-based residential treatment appears to have largely vanished as a valuable treatment option,” the report noted.
“A number of people stressed that a key component for addiction treatment and successful recovery is the assumption of personal responsibility,” the report said, adding that “many treatment regimens involving medication-assisted drug treatment programs fail to promote the theme of personal responsibility.”
Johnson, a pioneer in addiction research and chair of the psychiatry department at the University of Maryland’s medical school, was one of the task force’s 11 members. From his perspective, the issue is brain chemistry — not character.
“We have developed new medicines that can restore a brain that has been hijacked at the molecular level by addiction,” Johnson said. “This is neuroscience, not dogma, doctrine or mystical ideas.”
In 2010, when he was chair of the psychiatry department at the University of Virginia, Johnson attempted to draw a similar line in a published critique of 12-step, faith-based self-help groups, such as Narcotics Anonymous and Alcoholics Anonymous.
“Although AA doubtless helps some people, it is not magic,” he said in a column for The Washington Post. “I have seen, in my work with alcoholics, how its philosophy can be harmful to patients who chronically relapse: AA holds that, once a person starts to slip, he or she is powerless to stop. . . . Equally troubling, AA maintains that when an alcoholic fails, it is his fault, not the program’s.”
The column drew a stinging rebuke from Ronald Earl Smith, then a captain in the Navy’s medical corps and a senior psychiatrist and psychoanalyst at the National Naval Medical Center.
“I have been treating alcoholism in the Defense Department and the Navy for 33 years,” Smith said. “Alcoholics Anonymous works for us. . . . The Navy has some experience with drinking — and it knows how to treat alcoholism. Our lives depend on it. Marines like to go to war sober.”
In the public relations war between science and faith-based treatment, God and the Navy appeared to have the upper hand.
Now, five years later, a nationwide heroin epidemic is exposing shortcomings in many traditional drug treatment programs. In Maryland, heroin-related overdoses increased 186 percent from the first six months of 2010, compared with the first half of 2015. In the first six months of this year, there were 340 deaths, compared with 119 in the first six months of 2010.
This could help Johnson in his efforts to upgrade addiction therapies that he says are “decades behind what we know works.” The task force, in no small part because of him, has recommended that a plan be developed to increase patients’ access to buprenorphine and naltrexone, as well as to expand training for the use of naloxone — a fast-acting medication that reverses the effects of a drug overdose.
“I’m a religious person, and I think faith and religion are important,” Johnson said. “But if you are sick, I think God would want you to have the best medical care available. If I was sick, I would pray to God to get me better, but I would also go see my doctor.”
To read previous columns, go to washingtonpost.com/milloy.