Commentary
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40 Years of Progress in Addiction Treatment
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Joseph Volpicelli MD, PhD, reflects on 40 years of advancements in addiction treatment, from overcoming stigma to integrating evidence-based therapies like naltrexone.
In honor of the 40th anniversary of Psychiatric Times, we asked Joseph Volpicelli, MD, PhD, how the treatment and recognition of addiction has changed over the last 40 years. He said that the understanding of addiction held 40 years ago is different from the understanding clinicians have now.
“When we first did our research, the prevailing notion was that addiction is related to some sort of either moral failing or some sort of defect to one’s personality. So there was a lot of shame and guilt around addictions,” Volpicelli said. Now, clinicians have a better understanding of the biology of addiction. Over the past 40 years, effective treatments have been developed based on the science of addiction, but there is a challenge in having evidence based treatments be used clinically.
“For example… less that 2% are taking medication that has proven to be helpful with addiction,” Volpicelli said. His focus is to turn that number around.
As clinicians learn more about the biology of addiction and its impact on behavior and psychology, Volpicelli thinks treatment will be better tailored to the patient. Naltrexone can be used in a variety of ways, from abstaining completely from drinking or to control the amount an individual drinks. For some, he says, naltrexone can be taken before going to a high risk situation like a wedding, in order to help avoid the temptation. Naltrexone can be taken as an injection or oral medication to better cater to the patient. If a patient is more likely to waiver, the injectable course Vivitrol is extended release and lasts for 30 days.
The psychosocial element of treating addiction posed a question about motivation for Volpicelli, which he had to examine by putting himself in the patient’s shoes. “The reward is not in the short term, the reward is in the long term,” Volpicelli said. He designed a psychosocial treatment to help patients see how taking the medicine will open doors for them.
This is part 1 of a 6-part interview with Joseph Volpicelli, MD, PhD. You can watch the full interview here.
Dr Volpicelli is the executive director of the Institute of Addiction Medicine.
