The Anatomy of Addiction

Praise for
The Anatomy of Addiction

“A lucid examination of addiction and treatment from a neurobiological perspective . . . with particularly engrossing chapters dispelling the ten biggest myths of addiction.”

—
Kirkus Reviews

“In
The Anatomy of Addiction
, Dr. Mohammad's look at the current addiction treatment climate is direct, unflinching, and an absolute must-read for everyone touched by addiction. The man is a true pioneer in the field of addiction and one of the few addiction experts to accurately and effectively balance science, medicine, and behavioral health. If you want a new perspective on the world of addiction, read this book.”

—Darren Kavinoky, co-creator and host of
Deadly Sins
on Investigation Discovery; founding attorney of 1.800.NoCuffs; Certified Intervention Professional

“When I first met Dr. Mohammad, addiction had left me broken and destitute on every level. While I had spent time with countless, self-proclaimed addiction experts, Dr. Mohammad saved and changed my life in a matter of minutes. He was the only treatment professional to let me know that with the help of science, the truth about addiction, and a balanced treatment approach, I could have my life and family back. That was thirteen years ago and I've never looked back. What Dr. Mohammad shared with me that day is included in his book
The Anatomy of Addiction
; we are not powerless over addiction and this book tells you exactly why.”

—JW, a patient of Dr. Akikur Mohammad

“This is strong medicine with no spoonful of sugar; for many, it [may be] a bitter pill to swallow. But the book is not meant to inform; it is meant to transform.”

—Dr. Walter Ling, professor of psychiatry and director of Integrated Substance Abuse Programs (ISAP) at UCLA

“Dr. Akikur Mohammad is passionate about the issue of addiction, what it is and what it is not, and how it should and shouldn't be treated. Written for the layperson, this book is a helpful resource for readers struggling with addiction, and their families and friends, as well as anyone who is interested in the global problem of addiction.”

—George Simpson, MD, professor of psychiatry and the behavioral sciences at Keck School of Medicine at University of Southern Califorinia and former chairman of the department of psychiatry at Keck School of Medicine at University of Southern California

PERIGEE

An imprint of Penguin Random House LLC

375 Hudson Street, New York, New York 10014

Copyright © 2016 by Akikur Mohammad, MD

Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader.

eBook ISBN 978-1-101-98303-4

Library of Congress Cataloging-in-Publication Data

Names: Mohammad, Akikur, author.

Title: The anatomy of addiction : what science and research tell us about the

true causes, best preventive techniques, and most successful treatments /

Akikur Mohammad, MD.

Description: First edition. | New York City : Perigee, 2016. | Includes

bibliographical references and index.

Identifiers: LCCN 2015041635 | ISBN 978-1-101-98183-2

Subjects: LCSH: Substance abuse—Etiology. | Compulsive behavior—Etiology. |

Substance abuse—Treatment. | BISAC: SELF-HELP / Substance Abuse &

Addictions / General. | PSYCHOLOGY / Psychopathology / Addiction.

Classification: LCC RC564 .M634 2016 | DDC 362.29—dc23

First edition: February 2016

Neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book.

While the author has made every effort to provide accurate telephone numbers and Internet addresses at the time of publication, neither the publisher nor the author assumes any responsibility for errors or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

Cover design: Eric Fuentecilla

This book is dedicated to my mother, who inspired me in every way; to my very supportive sister; and to my loving family—my wife, Irina, and our daughters, Anastasia and
Sasha.

Praise for The
Anatomy of Addiction

Title Page

Copyright

Dedication

Introduction: The Invisible Epidemic That's Killing Us

Chapter 1. Addiction Is Preventable. Addiction Is Treatable.

Chapter 2. The Ten Biggest Myths of Addiction

Chapter 3. The Medical Illness of Addiction

Chapter 4. The Medical Consequences of Addiction

Chapter 5. The Process of Effective Treatment

Chapter 6. Painless Detox

Chapter 7. Maintenance and Relapse

Chapter 8. Dual Diagnosis

Chapter 9. Teens and Young Adults

Chapter 10. Fetal Alcohol Syndrome: Real and Preventable

Epilogue Overcoming the Culture of Disbelief

Bibliography

Acknowledgments

Index

About the Author

The Invisible Epidemic That's Killing Us

L
ast year, the treatment of alcoholism and drug addiction generated a staggering $34 billion in revenues. Rehab clinics dot the country and can be found in virtually every city and town in America. At 14,000 and counting, there are more addiction treatment centers in the United States than there are Starbucks stores.

Yet, the treatment of alcohol and drug addiction is failing miserably. According to the National Survey on Drug Use and Health (NSDUH), an estimated 20 million Americans, or about 8 percent of the population, aged twelve or older used an illegal drug in the past thirty days. In addition, the nonmedical use or abuse of prescription drugs—including painkillers, sedatives, and stimulants—is growing, with an estimated 48 million people, or about 20 percent of the U.S. population, aged twelve and older using prescription drugs for nonmedical reasons.

To look at it another way, 88,000 deaths were attributable
last year to excessive alcohol use alone in the United States. This makes excessive alcohol use the third leading lifestyle-related cause of death for the nation (it surpassed car accidents in 2009 and never looked back). Excessive alcohol use is responsible for 2.5 million years of potential life lost (YPLL) annually, or an average of about 30 YPLL for each death. In 2006, there were more than 1.2 million emergency room visits and 2.7 million physician office visits due to excessive drinking. The economic cost of excessive alcohol consumption in 2012 was estimated at $275 billion.

The problem of addiction is seemingly everywhere, but the disease of addiction still isn't recognized. If addiction were acknowledged by society—its care providers, the policy makers, the courts and judiciary systems, and most of all, the public—as the chronic disease that it clearly is, it would be quickly brought under control.

In a landmark study of addiction in the United States published by National Center on Addiction and Substance Abuse at Columbia University, the authors found that “addiction is this nation's largest preventable and mostly health problem.” They went on to say that the failure to treat addiction with scientifically sound, medically proven methods results in an “enormous array of health and social problems, including accidents, homicides, suicides, child neglect, incarceration and sexual assault.”

Admittedly, the figures are so overwhelming that we in the public become desensitized to their effect, until a loved one, friend, or associate succumbs to drug or alcohol abuse. Periodically, when a high-profile figure like Philip Seymour Hoffman dies of an
overdose, the country is jolted back to the reality of the dire situation, and the need for changes to addiction treatment are discussed, and then forgotten again until the next celebrity overdose.

But it doesn't have to be so. In the last decade, and, particularly in the last few years, advances have been made in the science of addiction medicine that make the disease both treatable and preventable.

As a board-certified psychiatrist with an additional certification in addiction medicine, I have been on the front line of using these advanced techniques, first, during my work in the emergency room (ER) department of Los Angeles County General Hospital, and now for the last several years at the addiction treatment center I founded in Malibu, California. Yet, I am the first to admit that evidence-based addiction treatment remains largely unknown to the public at large.

Why, then, is there such a disconnect between the problem and the solution? In this book,
The Anatomy of Addiction
, I explain how an entrenched rehab industry has grown scandalously rich by bilking some of the most vulnerable in our society for billions of dollars each year and how it also has no intention of voluntarily changing its way.

Shockingly, an estimated 90 percent of all rehab clinics do not use any evidence-based medicine in their treatment programs. In fact, only six states in the country require any type of education for addiction treatment personnel, often self-styled as “addiction counselors.” Instead of offering the kind of proven addiction medicine that has been endorsed by the American Medical Association and National Institutes of Health, these often unscrupulous
and always ignorant clinics base their treatment protocols exclusively on 1930s-era concepts of the support talk group concept and enforced abstinence.

Despite decades of scientific research that have proven beyond any reasonable doubt that addiction is a brain disease, the rehab industry continues to treat addiction as a moral failing and lack of willpower. It is abetted in this falsehood by an entrenched establishment that continues to preach its 12-step dogma, despite the facts to the contrary; by policy makers and judiciary, who view the disease as the target for criminalization rather than treatment; by a medical community still largely ignorant of the disease of addiction and its proper treatment; and finally, by a public that is simultaneously supportive and scornful of addicts but mostly just confused by the whole issue.

Here are the simple, scientifically proven facts about alcohol and drug addiction:

1. Addiction is a chronic brain disease, characterized by compulsive craving for alcohol or drugs, that requires medical intervention and management over a lifetime by trained and certified professionals (just like every other chronic disease).

2. Yes, it's a chronic disease of the brain like bipolar disorder, and thus its treatment requires more than counseling and group talk therapy (no matter how good the intentions might be).

3. In fact, alcohol and drug addiction requires first and foremost, pharmacological therapy in addition to counseling and lifestyle modification.

4. As a chronic recurring illness, addiction often requires continued treatment to anticipate relapses and diminish their intensity.

5. While relapses are to be expected, addiction is a treatable condition, and people with an alcohol or drug addiction can recover and lead fulfilling lives.

These guiding principles are at the heart of this book. As you will see, I explain in layman's terms what constitutes effective, evidence-based addiction medicine and how to find it. Just as important, I detail how to avoid so-called rehab clinics that are, at best, useless and a waste of money and, at worst, dangerous and even life-threatening.

The information in this book destroys the myths that, unfortunately, continue to guide addiction treatment in this country, including

• Addiction can be cured by abstinence and willpower.

• Addiction cannot be prevented, and addicts are doomed to life of despair.

• The best form of treatment is advice from former addicts talking about how they kicked their habits.

False, false, and false. Indeed, as a physician, clinician, and professor of medicine, I know of no other medical condition of the brain—be it Alzheimer's disease, Parkinson's disease, or any other—that has amateurs diagnosing and treating it. This simple truth has been proven irrefutable by many scientifically conducted studies: Addiction is a preventable, treatable disease.

In this book you'll find actionable,
scientific
information for addicts and their families. This is the same information that I teach to the students at the Keck School of Medicine of the University of Southern California in Los Angeles. My classes have been considered so essential that regardless of their intended specialties, all med students there are required to take them.

Now, for the first time, I am sharing this information with the public. My goal is nothing less than to once and for all end those who keep addicts and the medical treatment of their disease in the shadows of ignorance, fear, and stigma.

If there is one message you'll take away from this book, it's this: America does not have an addiction problem. It has an addiction
treatment
problem.