Addiction Medicine

Drug addiction is an enormous public health concern. It is the number one preventable cause of death in the adult American population. The indirect costs to society associated with drug addiction are estimated to be around $500 billion dollars annually. Addiction often leads to a downward spiral in health and self-care, exacerbating concurrent chronic diseases such as high blood pressure and diabetes. Drug use can also be a primary cause of disease, as seen in alcohol-induced liver cirrhosis or the spread of HIV and viral hepatitis through contaminated intravenous needles.

Understanding how drug addiction develops is crucial if we are to develop improved addiction treatments. Research has shown that environment, the effect of drugs on the brain, and genes play a role in the development of addiction, so each must be addressed for a treatment program to be successful.

Gavin Bart, MD, is the Chief of Addictive and Complementary Medicine at HCMC, the flagship acute care and teaching hospital of the Hennepin Healthcare System. He argues that efforts to treat addiction need to look beyond the short term detoxification of patients, to providing ongoing addiction treatment, which can help prevent future relapses.

He is conducting research on the physiological and genetic factors that play into the development of addiction and affect treatment outcomes. An individual’s stress response appears to plays an important role in addiction. People who have a specific, abnormal stress response have a predisposition to developing an addiction and are more likely to relapse after treatment. For example, the nearly 80 percent relapse rate seen in heroin addicts may be related to ongoing abnormalities in stress response. Appropriate use of medications such as methadone or buprenorphine can return stress response to normal and patients receiving these medications have a relapse rate of only 30 – 40 percent, similar to relapse rates seen in patients treated for hypertension or diabetes.

Understanding the biology involved in addiction and relapse is just the first step in advancing drug addiction treatment methods. Dr. Bart hopes that his research will be used by others to develop pharmacological treatments that correct the biological factors that predispose people to developing addiction and relapsing into drug use.

Dr. Bart is conducting research to tease out which genes influence the formation of drug addiction and impact the effectiveness of addiction treatments. In his clinical work, he treats people from many different ethnic backgrounds. Research has shown that one group in particular, the Hmong, responds particularly well to opiate addiction treatment methods compared to persons from other ethnic groups. While receiving exactly the same treatment, people of Hmong background require a lower dose of methadone and have a lower treatment drop-out rate.

The Hmong remain a relatively homogenous and isolated population in America, and only a very small percentage of that population is addicted to opiates. Dr. Bart hopes that by studying this population’s unique response to treatment that he can discover which genes are contributing to their improved response to opiate addiction treatment. Hopefully, this information can then be used to improve treatment options for the general population or other ethnic groups.

Despite our improved understanding of the role that genes play in drug addiction, Dr. Bart insists that the answer to treating addiction does not simply lie in a pill. There are many biological and environmental factors that contribute to the development of drug addiction and the likelihood that one will relapse. Physiological effects on the mind/body, genetic predispositions, and a person’s environment must all be addressed if drug addiction is to be overcome.