Severe Addiction Treatment

Addiction and overdose have been with us for years. The volume of Americans dying each year from overdose is simply astounding. There are those who believe that injuries (work and not) lead to prescription opioids, which lead to dependence in some instances, or addiction, and potentially death. They contend that even those whose prescriptions are weaned or discontinued may yet suffer as they turn instead to street drugs for relief of either the injury, or the pain that such substances can themselves inflict when used chronically for sufficient duration. The forms which deliver opium are incredibly diverse
Treatment is not a new idea. In the 1960s and 1970s there was a heroin crisis in America. One of the solutions to that crisis was (believe this or not) a prescription for a different opioid, Methadone. One addiction website characterizes the crisis when "heroin abuse moved out of the slums and ghettos to infect the sons and daughters of well-to-do." The implication seemingly being that the cause for concern was influenced by the "who" of the crisis" as much perhaps as the "what." 
Addiction is not a simple subject. As one site explains "addiction is a very complex disease that we’ve only recently begun to understand." It explains that addiction does not fit clearly into either a physical or psychological category. It seems that our difficulty comprehending it, and how to treat it, is in part caused by our prejudices, beliefs, and perhaps misconceptions about the nature of addiction. There is a misconception, they note, that addiction is a character flaw of defect. 
Certainly, how any of us reacts to outside stimulus is personal. We share similarities and commonalities, but we are each somewhat unique nonetheless. Thus, our propensities or personalities may play a role in how we respond to an injury, an insult, or even a substance. What is absolutely certain is that none of us is perfect, infallible, or incorruptible. 
The world of addiction treatment is evolving. Psychotherapy, neuroscience, supportive group involvement, and overdose antidotes are often discussed. There is a great focus on prevention through avoidance. I recently attended a medical conference at which multiple doctors explained the potential for avoiding the instigation of use or misuse by declining to prescribe opioids in a variety of clinical situations. Their is seemingly agreement that addiction can be started innocently through prescription opioids, and that path can be inhibited or limited with careful consideration of opioid prescribing habits. 
But, one of the latest addiction efforts recently made the news in Britain, though its focus is on the efforts in West Virginia. The British Broadcasting Company (BBC) reports that the U.S. Food and Drug Administration (FDA) has given the go-ahead for the use of "brain implants to help reduce their (addicts') cravings." In fact, the first surgical implant has already been deployed. The doctors involved are quick to assure us that this process is remedial in a specific manner, and that it "should not be used for 'augmenting humans.'" There is a fear of integrating humans and technology, whether realistic or not. 
The technology itself is not necessarily new. The BBC notes that "so-called deep brain stimulation" has already received FDA approval for "a range of conditions including Parkinson's disease, epilepsy and obsessive compulsive disorder." Notably, the latter of these is a recognized and "common" mental condition, according to the National Institute of Health. Thus, the prior FDA approvals already included both physical and non-physical maladies. 
To install this device, the physicians drill "a small hole in the skull" and "insert a tiny 1mm electrode in the specific area of the brain. This area, identified on brain scans, "regulate(s) impulses such as addiction and self-control." One of the physicians colloquially refers to this as a "pacemaker for the brain." In a similar fashion, this electrode will deliver a stimulation to the brain. to instigate reaction. In design, it is perhaps not dissimilar to other stimulation treatments, of which there are several
The researchers/physician involved reiterate the recognition that "addiction is complex." They note the "wide range of social dynamics" and "genetic elements" that may influence either addiction of the treatment it requires. They also are quick to caution that this procedure is not a go-to solution, but "is for those who have failed every other treatment." including "medicine, behavioral therapy, (and) social interventions." This blog has cited numerous contentions regarding the volume of overdose deaths in this country, and the evidence is that far to many continue to die
The BBC describes the pandemic of overdose in America. The "main cause of death for under-50s in the U.S." is overdose. And, that is a large problem in West Virginia. That state has the "highest age-adjusted rate of drug overdose deaths involving opioids." Why we bother with distinctions like "age-adjusted" is not clear. In short, there is a serious national problem, it disparately impacts West Virginia, and therefore the effort is underway there to attack addiction directly and innovatively. 
There are ethical concerns regarding the "merging (of) machines and humans. There are companies working on amazing innovations in neuroscience. The BBC notes that some will be inserting brain stimulators for maladies such as paralysis. Another company is working on a machine that converts thought to text at amazing rates up to "100 (words) per minute." A machine interpreting your thoughts. The science fiction value alone is astronomical. There are those who believe we will one day implant computer chips directly into our consciousness. There is fear about the potential
The advocates of stimulator-based addiction treatment reiterate that this is a surgical intervention. Surgery includes "inherent risks" and should not be the first modality engaged in many medical situations. Certainly, following a traumatic physical injury or systemic failure, surgery will be the first response. But, because of the risks, these researchers advocate this addiction treatment as a last resort. But, in time, should these various interventions with our brains bring success, it is possible that such inhibitions might diminish. With success may come a diminishing aversion to what today sounds a bit scary to many. 
The implications and potential impacts of this research are intriguing. Has medical science reached a point of influencing our very thoughts and emotions through mechanical intervention? Could we evolve to a state of consciousness that is significantly influenced, enhanced, or replaced by a computer? Might we view these potentials as rare and human interventions today, only to see them gain acceptance and through ambivalence come to significantly impact our existence? Or, is it all just science fiction? Time will tell. 
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    About The Author

    • Judge David Langham

      David Langham is the Deputy Chief Judge of Compensation Claims for the Florida Office of Judges of Compensation Claims at the Division of Administrative Hearings. He has been involved in workers’ compensation for over 25 years as an attorney, an adjudicator, and administrator. He has delivered hundreds of professional lectures, published numerous articles on workers’ compensation in a variety of publications, and is a frequent blogger on Florida Workers’ Compensation Adjudication. David is a founding director of the National Association of Workers’ Compensation Judiciary and the Professional Mediation Institute, and is involved in the Southern Association of Workers’ Compensation Administrators (SAWCA) and the International Association of Industrial Accident Boards and Commissions (IAIABC). He is a vocal advocate of leveraging technology and modernizing the dispute resolution processes of workers’ compensation.

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