Substance Use Disorder

Judith Branche, MD

National Drug and Alcohol Facts Week is a health observance week for teens that aims to shatter the myths about drug and alcohol use. This year, we recognize this observance from Monday, January 23rd through Sunday, January 29th. Dr. Judith Branche, MD of Cornerstone Family Healthcare’s Center for Recovery is Board Certified in Addiction Medicine and has spent countless hours helping those who suffer from addiction in the Hudson Valley and beyond.

Substance use disorders (SUD’s) affect a significant portion of the population in New York State. Orange County is estimated to have at least 20,000 people who either qualify as having an SUD or whose drug use is categorized as ‘at risk’.

The country, as a whole, is in the midst of an opioid abuse epidemic and addressing this epidemic has become a priority with both federal and local officials. Part of the problem that exists in getting help to patients is the lack of sufficient treatment slots for the number of patients requiring treatment. Another significant problem is the lack of understanding of the problem for what it truly is.

Therefore, I would like to take this opportunity to explain what a substance use disorder really is. Addiction is a chronic disorder of the brain which affects brain chemistry in a significant way. This may be a new concept for many who believe that drug addiction is no more than a moral failing or a character defect that a person should be able to overcome if he or she puts their mind to it. Nothing could be further from the truth.

Science has discovered the facts of this disease and we have thus come into a new era of understanding and treatment of addiction. Drugs of abuse affect communication in the brain disrupting normal chemical pathways and levels of neurotransmitters. These changes, in addition to being profound are chronic.

The key neurotransmitter affected because of addiction is dopamine; this chemical affects the reward system. All drugs of abuse initially increase the levels of dopamine in the reward system; this is what drives the seemingly uncontrolled cravings that occur with use of the drug of choice. But over time these levels actually drop to a subnormal level and more and more of the drug is required to achieve the same effect. In time, an addict must use the drug just to feel ‘normal’.  This is referred to as a resetting of “hedonic tone”. It takes a great deal of time, cognitive and other therapies, often along with medication to reverse this process. A person with a SUD who does not seek treatment and tries to quit on his own is almost assuredly doomed to fail.

Often there is misconceptions that treatment does not work. This too is untrue. Treatment works and the rates of success are similar to rates for other common illnesses such as diabetes and asthma. The problem is that people often don’t know where to turn for help.

The Center for Recovery at Cornerstone Family Healthcare offers comprehensive substance abuse treatment for all drugs as well as alcohol. Anyone who is dealing with a drug problem or knows someone who is, is encouraged to call us at (845)220-2146 for an appointment. Help is available.

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