Abstract
Addiction is a public health crisis in the United States. Understanding the cause and providing effective treatment for patients—in particular, those with substance use disorders—is challenging. Research has demonstrated that addiction is not a flaw in one's moral fiber or a disease of choice; rather, it is driven by alterations in neuronal mechanisms, especially those that involve the neurotransmitter dopamine, which plays a critical role in the brain's reward pathway. Much of osteopathic philosophy is based on the concept of total body homeostasis and allostasis. This article discusses the role of achieving dopamine homeostasis as part of a comprehensive biopsychosocial treatment strategy in the effective management of addiction. The authors aim to motivate osteopathic primary care physicians to incorporate osteopathic philosophy into the treatment of patients with substance use disorders.
Addiction is a public health crisis in the United States.
1 Former US Surgeon General of the United States Vivek H. Murthy, MD, released a report
2 in 2016 highlighting the challenges of addiction in the United States. The report cited the following 5 key areas that require immediate attention: (1) understanding of the neurobiological mechanisms of substance use, misuse, and addiction; (2) prevention programs and policies; (3) early intervention and management of substance use disorders (SUDs); (4) recovery options; and (5) health care systems with respect to treatment services and costs related to SUDs. These recommendations are based on the fact that 21 million people in the United States older than 12 years have a diagnosis of SUD, and an estimated 2 million people with an SUD have not received a diagnosis.
3 To put this number in perspective, more people have an SUD than diabetes, and addiction is 1.5 times more prevalent than any type of cancer in the United States.
4 However, unlike cancer or diabetes, only 10% of patients with an SUD receive any form of treatment.
5 In an accompanying letter to his report, Murthy asserted, “We can never forget that the faces of substance use disorders are real people.”
6(p vi) He called for expanding prevention and treatment programs in the community, increasing access to care, and enhancing the training of primary care physicians to better recognize and begin early treatment for patients with SUDs.
Despite significant efforts to better understand the core mechanism of addiction through research efforts, its cause remains poorly understood, often viewed as a flaw in a person's moral character, not a real disease.
7 This lack of understanding has resulted in significant prejudice experienced by persons with SUDs.