In a recent meeting with a substance abuse treatment and referral program, the Director and I spoke at length about a medically-based approach to the diagnosis and treatment of substance abuse. After a discussion about genetics, chemical imbalances within the brain, the draw to self-medicate as well as the use of new medications to treat underlying conditions and the success we have with this approach, the Director looked at me and said, “Still, they all need therapy to deal with their history of abuse, molestation and psychological trauma.” I was caught by surprise as it was apparent that his personal experiences had overshadowed the data and science.

Many families struggle with the concept of addiction as self-medication. After all, if it is self-medication, “they can stop, right?” On the surface what looks like addiction to substances is the biological draw to treat symptoms that create an ever-increasing psychic and physical discomfort. It is an angst unlike any angst. After one hit, one drink, or one toke, this angst is minimized; using the substance even more frequently prevents it from returning or rearing its ugly head again.

Who hasn’t had a stressful day and looked forward to a cold one or glass of wine? This is a very common and socially acceptable approach to relieving the stress of our chaotic world. Let’s say it becomes routine and over time the dose increases (one glass becomes two) or the strength increases (beer becomes liquor). Tolerance is a core symptom of substance abuse. The brain adapts over time by up-regulating brain receptors, down-regulating neurotransmitters which causes the user to seek out stronger forms of self-medication. Alcohol with its resultant hangover makes way to marijuana. Marijuana has minimal adverse effects with no discomfort the next day and effectively treats the underlying symptoms of anxiety and discomfort. Eventually, post-dental procedure or surgery, an opiate is prescribed and nirvana is achieved. Suddenly there is no pain, no anxiety, and the individual finds a truly long-lasting effect with minimal side effects. The cycle of adaptation (tolerance versus drug seeking behavior) in the brain begins again and at some point the clinician refuses to prescribe anymore pills. Once cut off from access to treatment for anxiety (not pain) by their surgeon or pain doctor, they look to street suppliers of opiate pain pills. Since the DEA implemented increased scrutiny, the availability of street pills has decreased and prices have risen. The result: a migration to heroin as longer-lasting, effective and a much cheaper alternative.

The solution for this medical conundrum is a medical diagnostic evaluation, including a review of the family tree (recall the word genetics) looking for psychiatric illness, substance abuse and dependence, a review of current prescription and street drugs and an understanding of beneficial effects from each (“what do you like about this medication or drug?”). By pulling together a complete picture of the individual, a treatment plan that is holistic and all-encompassing can be created and implemented.

The best success is achieved with buy-in from the entire family and its inherent social support. Remember, it takes a village! The more difficult cases occur within families that have poor insight into the disease and its process, deny the disease and direct anger and/or retribution toward the user or sometimes toward society. Talk therapy can facilitate medical treatment but it cannot treat the condition alone -- the underlying angst of anxiety will push addicts back to use again and again. Bottom line, we all recognize the problem and know there is an answer. Now we just need to do it.

Angelo Sambunaris, M.D. is the Founder and Medical Director of the Institute for Advanced Medical Research and clinical faculty member at Mercer University’s School of Pharmacy. Dr. Sambunaris directed clinical research for Bayer and Solvay Pharmaceuticals and has led more than 200 clinical trials in neuropharmacology. A veteran of the U.S. Army, he also served as Lieutenant Commander in the U.S. Public Health Service while completing his research fellowship at NIH. Learn more at