Interview with Dr. Jacobs on Addiction, PHP and The New Paradigm
Interview with Dr. Jacobs, Chief of Addiction Medicine at the Medical College of Georgia and Chief Medical Officer for Bluff Plantation Alcohol and Drug Treatment Center, on a July JAMA article about why residential addiction treatments are more effective than shorter programs
Q. Dr. Gold coauthored the July JAMA article, Setting the Standard for Recovery: Physicians’ Health Programs, that seems extremely important for treatment professionals and people seeking treatment and their families. What are your thoughts on the article?
A. As Dr. Gold has pointed out, the data clearly indicates that long-term residential treatment is the most effective solution for treating substance use disorders. We’re working very hard to educate people on “The New Paradigm,” as Dr. Dupont, another of the authors, calls it. We’ve developed a highly effective method over the years to treat physicians and airline pilots, among other groups, recognizing that addiction is a chronic disease, not an acute one. It’s not about putting people in brief episodes of treatment and sending them on their way, it’s about treating them, stabilizing them, and then continuing to monitor and treat them so that they’re in lifelong recovery. You wouldn’t stabilize a diabetic with insulin and then stop giving them the very medicine that was working.
Q. Can you say more about your history with Dr. Gold and your interest and role in this new paradigm?
A. Dr. Gold and I first reported our 5-year outcomes for physicians in Florida at the Society of Neuroscience conference in 2002. The subjects in our study had been involved in the Florida Physicians Health Program.
He and I have been associated for more than 15 years. I started as his fellow in 1998 when our Division of Addiction Medicine at the University of Florida was three people, including us. I left in May and joined the Medical College of Georgia. and he and I are both involved with Rivermend Health.
Q. How does the JAMA study, which involves physicians, apply to others battling addiction?
A. We agree with Dr. Tom McClellan, former deputy director of the Office of National Drug Control Policy that addiction is like diabetes, hypertension, asthma or any chronic condition.
If someone had good control of their blood pressure with medication and after stopping treatment their blood pressure rose again, medical professionals would say that treatment was successful because patients’ blood pressure had been well-controlled while they were being treated.
Addiction treatment has been looked at in a different way. Society saw addicts out of control—we put them in treatment and they did well, but they relapsed when they left with essentially no ongoing care, and people declared treatment a failure. There’s a dichotomy there between how outcomes for addiction and other chronic conditions have been judged that The New Paradigm addresses.
If I were to develop a new cancer treatment, the first thing that oncologists would ask me is what the 1-year and 5-year remission rates are. We should look at addiction—when the treatment is continuous and we adjust it as needed—the same way we do for diabetes, asthma, hypertension and cancer.
Q. What’s on the horizon for you?
A. Dr. Ken Blum, a consultant to MBRC, and I are presenting important data at the September conference of the American Academy of Clinical Psychopharmacology in Atlanta. We’ve found, in treating addicts, that doctors suffering from addiction are treated differently from other people with the same problem. Doctors may plan to treat an addict with methadone and buprenorphine, but when they find out it’s another doctor, they act differently—they don’t prescribe those medications. That’s because they know that the Physicians Health Program abstinence method works because of the data from 5-year outcomes, and that when patients are on medication, they often continue to use drugs.
Q. The JAMA article ends on an optimistic note. Can you say more about that?
A. I am very optimistic that as we continue to shift the way we treat addicts to the New Paradigm and to monitor them and adjust their treatment as needed, we will see relapse rates drop and more patients enjoy long-lasting recovery.