HBO’s Addiction Series

I went to a premiere of the new HBO addiction series last night and have a few thoughts.

On the positive side:

  • A really good segment on the latest in brain imaging. The also used a helpful way of explaining the role of dysfunction in limbic system and the frontal cortex. They described the limbic system as the “go” center of the brain and the frontal cortex as the “stop” center of the brain.
  • There was a very powerful segment on insurance parity advocacy efforts in Pennsylvania.
  • There was an inspiring segment about a steamfitter labor union local that became self-insured to avoid managed care restrictions on treatment access, developed recovery support groups for members, and developed a strong EAP program to intervene with and support union members.

On the down side:

  • It was not as hopeful as I would have liked. The emphasis was on addiction and treatment, rather than recovery. I thought that someone without much knowledge or experience might leave with the impression that recovery is the exception to the rule. I also thought that it presented treatment as the only viable pathway to recovery.
  • There was very little diversity. Almost all of the people depicted were white.
  • There was a lot of attention to pharmacotherapies and no portrayal of mutual aid groups.
  • One expert from a treatment program in Maine stated that 90% of opiate addicts are unable to achieve recovery without drug maintenance therapy. He went on to state that buprenorphine may be effective for people who are mildly addicted or only addicted to prescription medication, but that injection opiate addicts require methadone maintenance.

It was definitely worth seeing. My impression is that this 90 minute episode will air on March 15th and thirteen shorter episodes will follow. Hopefully the additional episodes will address some of the weak points in the first episode.

5 thoughts on “HBO’s Addiction Series

  1. I also watched the first episode of HBO’s “Addiction” last night and had a similar but quite different reaction. I found a few segments somewhat positive but overall I felt the show failed to deliver anything the average addict would find helpful other then to offer them a theory of why they are addicts. Most addicts will tell you that the “why” is of little importance NOW. The medical side offered some interesting insight but having a good first hand knowledge of addiction I found some of the theories confusing and found some of them very non~convincing, very little of the criteria mentioned fit my profile at all. Perhaps there is some truth, maybe even alot of truth in what was presented but simply speaking, the “high” is the hook and once it’s set, your on the stringer paL. It may take a few of them “highs” but eventualy you wake up one day and you know your there. Unlike what was stated in the show that addiction rarely begins in middle age adults I know many addicts including myself who only became addicts after we turned 45, when after playing with drugs in our youth and thinking those days were long gone, in fact in those days I wasnt even a near~miss of an addict, just a user (and yes despite what the experts say, there is a BIG difference between the two). Then 25 years later with no real reason to….BANG— Unfortunatly many addicts who either have no job or lack the funds to seek treatment will be frustrated after watching this program since the treatment including the RX~meds that this show promoted are extremely expensive. Also as stated in the show, those of us that work in factories and other middle income jobs are now covered under a managed healthcare plan and although workers are encouraged to come forward with their addiction problem, the truth (and trust me it is the TRUTH) is~~ the employee becomes a marked card once they come forward and after~which must deal with randon drug testing (and with no love baby) once treatment is completed and anyone that understands addiction knows, the chance of relaspe after your initial treatment is very-VERY high plus the majority of companies only provide a “one time shot” only treatment program that may only last from 1 to 4 weeks depending on the healthcare provider. We would like to believe that programs such as this would encourage “Corp~America” to reform their current policy but most company execs. and VP’s will tell you flat out that employee drug treatment is a very small priority with minimal productivity and this really pains the shareholders. This is reality folks and it is not likely to change. Addiction is not a current trend but has been a long on~going problem for decades and has been addressed countless times in the past. The bottom line is that unless the addict is able to get the treatment and recovery needed then this problem will not improve anytime soon.Sadly with all the problems we face in this country today as well as in the very near future, addiction remains a very low priority when you look at it honestly. Drug treatment and recovery programs are not free tickets to get clean, the cost for a average 30 day inpatient treatment can cost 25,000~50,000. Sadly today when most Companies having switched over to managed healthcare providers, the plans that many workers may have had in the 1980~1990’s were far better then the plans they have today making it even harder for addicts and famlies with addicts~children to afford this needed treatment.No matter how attractive and informative HBO’s “Addiction” series may be it is very doubtful the actuaL problem of addiction will change for the better in this decade and perhaps the next. The show resembled “eye~candy”, as in dangling the carrot in front of the addict with the addict knowing all too well the cold reality of how it works.The majority of addicts truely want treatment but wanting and getting are not equal. TV shows such as “Oprah” and “Dr.PhiL” and even “Intervention” are like Lotto winners, in that for every addict you see on one of these programs who are given “premium grade” treatment & recovery opportunities at NO COST , there are tens of thousands, maybe hundreds of thousands who have zero or limited opportunities, think about that. The Four Hard Truths (1).Addicts have few friends in State or Local governments who treat addicts with jail or prison with “NO DRUG TREATMENT” included.(2)Corporate America would just like to see them all go away (as in “your fired”).(3)Drug Treatment Facilities will be your friend as long as your insurance says its OK (if not OK~you go away not OK!)(4)If you are an Addict with no family or REAL friends to support you then you are really shit out of luck.Sorry for laying the grim reaper point but when I see programs such as HBO’s “Addiction”, programs that I honestly believe are very weLL intended and meant to educate what addiction is but the programs we need to see are reaL life treatment programs where addicts can get the help they need in real time and today. When I see the figures we have spent trying to fight a war that should never have happened. Waging war in the name of Freedom for some ungratefuL oil rich enemy infested country in the desert while Americans are being sent to prison for having a severe addiction, it pisses me off to the point of madness. Hypocrisy is the true enmey and the one that will surely destroy us aLL in the end.

  2. GMTA MARK.I posted this on HBO’s boards and not one person has even bothered to respond…Sadly, I am very well-read on this subject and have read many of the 300 page commission reports, scientific papers, medical theories and methodolgies etc, put out by many of those professionals and organizations that were featured in the initial documentary.Reports and commissions ARE nice..but where was the biting in-depth investigative reporting as to WHY drug treatment programs are being drastically cut? Why did the documentary filmmaker not follow the Harrisburg representatives AFTER the hearings to get answers from them about what THEY were going to do about the HMO takeover/hostage/rapid decline of established medicine based treatment centers?Where were the Medicare/Medicaid population in this documentary ? Where was the disgraceful HMO’s who rule by outsourcing their mental health/drug coverage to the lowest bidder and leave the insurance holder with no real options for any meaningful treatment? When was the issue raised that in my state for the poor..3 day standards are the rule..regardless of your situation, health,etc.? Also – one 7 day period per year if you are lucky and can even get “prior authorization” for anyone who was a daul-eligible who got thrown into the entire Medicare Part D debacle ??!! Forget your needs, forget your co-existing conditions, forget your personal criteria, forget those fancy 300 page commission reports..7 days is all you get. How about the issue that more and more doctors are refusing Medicare and/or Medicaid patients? That the best treatment centers do not accept Medicare. (I know..I think I had called virtually all of them even before the Medicare Part D mess with their restrictive HMO Advantage made it even more difficult to find a “gatekeeper” primary care physician willing to spend huors on the phone or filling out forms for the meager amounts they are paid !!!) I watch shows like “Intervention” on A&E and my heart breaks as these chosen few get “90 day or even one year care” and know that is out of any of my loved one’s grasp..solely due to their financial status. Why did no one bother to inform the public that Suboxone treatment (and in many cases, the medicine itself) IS not yet covered by the majority of HMO’s? In my area..to get Suboxone it is strictly a cash only business. Some programs are set up by some very distinguished doctors (like O’Brien) if you can afford it and others by some very profit-oriented doctors who have no real motive or expertise to practice addiction medicine. (Think pill mills, cash only, seedy offices, no secretary , easy dollar types and you get the picture.) Where was the discussion of the huge benzodiazepam problem and the HMO’s who are telling the treatment centers how to treat patients that goes against any proven science? How life -threatening this detox is and how the amount of time necessary to detox someone effectively off of these is not doable for the shareholders whom these HMO’s report to? (Too costly to treat.) Where were the segments about the disgraceful lack of pay or incentives in this field for dual-diagnosis/drug addiction centers to work together as they fight for the same dismal treatment funding? Drug treatment is of now only for the wealthy or extremely well-insured. (Think celebrities, upper class and especially non-HMO carriers.) Dual-diagnosis and/or co-addiction dual diagnosis centers may as well not even exist..especially if you are on Medicare. I speak not from any highly funded research granted position but as someone who became self-educated only to find through my own investigations that the lower amount of insurance you have..the worst the treatment options are.On one issue, I called and spoke at length to a facility considered “top tier ” in my state ($46K to walk in their door), one considered “middle of the road” and four who are for the unfortunate souls on Medicare or Medicaid. Their candid responses to my queries as to how they treated their clients, why the treated them as they did and the type of treatment they could (or were allowed by the HMO’s to dispense) was eye opening and heartbreaking to say the least. My most mind-boggling conversation from the middle of the road facility went something like this..ME: “Well, have we came to the same conclusion that as of now.. that is the only way proven to effectively treat this particular problem?”THEM: (Medical Programs Director): “Yes, I wholeheartedly agree with you. You are 100% correct.” ME: “Then why are you ignoring proven medical science and not treating as such?”THEM” Well because the HMO’s will NOT allow us to. ME: “Well why even bother then if you know what you are doing is not only dangerous, but ineffective.”THEM: “Well we have to do as they say or we will not get paid.” ME: “Is getting paid worth it if you are not being allowed to treat effectively? “THEM: “Again..we have no say anymore. It’s the HMO’s ,not US, who decide everything. Our hands are tied and we are literally fighting to even stay open.” I could on and on with probably 300+ links, reports and articles to read regarding what treatment standards should be, what is happening with HMO’s exerting almost zealous control, the dual-diagnosis field being placed in direct competition with the addiction community for funding, budget cuts, horror stories from the field, commission reports, blogs from angry and burnt out doctors and practitioners on the front lines, political manuvering, personal experiences, etc.However..I doubt anyone wants to discuss it. I think of what has happened in our medical world these past 10 years and especially in D&A treatment and I think those who do not have monetary means are doomed.Looking at your partner website with the RWJohnson confirmed this. Click on S Carolina’s top notch research center and you do not get in for free. The University of Penn which gets large amount of federal funding and grants(whom O’Brien “affiliates” himself with) entire psych department does not even take our insurance because as I was told..”They don’t pay anything.” (I appreciated the candor..rather than a fumbled excuse.) THE GROWING DISPARITY OF CARE AND TREATMENT OPTIONS IN OUR COUNTRY IS THE BIG PINK ELEPHANT THAT NO ONE WANTS TO TRULY ADDRESS SERIOUSLY. Then again, if you see what happened in New Orleans or even in Walter Reed..is anyone shocked to know that QUALITY cutting-edge drug and alcohol treatment is out of reach for most of us with low incomes?I see that no one is even discussing this. Even sadder.–Edited to Add…Well I see no one wants to address these concerns. I just spent hours on your linked site with TRWJ Foundation and I must repeat…there is no hard-hitting investigative push for the realites concerning the difficulties those without good insurance face.The only sentence I saw on both of these sites even broaching the whole mess was..”Medicare and state Medicaid plans provide some limited treatment services for those who are eligible.”I did not know whether to laugh or cry at the whole documentary and website section devised for getting treatment..like what to look for, what to ask, how the care SHOULD be,etc. Try telling this to my restrictive gate kept Medicare Advantage plan as they certainly would not appreciate me asking any of those questions! Consumer choice? Statistical data? Comprehensive treatment? I would love to be a fly on the wall with all of those Ivy League experts and agencies and see them try to deal with and/or them discuss these issues with my Medicare Advantage plan. This entire series is obviously devised for those with means AND choice…I think withholding the real truth about costs and dangling the best treatments and approache
    s to those who can never access them in real life is cruel and destructive in more ways than most people can even begin to fathom.

  3. I have seen two nights of “Addiction”. Though I am pleased with the way it portrays the raw truth of addiction and the effects on the brain, I am very dissappointed in the way that new HOPE found in these new scientific findings, with regard to addiction PREVENTION, is totally ignored.I am also dissappointed in the way “Addiction” appears to blame insurance companies for not giving better financial coverage for addictive diseases. I am no fan of insurance companies, but you need to know that addicts relapse frequently. With 3 or 4 stays in a rehab center, the medical bill mounts to about $100,000! If insurance companies begin to cover this lavish cost, YOUR personal insurance premium (or that of your employer) will double. There goes your raise for the next 5 years. There are plenty of outpatient treatment centers and free 12-step programs. There is no evidence to prove that inpatient treatment is superior in the long term.I studied this new NIDA information over a year ago and found that hope is found in how this information leads us to PREVENT addiction. Unfortunately once addicted, always addicted–though treatment can allow the addict to lead a functional life if he has a lot of motivation and gets treatment.For the blogger who said, “I didn’t become an addict until I was 45.” He is partially correct. What you don’t realize is that the addiction process virtually ALWAYS begins with the use of addicting substances before age 15 with the brain primed to become fully addicted. Circumstances later in life will sometimes trigger latent addiction which is manifested during adulthood. In the book, “Preventing Addiction: What Parents Must Know To Immunize Their Kids Against Drug And Alcohol Addiction,” you will see that addiction is an adult disease with a childhood onset. Addiction almost always occurs from child-rearing failures, whether through neglegence or ignorance.Therefore for those addicted, there is nothing to offer but a life of treatment through 12-step programs, but they will never be cured. On the other hand, every child is a potential addict, but as such every child is also a potential non-addicted person, if their parents will follow some simple, yet important concepts and techniques. Please consult http://www.johncflemingmd.com

  4. John5000,I came close to rejecting your comment as spam but decided not to because of the other content. I have two reactions to your post.First, you seem prey on the fears of parents (“…they will never be cured…every child is a potential addict”) and offer an unkeepable promise. (“…every child is also a potential non-addicted person, if their parents will follow some simple, yet important concepts and techniques.”) This sounds like the sales pitch of a 19th century tonic salesman.Second, on what do you base your comments on insurance parity? We have lots of information on the costs of parity. Large companies have implemented it, states have implemented parity laws, the federal government has provided parity for federal employees, and there have been several actuarial studies. Every study done on the subject has found that the actual cost of parity is far cheaper than everyone expected–typically resulting in a premium increase of less than 1%. As a physician, this is something you should be aware of.Here are some links:http://ncadi.samhsa.gov/workplace/insur/3.aspxhttp://www.rand.org/pubs/testimonies/2005/CT163.pdfhttp://www.mathematica-mpr.com/publications/PDFs/vtemployer.pdfhttp://www.rand.org/pubs/testimonies/2005/CT180.pdfhttp://content.healthaffairs.org/cgi/content/abstract/20/4/58

  5. I thought there was hope set forth in the documentary that will bring a new awareness to the population of addicts still suffering after failed attempts at abstinance based recovery. Many, many addicts don’t know that there is medication assisted treatment (MAT) for addiction so they consider themselves failures for lack of responding to the ‘traditional’ types of abstinance based treatments. I am glad that they labeled the 12 step support groups as support groups cause too many folks have been brain washed to believe that these support groups are treatment.Once we take a medical approach to addiction we will be able to rein in the long term negitive effects of addiction and help people move on to live full lives. This will free up resources in the community such as law enforcement and the community services that reach the destitute street addicts. Once they get on medication to quell the symptoms driving their substance abuse they can move on to impove their life situation. They will be able to avoid the traps in our laws that imprision people who abuse illict drugs for self medication.We have passed this way before with the immancipation of the institutionalized mentally handicaped patients in the 70’s. This group included alcoholics in many cases. It showed itself again for the folks who use to suffer a lessor quality of life due to depression, anxiety and certain phobias. Once it becomes mainstream to treat addiction as a diease, people will be able to comfortably stop feeding the stigma that exists.If ever the saying “the world is your oyster” holds true, it will manifest it’self thru medical and pharmactical intervention for addiction. Kerri

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