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RACHEL MARTIN, HOST:

Last year, more than 23 million Americans needed treatment for drug or alcohol abuse. Just roughly 11 percent of them actually went to rehab for their addictions. We're exploring addiction in today's show, and we're hearing from people with addictions to alcohol, to technology, even to food.

JAMIE KILSTEIN: I'm a 31-year-old man and my heart is racing like the first time I'm about to kiss a girl because I'm so nervous about ordering this food.

MARTIN: That's comedian Jamie Kilstein, explaining what it's like when he over-orders takeout. Isaac Viceburg is addicted to video games.

ISAAC VICEBURG: It gave me somewhere to escape to when, you know, I couldn't find anybody to hang out with, didn't have much to do.

MARTIN: He sought treatment twice for his technology addiction. And Ann Dowsett Johnston found herself to be a very different kind of alcoholic than her mother.

ANN DOWSETT JOHNSTON: I didn't crash cars. I didn't miss days of work. I didn't make those mistakes that would have been emblematic of my mother's drinking.

MARTIN: So, what exactly is addiction? I put that question to Dr. Charles P. O'Brien. He is the cofounder of the Center for Studies of Addiction at the University of Pennsylvania.

DR. CHARLES P. O'BRIEN: Addiction is a memory. It's a reflex. It's training your brain in something which is harmful to yourself. And we can see these changes in the way they react in brain imaging situations. So, we know, for example, if we have a former smoker or a former cocaine addict, if they've just been off of that drug for 30 days or so, the acute effects are gone. And then we show them pictures or odors or people that anything that's linked to their addiction, the brain automatically lights up. It's a reflex. They don't have to think about it.

MARTIN: Let's talk about treatments. Many people think of in-patient rehab or anonymous group meetings - Alcoholics Anonymous or Narcotic Anonymous - as the go-to treatment for addiction. Can you explain how those therapies help and whether or not there are any shortcomings to that kind of treatment?

O'BRIEN: In the 1930s, a doctor and a salesman founded Alcoholics Anonymous. I tell all my students that they should learn about the AA groups in their area. There are about a thousand in Philadelphia - a thousand different groups. And they should be proud of it because it's an American invention that doesn't make any money for anyone - it's free - it's not violent, and it only helps people. And unfortunately, AA groups contain well-intentioned people but they don't have the kind of information and training that they need to be good therapists. And I always refer all of my patients to an AA group as an adjunct, but it is not treatment.

MARTIN: So, let's talk about other forms of treatment. There are actual addiction medicines that you can take, right?

O'BRIEN: That's right. In the 1970s, it was the discovery of the endogenous opioid system, the so-called endorphins. Before the 1970s, no one even knew that these hormones existed. And what we discovered was that when alcohol enters the body, it activates endogenous opioids. So, some people have a very sensitive endorphin system, so when they drink alcohol, they become euphoric almost as though they've taken an injection of heroin. And they respond extremely well to a naltrexone, a drug that blocks the opioid receptors. We also have evidence from randomized trials showing that patient-treatment matching is in general the best way to go. So, that means essentially, you evaluate the patient, you find out about their problems - whether they're marriage problems, depression problems or whatever - and then you focus on that in addition to the drinking. So, patients are different, even though at its core, addiction is similar.

MARTIN: So, I hear you're saying you don't recommend drugs in isolation; they are part of the solution?

O'BRIEN: Absolutely. Absolutely. We have a medication now, for example, that you can give an injection and it lasts for 30 to 40 days. So, you only have to take it once a month. But I never recommend that this is it - you get your shot and go. No, you still have to get into the counseling program and even AA. I mean, you know, that's a combination that works best.

MARTIN: You have spent decades studying addiction. I wonder is there an outstanding question that still vexes you, something that is unanswered that could unlock a new dimension to understanding addiction?

O'BRIEN: Well, there are plenty of things. But one of the most vexing problems for me is to see all the progress that's been made and to see how little this has permeated the medical profession and the specialists that run the treatment programs. You know, there's a lot of rigidity in these therapists, and I think that something good is happening today since the people who framed the Affordable Care Act decided that all people with substance use disorders should be treated. And so these medications that I've just been referring to will all be covered by the Affordable Care Act, and that means that a lot of people will get treated. And I hope that doctors will begin to learn about the benefits of these new medications.

MARTIN: If you come from an alcoholic family, can you have a healthy relationship with alcohol? Or if you have been treated for alcoholism, can you still take a drink?

O'BRIEN: I think that, in general, the safest thing is to be totally abstinent. Now, what we've learned, based on scientific articles, is that going from being a very heavy drinker to just a moderate drinker is better for your health and for your behavior and so forth, but it's also risky. So, that those very heavy drinkers who don't become abstinent but rather just reduce their level of drinking, they're at a higher risk for slipping all the way back to the worst kind of drinking. So, I tell my patients that the best thing is to totally stop.

MARTIN: That was Dr. Charles P. O'Brien. He is the cofounder of the Center for Studies of Addiction at the University of Pennsylvania.

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MARTIN: We're going to have more on addiction coming up later on this show. You can share with us how addiction has touched your life by tweeting with the hashtag NPRAddiction.

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MARTIN: You're listening to NPR News.

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