Seven. That’s how many attempts it took Joseph Bryant to kick lifetime addictions that began with alcohol when he was just 10, followed by heavy marijuana use in his teens, and topped by a $700-a-day heroin habit in his 20s. After he served prison sentences for car theft and drug peddling, and as he took up residence in abandoned houses at the age of 27, he realized he had to change his life, or he would find himself, as he put it, “in jail for the rest of my life or dying on the streets of Baltimore.”

Bryant’s seventh — and last — try to overcome his addictions in 2004 couldn’t have been better timed.

Even as he bounced in and out of a string of ineffective treatment centers, innovative research and changing attitudes about drug addiction, treatment and recovery were starting to take hold.

New and effective medications now suppress drug cravings. Hospitals and treatment centers are making stronger efforts to prevent people with addictions from falling through the cracks as they are passed between institutions. And physicians, hospitals and private clinics have learned that treatment means not only medical attention but setting the stage — with social services, housing and job training — for a successful reentry into a challenging life without drugs and alcohol.

The strongest treatment programs have always offered a smorgasbord of services under one roof or connected critical lifelines for their clients, but the push now across the country is fueled by groundbreaking brain research in the 1990s indicating that addiction isn’t driven by weak character, loose morals or lax discipline.
 

While downing those first few drinks or pills may be a choice, 20 studies conducted over as many years indicate that, from there, genetics may take over for up to half of addicted Americans. In 1987, Brookhaven National Laboratory became the first research institution to use imaging to study brain changes in the aging, obese or addicted. Led by Nora Volkow, now the director of the National Institute on Drug Abuse, researchers at the Upton, N.Y., lab documented alterations in the brain linked to drug abuse, alcoholism or other impulse behaviors that suggested a genetic predisposition to addiction. Subsequent research, increasingly sophisticated, has made stronger connections between addiction and genetics.

The discovery, based on extensive medical study, has led to a growing sense that a connect-the-dots approach is needed at every turn to help people like Bryant, who has clearly benefited from his first comprehensive treatment plan — he’s been clean since that summer two years ago.

“It’s a good time to be addicted,” said Thomas McLellan, the founder and executive director of the Treatment Research Institute in Philadelphia, a research think tank that attempts to influence clinical practice and public policy through scientific and real-world studies. “The treatment is beginning to catch up with research. This will save a ton of money and, more importantly, lives.”

At the same time, the medical, addiction and treatment communities are paying attention to what’s called “the continuum of care,” a buzz phrase meaning addiction treatment and recovery – as well as the training of health-care professionals — that promises seamless experiences for patients who work with a variety of specialists on the way to their new lives.

McLellan and others do see an area of medicine that still languishes. The ties between doctors, hospitals and treatment centers are still disconnected in many communities. Tired stigmas and misconceptions about addiction hinder vital partnerships between institutions, and make it harder for patients to talk to their doctors about their problem.

Health-care providers also make it exceedingly difficult for people with addictions to get help; insurers severely limit coverage, leading to what amounts to a class divide in treatment. Affluent Americans can dip into their own pockets or tap into company benefits for services that can easily exceed $20,000 for treatment and ongoing recovery, while middle-class and poor Americans struggle to find financial help, or go without.

Addiction also gets relatively low priority in the medical community, starting with training. Though efforts to improve medical school curriculum are growing, a new generation of doctors still doesn’t get enough exposure to diagnosing and treating addiction. Dr. Jennifer Smith, a physician at John Stroger Hospital of Cook County in Chicago and a professor at Rush Medical College in Chicago, remembers receiving two hours of instruction in addiction during her four years of medical training in the early 1980s. The scenario has only slightly improved, she says.

“We’re not at a tipping point yet,” said Smith. “But we’re getting there.”

That’s important, because physicians, researchers say, are key in making the link between addiction and chronic disease, a connection that historically hasn’t been strong. While treatment and recovery centers, pharmaceutical companies, scientists and researchers all liken addiction to heart disease, cancer and diabetes, medical doctors aren’t applying the latest data to their patients.

“As a country, we took alcoholism out of the medical milieu,” Smith said. “For many years, addiction didn’t belong to doctors. This is changing with time.”

If addicts today stand a much stronger chance of getting and staying sober and clean, science is largely the reason. While environment and stress play a role, the studies indicate strong genetic and biological links passed through addicted parents make offspring more susceptible to addiction.

If your parents or siblings are hooked on alcohol or drugs, these studies concluded, you have a 50 percent chance of addiction; some studies put the likelihood of addiction as high as 70 percent. What’s more, once addicted, the part of the brain linked to the pleasure-reward system heightens cravings for the drug, so trying to stop addiction without treatment is near impossible.

Armed with the science, pharmaceutical companies have responded with three different drugs to combat the cerebral cravings: Buprenorphine, Acamprosate and Naltrexone. The drugs, available only this decade under a variety of commercial brands, are designed to curb or even eliminate cravings and minimize the side effects of withdrawal for both alcohol and specific drugs, like opiates, marijuana and cocaine.

The drugs alone don’t ensure successful recovery; they need to be part of a larger strategy, doctors say. But the new medications, taken over a period of days, months or years, have offered new hope.

For Bryant, one new medication provided the antidote to a string of failed recovery efforts, when, he says, previous treatment centers “didn’t pay attention to details. There was no one on one to help you find out why you were on drugs. Therapy was not available.” The new medicines weren’t available to him, either, so he tried slowly weaning himself off drugs. During one such attempt while he was in prison, the pain of withdrawal was so great that he ran head-first into the brick wall of his cell to knock himself unconscious.

On his last try, Bryant turned to an uncle in New York who enrolled him a Phoenix House treatment facility in Brooklyn, N.Y. What Bryant found there is everything researchers and social scientists recommend in a drug rehabilitation and recovery program — beginning with Buprenorphine.

The small orange pill, quickly dissolved under his tongue, eliminated Bryant’s cravings. The intense physical pain common to withdrawal was so minimal that Bryant found he could sleep through the night. “I could eat,” he said. “The hot and cold sweats, the chills — the drug minimized all of that.”
 

Within his first week of treatment, Bryant was off Buprenorphine and transferred from his detoxification room to a bed under the same roof, a logistical godsend at a critical time in treatment. Following his previous detox experiences, he had been sent to recovery centers often miles away; sometimes they had available beds, but more often Bryant had to wait two or three days. The interruption proved costly. That’s when Bryant invariably found himself back on drugs.

On the one occasion that he could immediately move from detox to a bed, he was told after 28 days that he was being discharged because another client needed the bed – and because his funds had run out. “Whether you are ready or not, you have to go. That’s one of the messed-up things about recovery. People look at it as a business.”

And treatment and recovery is a lucrative business. In 2001, the last year for which statistics are available, $18 billion was spent on substance abuse treatment, up from $11 billion in 1991, according to a study by the federal Substance Abuse & Mental Health Services Administration. In that same 10-year period, public sources like Medicaid shouldered the brunt of payment.

Bryant, for example, had to use Medicaid to pay for his treatment and recovery at Phoenix House, the nation’s largest nonprofit addiction treatment and recovery organization, which charges $19,000 a year. Drug-free for 18 months and in the last stages of his recovery program, Bryant still lives there, leasing a room for $15 a week until he saves enough money from his job as a carpenter to find his own place. Housing assistance is key in its recovery program, Phoenix House officials say, because the low-cost shelter allows people in recovery a solid shot at long-term stability as they piece together their lives.

After spending much of his life living on the edge, Bryant approaches his life these days with simplicity - and sobriety. “I take my life one day at a time,” he says.

 
New attitudes about taking responsibility, more support from psychologists and psychiatrists, assistance from job counselors and vocational training programs have ushered in a fresh mindset in the last decade at places like the Audie Murphy Hospital, part of the sprawling South Texas Veterans Health Care System in San Antonio.

“Before, we treated anyone for any reason,” said Dr. Ursula Sanderson, chief of the residential rehabilitation program. Maybe their habit had become too expensive. Or they were homeless with an addiction. Whatever the reason, Sanderson said, veterans with addictions showed up routinely at the clinic, appearing so often that the staff considered them “family” and welcomed them warmly.

“We would admit anyone as long as we had a bed,” said Sanderson. “We had a large revolving door.”

Gone are the days when people with addictions could simply walk into the clinic and check themselves in. Non-emergency room visitors are screened for possible substance abuse, and if there is no immediate health risk, addicted veterans are referred to a psychiatric unit or the health center’s detoxification unit.

 
During the typical month-long stay, days are more structured, crammed with meetings with doctors, psychologists or psychiatrists, nurses, job counselors and, when the time is right, job training and job placement. The revamped treatment and recovery program is more collaborative, more comprehensive.

“For one, the veteran was not participating,” said Sanderson of the old days. Now, she said, after developing a written statement of his life, he meets with a psychiatrist, a nurse, a psychologist, a social worker, a recreational therapist and even a chaplain, all in the same room, to design a lifestyle plan that will take him through recovery and reintroduction to society. “We establish pretty clearly where they are going to go,” said Sanderson, “and how they are to support themselves.”

Carlos Canales, 48, in recovery for a decade, has benefited from the hospital’s heightened sophistication. During his first stay in the mid-1990s, he remembers a strong sense that people were simply “warehoused.” Today, Canales said, “the caliber of care and the caliber of understanding of what it takes to care for people in this situation is greater.”

The Air Force veteran and former school teacher credits the services with helping him redirect a life that was waylaid for more than two decades to addictions of every sort.
 

He first began drinking beer at his San Antonio high school to “fit in” and to overcome his low self-esteem. By the time he graduated in 1976, he was drinking heavily. He joined the Air Force and added recreational drugs. Every chance he had, he either drank or did drugs — sometimes both.

“I wandered around in a self-medicated state for 22 years,” he said. “I did coke, heroin, pot, alcohol, whatever was accessible.”
 

In his late 30s, he knew was in trouble. He checked himself in to the veterans’ hospital, where he detoxed and began using the hospital’s growing array of services. Key to his recovery was the support from the Veterans’ Administration — “otherwise,” Canales said, “I would have ended up in a state hospital or prison.”
 

He still attends weekly support meetings at the hospital and the staff greets him by his first name, even though he hasn’t seen anyone there medically for four or five years.
 

“That’s pretty outstanding,” he says, of the staff’s attention to details. “I’m in good shape now, thanks to the hospital.”
 

The years of abuse and failed treatment took their toll, however. Canales has terminal liver disease.

(William Celis teaches journalism at the University of Southern California’s Annenberg School for Communication. He is a former reporter for The New York Times and The Wall Street Journal.)
 

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