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Pinsky: A hijacking of the survival system

Dr. Drew Pinsky is a specialist in treating addiction.
Dr. Drew Pinsky is a specialist in treating addiction.

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(CNN) -- In a statement during his nationally syndicated radio show Friday, Rush Limbaugh acknowledged an addiction to prescription pain medication. The conservative commentator also said, "I am checking myself into a treatment center for the next 30 days to once and for all break the hold this highly addictive medication has on me."

Dr. Drew Pinsky, an addiction specialist, spoke with CNN anchor Miles O'Brien about what Limbaugh is facing in terms of the drug, OxyContin, and beating addiction.

O'BRIEN: They call it "Hillbilly Heroin" in some parts of the country. [Abuse of] OxyContin is a real problem. Just give us a sense, though, from your perspective as somebody who deals with people who are addicted to these kinds of things, how big an uphill battle does Rush Limbaugh face right now?

PINSKY: Well we're really talking about opiate addiction. And it doesn't matter if you're taking OxyContin, Vicodin, Lortab, heroin or codeine. It's all the same disease and it has basically the same biology.

It is the form of addiction with the highest recidivism. The biology, the biological grip of the disease, is profound. The withdrawal is miserable and painful. And it takes a long time to recover. Treatments are drawn out. [Addicts] need to stay engaged in intensive, highly structured treatment.

In my opinion, it's unrealistic to expect somebody to get significant recovery or a high probability of success from opiate addiction without three to six months of intensive treatment. The 30 days is really just getting things started.

I think we should wish [Limbaugh] well. Who wants this disease? It's the disease that comes upon [people] often accidentally. These are common medications that are prescribed. If you have a history of alcoholism or addiction in your family and you're prescribed that for a period of time, eventually that switch gets thrown in this disease, and you're off to the races.

O'BRIEN: Is it a physical addiction, a mental addiction or a little bit of both?

PINSKY: Addiction is addiction is addiction. You can either stop or you cannot. ... There's an activation of a 'reward system' in the genetically prone individual that alters permanently the motivational priorities of the brain.

It is literally a hijacking of the survival system, whereby the brain begins confusing the actuality of survival with the chemical message of the drug. So people with this disease ... will literally die to get the drug, do anything to get the drug without really consciously realizing this is what's behind the behaviors.

There's a lot of controversy in my field about how to treat opiate addicts because it is such a profoundly powerful disease that's there's a school of thought we shouldn't even try to treat them. We should just put people on methadone or buphrenorphine or one of these replacement chemicals and just call it a life; just put them on chronic replacement.

I don't think somebody like a high-level, high-functioning professional would take that option. I hope to hell he doesn't. ...

That's committing to somebody to really, in my opinion, chronic disease.

I suspect this will -- [his] coming forward with his disease -- create dialogue about what kinds of treatments are appropriate. I've seen miracle recoveries. I've seen people become better than they ever knew they could be after having suffered this disease. And I have no doubt that he could achieve the same.

I think putting him on methadone, which is a very difficult drug to stop using, would be a travesty.

O'BRIEN: Let's talk a little bit about OxyContin. We've been talking about [OxyContin addiction] being an emerging problem. Can you give us a sense of how big a problem it is nationwide?

PINSKY: It is exceedingly common. Vicodin, hydrocodone, this has been a longstanding problem for those of us who work in the field of addiction. OxyContin is basically just a way of giving a more powerful, high dose of the chemical -- the same kind of opiate chemicals.

O'BRIEN: You know there has been some criticism of the company that makes this, Purdue Pharma.

PINSKY: It's a mistake to blame the product, because it's an excellent product. If you're a cancer patient, you're thanking God it's available.

O'BRIEN: You've referred to this earlier: The rate of failure in attempts to break oneself of this is very high.

PINSKY: Opiates, specially, very high. ... The first step is to keep them abstinent from these substances so the brain mechanisms themselves can heal. There's literally a sort of a settling down of this process. Then we engage them in an emotional dialogue with other of their peers that helps them, again, slowly, in an experience-by-experience basis, rewire some of these mechanisms that allows their brain to integrate better.

It's a complex process, and that's about the simplest way to explain to it you. But the first thing is really getting off the drug and letting the biology settle down.

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