Nora Volkow's Disease Model Analysis

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Nora Volkow, MD stands out for laying the groundwork that dopamine is a pivotal player in addiction. She is Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH). Her groundbreaking work led to our understanding that addiction is strongly influenced by the release of dopamine in the brain and spinal cord.
This “disease model” of addiction is not universally accepted (http://bit.ly/1K3AvnM). However, as we learn more about the science of addiction, the disease model takes a firmer hold as the correct model. It is a model I firmly believe in, both from my readings and my clinical experience.
Another model is that addiction is narcissism. The need to get “high” is a means to reduce the insecurity that
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It’s now two months, and I still don’t feel like my old self. What is wrong?
Your doctor was mostly right. There can be a complication know as Post-Acute Withdrawal Syndrome or PAWS (http://bit.ly/1cAP6uB). We don’t know why PAWS develops. Symptoms include insomnia, anxiety, restless legs, fatigue, depression, and difficulty with concentration. Symptoms gradually fade over time, but can last six months or longer. Most addicts do not experience PAWS.
My doctor said that treatment with methadone or buprenorphine was harm reduction. You classify them as treatments leading to recovery. Who is right?
Both of us are right! Physicians who support abstinence-based treatment would view methadone and buprenorphine as harm reduction strategies.
From my perspective, if methadone and buprenorphine are used for a limited time and then discontinued, I would classify their use as treatments leading to recovery. If they were to be used indefinitely, then I would reclassify them as harm reduction strategies.

Do physicians over-prescribe
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However, there is an increasing propensity to use buprenorphine. Your doctor will complete a risk-benefit assessment using the latest evidence-based medical information to provide options for the best course of action. Your preference is important in deciding a course of action.
How are newborns affected by methadone or buprenorphine?
Babies born to expectant mothers on methadone often experience prominent withdrawal symptoms immediately after birth known as neonatal abstinence syndrome. Symptoms are much like those experienced by an adult, such as irritability, difficulty with sleep, nausea, vomiting, and diarrhea. Infants may require medications to ease symptoms of withdrawal. With buprenorphine, there seems to be a reduced likelihood of a problematic withdrawal, but it can develop.
Expectant mothers should be under the care of a high-risk obstetrical clinic to provide the opportunity for increased observation and testing, such as more frequent office visits, sonograms, and blood tests.
Babies born to mothers using either methadone or buprenorphine ideally should be monitored in a neonatal unit that specializes in high-risk

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