Maine has a serious drug problem, and we’re seeing only half of it.

We continue to lead the nation in prescription opioid addiction per capita. Police say that heroin is now “flooding” Maine, undercutting the price of prescription drugs. Intravenous overdose deaths quadrupled between 2011 and 2012, while orally administered prescription opioids — chillingly known as “painkillers” — are responsible for three-quarters of the fatalities. Total drug overdoses have surpassed automobile accidents as the leading cause of accidental death.

And that’s not all. Unsterile needle use for intravenous heroin is associated with multiple, potentially deadly, infections such as hepatitis C and B, HIV/AIDS, syphilis, tetanus, septic thrombophlebitis, skin abscesses/cellulitis, brain abscesses, osteomyelitis, pneumonia and endocarditis.


According to the Maine Alliance to Prevent Substance Abuse, alcohol and other drug abuse in Maine costs Maine $1.4 billion a year, or $1,057 for every state resident.

The problem has been studied from every angle, but we are missing something that’s very important.

I have treated more than 20,000 addicted patients during 42 years of medical practice as a military physician, medical director of three hospital-based dual-diagnosis programs with medical school appointments and in private practice.

In almost every case of addiction I have seen, regardless of the substance, I have found pre-existing and undiagnosed conditions such as depression, anxiety or bipolar disorder. Usually, it’s these conditions that brought on the addictive behavior in the first place.

But when a patient comes in for drug treatment, he gets treatment for his addiction and only his addiction. When it comes to treatment in Maine, the caboose is pulling the train.

The traditional addiction model was summarized by Dr. Eric Nestler in 2013: “At its core, addiction involves a biological process: the ability of repeated exposure to a drug of abuse to induce changes in a vulnerable brain that drives the compulsive seeking and taking of drugs, and loss of control over drug use.” Generally, adolescence represents the most sensitive time for a still-developing brain to be susceptible to drug use.

Traditional addiction treatment couples programs such as detoxification with Alcohol Anonymous-style self-help groups. For more than 80 years, these programs have rescued millions of lives worldwide. However, a scathing June 2012 report from the National Center on Addiction and Substance Abuse states that “51.8 percent of (programs) don’t assess co-occurring mental health disorders.”


Addiction treatment programs commonly miss that individuals attempt to “drown out” varying degrees of misery using alcohol and/or other drugs. Misery triggers addiction with a phenomenon known as “self-medication.” Mind states such as depression, anxiety, irritability and impulsivity can result from pre-existing and undiagnosed mood, anxiety and/or attention-deficit/hyperactivity disorder, causing pain that the sufferer tries to numb with drugs, including alcohol.

Usually, multiple addictions and disorders are present in every patient, and addicted individuals are rarely aware of these underlying disorders.

Self-medication addiction treatment includes diagnosis of these pre-existing disorders, appropriate medication use and individual talking therapy, supplemented by (with informed consent) couples, marital or family therapy.

The comprehensive dual-diagnosis model and treatment integrates the “traditional” and “self-medication” models and treatments. Both are necessary to understand and treat addiction.

Pre-existing and undiagnosed disorders should be searched for as part of every evaluation of every addicted person, adolescent, adult or elderly. It is as much a mistake to treat the addictions and ignore the underlying disorders as it would be to treat the underlying disorders and ignore the addictions.

It’s a problem that can start young and last a lifetime.


A recent study determined that one in four Americans who began using any addictive substance before age 18 became addicted, compared to 1 in 25 Americans who started using at age 21 or older. Thus, parents need to frequently tell their children and adolescents not to begin smoking, drinking or using other drugs. Fear of upsetting parents is the biggest reason kids don’t use drugs.

But this is not a problem for drug treatment specialists alone. Approximately 80 percent of Mainers and other Americans go to primary care practitioners — physicians, nurse practitioners, physician assistants — and receive evaluation for addiction and treatment when needed.

These practitioners also should identify and treat underlying mental health disorders or refer their patients to addiction and psychiatric physicians to do so. If pre-existing mental health disorders still remain undiagnosed, then addictions likely will worsen.

How many more millions of lives could be rescued, worldwide, if only this comprehensive dual-diagnosis model and treatment became routinely implemented by health care professionals?

Dr. Robert Blaik practices dual-diagnosis psychiatry in Portland.

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