An Interview with Dr. David Sack

Dr David Sack“Treating addiction requires more than treating someone’s brain chemistry,” according to David Sack, M.D., noted Addiction Psychiatist and CEO of Promises Treatment Centers. Addiction is not a problem that arises in a vacuum. Most people who abuse drugs have psychiatric symptoms that begin long before their drug use. “Treatments for drug or alcohol dependent individuals that rely solely on pharmacologically altering the brain’s reward system are destined to fail in a large majority of cases,” says Dr. Sack.

Dr. Sack’s current approach to drug and alcohol treatment has evolved over his more than two decades in the field. As the Medical Director at a private psychiatric hospital in the 1980’s, Dr. Sack observed that clients who had both a psychiatric disorder and a substance abuse problem were much more likely to relapse and be re-hospitalized than other patients.. This problem was exacerbated by the fact that most psychiatric facilities at that time failed to provide specific treatment for drug and alcohol problems. In response, Dr. Sack created a clinical treatment model for patients with co-occurring psychiatric and drug or alcohol related problems and also served as the basis for one of Dr. Sack’s first research articles. After working in a variety of different treatment and research settings, Dr. Sack was determined to develop programs that would move beyond the revolving-door phenomenon and address patients whose problems were too complex to be treated on an outpatient basis but did not warrant being locked in a psychiatric facility.

Dr. Sack’s goal at Promises focuses on helping people transform their lives. To do this, though, requires giving the patient a reason to stay once they enter treatment. “Most people who start treatment are very ambivalent,” explains Dr. Sack. People enter treatment under a lot of pressure from work, family, health, or legal problems. Patients may feel desperate or hopeless, but they may also be very angry about having to make changes in their lives. In the early days of drug and alcohol treatment, the first week was very confrontational and the process was demeaning. Treatment providers used to believe that clients would not get better if he or she had not made the choice to start treatment. Research has shown that this simply is not case. “Most people are sitting on the fence about stopping drug use when they enter treatment. They are asking themselves how much better will their lives really be if they give up using drugs,” says Dr. Sack. “Rather than criticize clients for being unready to change, Promises helps clients work through their ambivalence so they can begin to choose what their lives will be like.”

Promises combines this open-arms approach with the use of integrative medicine strategies to make people more comfortable in that initial period of ambivalence. By addressing the physical discomfort, fears, and doubts that clients experience while going through detoxification, Promises removes the hurdles that prevent people from staying in treatment. From day one, the treatment process involves identifying the individual client’s challenges and needs and then providing treatments that bring all the resources that are available to help that person. Dr. Sack’s philosophy does not assume that any one technique is capable of solving all of someone’s issues, and what sets Promises apart is the depth and breadth of experience within the clinical teams.

Dr. Sack emphasizes that while our knowledge regarding the causes of addiction and effects that drugs have on the brain has increased dramatically over the last twenty five years, treatments have not yet caught up.

There is the need for identifying new chemical targets in the brain that will help in treating addiction along with a treatment model that recognizes people in treatment will probably always need treatment. The medical and self-help communities need to explore new ways to keep people sober because neither medicine nor social support alone is enough. Despite these needs, there are new and promising developments too. Dr. Sack gives the example of the exciting strategy of vaccines for addiction, and early experiments for a cocaine vaccine are already under way.

“Promises has been a leader in addiction treatment and will continue to make original contributions to the field going forward,” said Dr. Sack. “We hope our work will result in clinical treatments that fully integrate new medical discoveries with the traditions of recovery that emphasize accountability, honesty, and commitment to serving others.”

There is still hope.

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