A Therapeutic Community
The Florida Recovery Center provides a safe haven and a living laboratory for addiction research
by Cindy Spence
The young doctor was on the road to ruin, drinking secretly in his garage after tucking his children into bed and abusing medications obtained with bogus prescriptions. He was an addict, his marriage troubled, his career in jeopardy. Then his state’s medical society ordered a detour, to the UF&Shands Florida Recovery Center.
Waiting outside Medical Director Scott Teitelbaum’s office for a final word of encouragement, he is one of the first “graduates” of the center’s new campus, a unique place where treatment, research and education converge for one of the most comprehensive approaches to addiction medicine in the United States.
On this, his 94th and final day in treatment, he talks about the journey ahead, a ride to the Orlando airport and a plane trip halfway across the country, as well as the longer road beyond that: recovery. The future is uncertain, he says, but at least now he may have one.
Teitelbaum turns him loose, knowing all too well that the measure of the young doctor’s success is likely years away.
“There is the beauty of recovery, the miracle of recovery, but there is tragedy, too. Not everybody gets better,” Teitelbaum says. “But there’s always hope.”
The Florida Recovery Center’s campus, dedicated in July, represents a $6 million investment in hope, Teitelbaum says. The site is a former Marriott Residence Inn and will house up to 120 patients when fully renovated. The 10-acre campus is serene, with palms and moss-draped oaks, and facilities such as a pool, a sports court, a barbecue area and a laundry. Suites accommodate two or three patients and other buildings house group therapy and offices for doctors, researchers and medical students. The location, minutes from the UF Health Science Center and Shands Hospital, also allows health professionals to participate in educational programs.
Before July, the center was scattered between rented apartments and office parks where, Teitelbaum says, “no one wants you. Being next to a treatment center for people with drug and alcohol addiction is almost as bad as being next to a garbage dump or a nuclear power plant.”
The new campus felt different right away. Patients not only go through therapy together, but they live together. Conversations spring up, connections are made simply doing laundry or chatting on a balcony late at night. The magic of recovery can happen in a gathering beside the pool. Before, Teitelbaum says, patients might leave a heart-rending therapy session and walk out to a parking lot to see hostile stares. On campus, patients have each other and a support system.
“Healing is about pain, but also hope. You want a milieu that’s conducive to recovery,” Teitelbaum says. “Here, we have a therapeutic community; that’s what we have by having a campus.”
Demand for addiction medicine treatment, research and education has grown, as addiction has been identified more as a factor in many illnesses. Today, more than 50 percent of preventable causes of death are related to addictions, according to Mark S. Gold, chair of the UF Department of Psychiatry in the McKnight Brain Institute. Gold’s accolades befit his status as a pioneer in addiction medicine. He is a UF Alumni Distinguished Professor, a UF Distinguished Professor, the Donald R. Dizney Eminent Scholar and has published dozens of books on addiction. He remembers a different approach to addiction four decades ago.
“When my career started, you couldn’t admit alcoholics to the hospital,” Gold says. “Today, addiction is a disease.”
The Florida Recovery Center rests on a foundation Gold began laying in 1990, when he joined the UF College of Medicine faculty. Teitelbaum laughs when he thinks back to the day he showed up in 1997, as Gold’s fellow, to find the noted addiction researcher ensconced in an office in the cancer center, reflecting an early focus on addiction and smoking.
“It was just him and me,” Teitelbaum says.
But Gold was already riding a wave of discovery in neuroanatomy. He has been responsible for breakthroughs in “state-dependent memory,” showing that students who use amphetamines to study will need amphetamines again to recall the material. He proved that opiates alter brain function, and he holds a patent for a drug used for opiate withdrawal. His work on cocaine addiction showed that chronic cocaine use causes depleted dopamine levels in the brain, leading to new treatments. Gold’s work has also determined that proximity to addictive substances can lead to addiction, for example, in children exposed to secondhand smoke or medical workers exposed to anesthesia in an operating room.
“Today we have evidence that drug use changes the brain,” Gold says. “All drugs of abuse have the same effect on the brain. All cause the fatal attraction.”
Gold’s work attracted other researchers and physicians, and today the UF addiction medicine faculty is one of the largest in the nation with 12 members, and another 12 to 15 researchers working in addiction medicine.
Still a pioneer, Gold is advancing addiction medicine with research into second- and third-generation effects of opium smoking among populations in Afghanistan and much-talked-about work on food addiction, which is among the treatments offered at the Florida Recovery Center. Although some experts have been reluctant to put food in the same category with alcohol or narcotics, the nation’s obesity epidemic is making more and more scientists receptive to considering food addiction, says Gold’s colleague, psychiatry Professor Sara Jo Nixon.
“As our understanding of how the brain works and responds to stimuli has matured, we have to consider that there are other things — not just alcohol or cocaine — that create this disruption in the reward system, so that this thing has undue value, value it shouldn’t have,” Nixon says. “If you look at people who are really driven by food, their response to food is very much like an alcoholic’s.
“There’s some very interesting brain data looking at activation patterns, that supports food addiction.”
Nixon says the center’s residential campus makes it possible to ask and answer more questions about addiction and recovery — for example, what kinds of sleep disruptions occur with addiction and how to address sleep to promote recovery.
Patients, doctors and non-doctors alike, are encouraged to attend grand rounds, generally designed for doctors to educate doctors. Nixon says a recent talk she gave on women and addiction prompted a dialogue not only from a woman in the audience but also from a physician in South Florida, who had tuned in over the Internet.
It’s exciting, she says, to see more attention to a condition that used to be swept under the rug. Impaired health professionals, in particular, need reassurance that it is OK to seek treatment.
“What does being impaired mean for a health professional?” Nixon asks. “Does it mean I don’t make very good decisions about drinking and drug use? OK, I can handle that. But are you saying there is something wrong with my brain? That could mean I couldn’t practice; the implications are huge.
“We train professionals that you can’t be weak, you can handle anything, you’re smart, look at all the stuff you got done, that somehow being smart protects you. Being smart doesn’t protect you.”
Lisa Merlo, an assistant professor of psychiatry and director of research for the Professionals Resource Network, a program that monitors impaired health professionals in Florida, says many professionals report being relieved when their addiction is caught. A new study being developed to study wellness among medical students aims in part to make asking for help acceptable.
“Addiction is still very stigmatized within the lay community as well as the medical community,” Merlo says. “People would rather deal with it on their own, but they’re almost never successful doing that.”
Merlo, who moved her office to the campus, says the health professionals receiving treatment there report that the environment is key. Being surrounded by other health professionals reduces their shame, and seeing those ahead of them succeed gives them a role model. For many health professionals, community 12-step programs like Alcoholics Anonymous are not comfortable.
“You can’t go to a community AA meeting and talk about stealing your patient’s drugs — that’s not going to go over well — even in an AA meeting,” Merlo says. “But here you can talk to other health professionals who understand.”
Merlo says recovery rates are high for health professionals, with 80 percent back to work with no relapse five years after treatment. Monitoring programs help, because relapses can be caught early and treatment resumed. In another study, Merlo hopes to determine whether success rates remain high when monitoring ends.
“There is a distinction between just being sober and being in recovery,” Merlo says. “There is a shift in mindset.”
Until recently, physician abuse of prescription drugs was five times greater than in the general population. With the rise of pill mills, the general public has caught up, creating an epidemic. Part of the problem, researchers say, is that potent narcotics previously prescribed only for cancer pain now are prescribed more frequently.
“You can have a dental procedure and walk out with a prescription worth hundreds of dollars on the street,” Merlo says. “If you have minor surgery and only need two pills, and you have a prescription for 30, that’s a lot of pills out there available to be misused.”
Educating doctors about the potential for addiction is an important part of curbing the pill epidemic. UF has the largest addiction medicine fellowship program in the country and requires all medical students to do a two-week addiction medicine rotation. A doctor doesn’t have to practice psychiatry to run into addiction, Gold says. In every medical specialty, addiction shows up, often as the cause of other medical problems like heart disease, lung cancer and cirrhosis of the liver.
Teitelbaum has seen firsthand the need for education. He is both medical director and object lesson. In the early 1990s, he was a successful pediatrician, the doctor moms called after hours in his Connecticut town. By 1995, he was struggling with addiction, doing yard work, raking pine straw in Mississippi, his family and career lost. His first attempt at rehab that year failed, but he tried again, and in 1996 recovery began in earnest.
Sixteen years later, Teitelbaum says recovery is a daily goal.
“When somebody comes into the emergency room with a heart attack or diabetes, the doctor may say, ‘You need to change the way you live, lose some weight, diet, exercise more.’ If that person comes in six months or a year later after a second event, we don’t kick them out and say, ‘You’re a failure.’ We say ‘OK, here are some things you did right, that’s good, but here are the things you haven’t done that you need to change.’
“My treatment in 1995 would look like a failure. But I had begun to begin a recovery program, so was it a failure? No, it wasn’t,” says Teitelbaum, who attends meetings and keeps a copy of The Big Book of Alcoholics Anonymous handy. “I stay grateful, I remember the pain I felt in my heart. I still do the things today that I did to begin to get well years ago.”
Addiction, he says, is an illness that offers the possibility of a healthier future.
“If you have heart disease or cancer, the worse you are when you come in, the worse your prognosis,” Teitelbaum says. “Not so with an addictive disorder. There’s always hope.”
Eminent Scholar, Department of Psychiatry
Assistant Professor, Department of Psychiatry
Sara Jo Nixon
Professor, Department of Psychiatry
Medical Director, Florida Recovery Center
Food for Thought
For some, the famous potato chip slogan “Betcha can’t eat just one” isn’t a wager — it’s a promise.
This idea, that food can be as addicting as drugs, cigarettes or alcohol, is the focus of the new book Food and Addiction: A Comprehensive Handbook. The book, co-edited by UF addiction expert Mark Gold, is the first to compile academic essays examining the scientific evidence for food addiction.
The medical community has only regarded food addiction seriously for the last decade, the authors say. Backed by brain-imaging studies and multidisciplinary research, it’s finally a concept many specialists are willing to sink their teeth into.
However, since the topic stretches across multiple disciplines — nutrition, addiction, psychology, epidemiology and public health, to name a few — the experts in these fields were largely unaware of each other. That is, until Gold and Yale public health and policy researcher Kelly D. Brownell decided to bring together the work of many of these researchers and publish their findings.
“It’s like an encyclopedia of experts,” says Gold, chair of the College of Medicine’s Department of Psychiatry.
Brownell, director of Yale’s Rudd Center for Food Policy & Obesity, and Gold chose contributors whose expertise ranged from policymaking to a variety of scientific disciplines.
“The merger of public health and policy with neurobiology and translational medicine is a unique aspect of the book,” says Gold, a distinguished professor in the McKnight Brain Institute. “We wanted to include a wide variety of specialists, as well as to give people on the policy side access to basic science so their policy initiatives might be more evidence-based.”
For example, basic science has confirmed that certain foods target the brain and have drug-like qualities.
“Food and drugs compete in the brain for the same reinforcement sites,” Gold says. “Drug-addicted people, once they stop using drugs, always overeat. People who are stressed or in pain overeat. And they don’t just eat anything — they eat desserts, pizza or other reinforcing foods that have drug-like effects.”
Food has changed, and so has our access to it. About two-thirds of U.S. adults are overweight, according to the Centers for Disease Control and Prevention; but Americans also consume more processed food per person than citizens of almost any other country. In countries where fast food is gaining popularity, obesity rates are similarly exploding. In China, the rate of obesity has increased 208 percent since 2002, according to the World Health Organization. Scientists have very little understanding of how all of this manufactured food affects our brains, Gold says.
“We’ve shown that animals will selfadminister sucrose, glucose and fructose corn syrup, and they will become dependent on those as if they were drugs,” he says. “You can even cause them to have drug-like withdrawal.”
Gold says it’s important to educate the medical community that addictions, including food addictions, are diseases and that blaming patients is not an effective strategy for helping them.
“We’re in a ‘globesity’ epidemic — a global obesity epidemic — and I think public health approaches and preventions are relevant,” Gold says. “If food is very much like tobacco and the health impact and cost are very much the same, what’s the public policy?”