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Health Notes: Addiction Treatment; Palliative Surgery - 2001-07-25

Addiction Treatment

Drug and alcohol addictions are serious problems. Illnesses, in fact. But a recent study shows that more than three-quarters of people with serious drug or alcohol problems fail to seek treatment. Public health officials and treatment specialists believe that may be because many people don't realize that treatment for addictions is just as effective as treatment for other chronic conditions, such as asthma or diabetes.

Now, an American organization that works with communities to help reduce substance abuse has developed a new initiative to help educate the public. Janice Ford-Griffin is deputy director of the organization, "Join Together". She says the new initiative is called "Demand Treatment."

"'Demand Treatment' is a new 'Join Together' project that will support and highlight comprehensive, strategic approaches to increasing the access to quality treatment throughout the nation," she says.

Ms. Ford-Griffin says it's important for community leaders and citizens to demand easy access to treatment programs for people addicted to drugs or alcohol. She says the first step is making people aware that recovery from addiction is possible.

Palliative surgery

Palliative surgery is any surgery intended to relieve symptoms or provide comfort to a patient rather than cure the disease.

Dr. Betty Ferrell, a research scientist at City of Hope National Medical Center in Duarte, California, has studied the effectiveness of palliative surgery and explains how it works.

"For example, if a woman has initial breast surgery and then, a few years later, the cancer returns. She might have a new tumor that's within the chest and it's pressing on nerves or bones. And so it's causing a lot of pain," she says. "We would be aware that she's not going to be cured. That, in fact, she likely will die of her disease. But the surgery will be intended to eliminate the problem, to provide her with relief from the pain."

In her research, Dr. Ferrell has found that surgeons must weigh the potential benefits of palliative surgery against the potential hazards.

"We know that all the things that have the potential of helping the patient also have the potential of doing harm to the patient," she says. "So, if a patient's going to undergo surgery, then the surgeon and the patient need to weight the positive things and the negative things. We would want to really evaluate what is the surgical risk, what is the likelihood that the patient might either die from the surgery or complications of the surgery, or what is the risk that the surgery could create new problems that would make things worse, not better."

Sometimes, she says, physicians face real ethical dilemmas when trying to decide whether or not to conduct palliative surgery.

"We did a survey of about 400 cancer surgeons last year in the United States," says Dr. Ferrell. "We asked the surgeons what were their greatest ethical dilemmas. The number one conflict was providing the patient with honest information while not destroying hope. Another one of the highest rated dilemmas was conflicts between the patient and his family. So, you know, maybe you have a family who's saying, 'We want everything done [to help the patient],' but maybe you have a patient who's tired and they say, 'I really don't want to go through another surgery…just let me go home and whatever time I have remaining, I'd rather spend it at home.'"

Dr. Ferrell says the goal of her research is to try to assist surgeons in making the best choices with regard to palliative surgery and, in turn, helping their patients do the same.