Dr. Richard Karrel's Schools

• Northwestern University Medical School , Class of 1979 MD

Dr. Richard Karrel's Publications

• Sol Stein, Dr. Richard Karrel September, 2010 Publisher, editor, and author Sol Stein played a pivotal role in the development of American and international letters. Stein was responsible for more than two dozen works of nonfiction, fiction, and drama, as well as for the introduction of preeminent European authors to American readers; in particular, his influence as the head of Stein and Day Publishers cannot be overlooked. Born in 1926, Stein spent the first part of his literary and academic life at the City College of New York. After completing a tour of duty from 1945 to 1946, Stein completed his degree at CCNY and then received his Master of Arts in English and Comparative Literature from Columbia University. After he completed his Master’s degree, Stein was accepted to the renowned seminar run by Lionel Trilling and Jacques Barzun at Columbia, and he forged lifelong intellectual and personal friendships with Trilling and Barzun, as well as British poet W. H. Auden. Together, the four would later found the famed Mid-Century Book Society. In the early 1950s, Stein became a freelance General Editor for Beacon Press and brought in manuscripts by Richard Hofstadter, Bertram D. Wolfe, George Orwell, and Simone Weil. The year 1962 saw Stein and his wife, Patricia Day, establish Stein and Day. The publishing firm was one of the country’s most eminent in its 27 years of existence, first publishing works by Elia Kazan (an old friend of Stein’s) and then becoming the originating house for works by Dylan Thomas, Mary Cheever, Marilyn Monroe, Maxim Gorky, Che Guevara, and a score of others. Stein’s own work includes the novels The Husband (1969), The Magician (1971), The Resort (1981), and The Best Revenge (1991). A founding member of the Playwrights Group at The Actors Studio, Stein is the author of Napoleon (1953) and A Shadow of My Enemy (1957); he is a dramatic contemporary of Lorraine Hansberry, William Inge, and Tennessee Williams.

• Buprenorphine for Opiate Addiction, Dr. Richard Karrel July, 2011 by Dr. Richard Karrel, Medical Director and CEO of the Narcotic Management Program According to the National Institute on Drug Abuse (NIDA), about 2.5 million people in the United States are dependent on some type of an opiate. Around 1 million of those people are addicted to heroin, while the rest abuse other types of prescription painkillers such as Vicodin or OxyContin. These types of drugs affect opiate receptors in the brain, interacting with endorphins to regulate pain and emotions. With ongoing use, the brain stops producing its natural painkillers (endorphins) as they are replaced by opiate intake. This ultimately causes dependency on the external source of the drug. Opiate addiction is not a psychological illness or a character defect. Rather, physicians classify it as a central nervous system disorder because physical changes occur with ongoing opiate use. Since the 1960s, doctors have treated opiate addiction with methadone to reduce the narcotic cravings. More recently, physicians have focused on buprenorphine to relieve cravings with fewer risks and side effects. The drug, a synthetic opiate, received FDA approval in 2002 for use in addiction treatment. Clinical trials showed buprenorphine reduced or eliminated the effects of opiate withdrawal in dependent patients, sometimes as soon as an hour into treatment. This rapid reduction of the opiate’s impact allows patients to taper their buprenorphine use over time without the physical symptoms associated with withdrawal. Buprenorphine appears to be much safer than methadone. Trials have shown there is little overdose potential, and the medication does not cause the same euphoria or drowsiness as other opiates, eliminating any unwanted reinforcing consequences of the drug. Additionally, buprenorphine has anti-opiate properties, negating the effects of other opiates when patients take them while on the medication. This may prevent the danger of a return to use of the addictive substance. Addiction specialists have experienced tremendous success using buprenorphine as part of a comprehensive treatment plan for opiate dependence, making it the medication used in many treatment centers.

• A New ASAM Definition of Addiction, Dr. Richard Karrel October, 2011 By Dr. Richard Karrel As a longtime member of the American Society of Addiction Medicine, I am interested to see recent changes in the organization’s definition of addiction. ASAM has clarified that addiction cannot be classified as a strictly behavioral problem that involves an excess of “alcohol, drugs, gambling or sex.” Rather, the new definition highlights evidence that presents addiction as a chronic brain disorder. The crafting of this new definition was spearheaded by former ASAM President Dr. Michael Miller, who saw redefinition as an opportunity to dispel public perceptions that addiction is primarily a social, moral, or criminal issue. When people witness friends or family members suffering from addictive behaviors, they often focus on the problematic behavior rather than the root cause. While many criminal, immoral, and socially destructive behaviors are driven by addiction, the disease of addiction is centered in the brain and in underlying neurological problems. ASAM’s addiction redefinition process spanned four years, reflecting the input of more than 80 professionals actively engaged in addiction treatment and research. This included public and private sector medical clinicians, neuroscience researchers, and addiction authorities. In addition, the full governing board of ASAM and several states’ chapter presidents were involved in developing a new definition for addiction. A novel aspect of this definition is that addiction is now described as a primary disease, rather than being symptomatic of psychiatric or emotional problems. In addition, addiction is now characterized as chronic in nature, placing it in the same category (in this respect) as diabetes or cardiovascular diseases. ASAM’s action reflects a broad consensus among addiction specialists that the past 20 years of progress in neuroscience should be reflected in a new definition of addiction. In particular, addiction has been demonstrated to affect neurotransmission, leading addictive behaviors to take precedence over healthy ones. Memories of food, sex, drugs, and alcohol often alter and circumvent the brain circuitry that regulates impulse control, which can trigger renewed addictive behaviors. This is particularly true for individuals who were exposed to drugs and alcohol throughout their formative teenage years, when addiction-forming areas of the brain were still developing. ASAM’s redefinition in no way takes away from the important role that choice plays in seeking help for addiction. What it effectively does is to bolster and give legitimacy to research and treatment of addiction as a primary disease. About the author: One of the first U.S. physicians to gain certification from the American Society of Addiction Medicine, Richard Karrel, MD, serves as Medical Director of the Narcotic Management Program in Louisville, Kentucky.

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