The controversy is real—some believe wholly and unconditionally that addiction is a chronic disease while others believe it’s a condition purely made up of mental weakness. For advocates of addiction as a chronic disease characterized by distinct periods of relapse much like diabetes or asthma or, even cancer, the current means and methods of treatment that are offered simply don’t add up.
Think about it—we all know someone with a chronic disease; diabetes, asthma, cancer, arthritis—there are tons of these diseases. But there’s a very distinct difference between how all of these chronic diseases are treated and how addiction is treated.
What happens when an individual with diabetes has a setback? They go into the hospital, they receive around-the-clock care, they are discharged and continue to receive long-term follow-up care until they are stabilized. The patient is provided a plan of treatment that will help him or her to prevent a future relapse that lands them back in the hospital, and, IF the patient follows the treatment plan, chances are good that they will not relapse—at least not for quite some time.
Likewise, chances are, even with the correct treatment plan in place to prevent another diabetic episode, at some point relapse may still occur. So what does the healthcare team do to help prevent this to the best of their ability? They get proactive. They encourage regular checkups. They encourage proper dosing and monitoring of blood sugar. They encourage proper diet and exercise.
And the patient walks away with a positive chance of staying on top of the chronic disease.
But what happens when an addict seeks help?
Addiction is a chronic disease—right?
So, then why does an addict receive distinctly different care than that of someone suffering from any other chronic disease such as cancer, or diabetes or asthma?
Here’s what the typical treatment regimen looks like for an addict:
The individual overdoses and lands himself in the hospital. Because he entered the hospital as an overdose patient, nurses and doctors shun him and treat him like garbage. His medical care is often subpar because the medical team knows that the overdose occurred as a result of his own desire or decision to use.
But how does this differ from that of a diabetic who lands in the hospital because he ate too many sweets and didn’t properly monitor his blood sugar?
Both mistakes are just that—aren’t they? Mistakes.
The treatment for the addict continues on. He is discharged from the hospital as soon as he’s stable enough to leave and the medical team may (or may not) recommend that he seek further treatment for addiction.
Chances are the health insurance will only cover a small portion of his treatment, to take place in a detox facility over a period of up to 7 days. Then what?
IF the addict is lucky, rich, or has super great health insurance, and IF the addict has the support of loved ones, and IF the addict is strong enough emotionally to accept that additional help is needed, he may enter a rehab program where he will receive up to 90 days of treatment and will likely be discharged as a “healed” man.
But wait? Didn’t we mention that chronic diseases are characterized by relapse? Didn’t we mention that even a diabetic that follows ALL of the rules of his prescribing doctor and medical team could relapse and land back in the hospital? Didn’t we mention that the individuals suffering from these other “chronic” diseases receive long-term follow-up care to ensure their best possible chance for recovery?
So why then is the addict faced with the challenge of receiving subpar treatment and inadequate follow-up care? Addiction IS a chronic disease, isn’t it?
Unfortunately, treatment for addiction is heavily focused on methods of care similar to those used to treat acute health problems such as an injury or episode of illness that are expected to heal and diminish over a short period of time.
As long as addiction treatment focus is on acute care, versus chronic or long-term care, the addict is going to suffer from constant, acute, situations of relapse and will not have any real chance of recovery. Addiction is a chronic disease, and it requires treatment that uses a chronic-care model much like the treatment models needed for other chronic conditions such as cancer, diabetes and arthritis.
How Can We Shift the Paradigm?
The shift from acute addiction treatment to chronic care will require that treatment professionals, medical teams, support networks and the community to band together to eradicate addiction. But how?
- Educating patients so that they don’t feel like they are “finished” with treatment as soon as they complete a detox program or a standard 30 day treatment plan. Treatment for a chronic disease is never really “finished” or complete. Once we get patients to accept that they must continue to take steps to minimize their relapse risks, we’ll begin to see fewer instances recurring relapse.
- Putting an end to rehab graduation ceremonies and similar programs that lead patients to the understanding that they are “done” with treatment. While we must recognize the hard work and effort that a patient puts into recovery, we must also not hinder their understanding that recovery is a lifetime journey, it doesn’t end with “graduation.”
- Changing care methods so that ALL care is covered by insurance—not just detox and not just a set time of treatment. Addiction treatment takes time—and the amount of time that it will take for each patient to recover and be ready to exit treatment varies. Insurance companies should recognize that 7 days in detox simply is NOT enough time for anyone to recover from addiction.
- Eliminating treatment admission questions such as “how many times have you been in treatment?” Who asks that of a diabetic or an asthma patient? Addiction is a chronic disease, which means there WILL be multiple cases of treatment, why ask how many?
What Is Chronic Addiction Treatment?
Optimal treatment for addiction should mimic that of the treatment plans for any other chronic disease. The intensity of the treatment must match the intensity of the symptoms that the patient is suffering at a given time. This means that a patient may receive inpatient treatment for one episode and he may receive outpatient treatment at another episode. The care will follow patient needs at each given time in the recovery process.
Ongoing monitoring, much like any other disease, will be crucial to recovery. Perhaps the patient receives a quarterly or semi-annual visit with a counselor to provide a “check-up.” Why not? This type of care is routine for diabetics and for cancer patients, why not make it routine for those suffering from addiction?
Routine check-ups or check-ins with a counselor or therapist should be the norm for someone in addiction recovery. These should take place for at least 5 years following treatment and longer if relapse occurs.
If we shift, to a model in which we treat addiction like we treat every other chronic disease, we will likely see more people in recovery and fewer at the peak of their relapse suffering from overdose and other serious complications as a result of this disease. This is where long-term, sustained recovery begins.