The American Society of Addiction Medicine (ASAM) defines addiction as a “primary, chronic disease of brain reward, motivation, memory, and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathology pursuing reward and/or relief by substance use and other behaviors. Addiction is characterized by the inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.”
So, in short, addiction is a chronic illness that leads to not just substance misuse, but also a change in thinking and behavior and ongoing issues regarding living a high-quality life.
In order to find recovery, treatment and recovery-related activities must be able to support change of not simply the substance misuse, but also the underlying issues resulting in the dysfunction in thinking, feeling, and behaving.
But to understand addiction more, let’s understand what chronic disease is, as there are many medical issues that are classified as “chronic” diseases. A chronic illness (or a chronic disease) is a long-term health condition. The CDC classifies them as “Chronic diseases are defined broadly as conditions that last 1 year or more and require ongoing medical attention or limit activities of daily living or both. Chronic diseases are the leading causes of death and disability in the United States.” Additionally, chronic diseases cannot be prevented by vaccines or cured by medication, nor do they simply disappear. In fact, in most cases, there are no cures for chronic disease, and they require long-term ongoing disease management.
Some examples of chronic diseases are:
- Heart Disease
- Cardiovascular Disease
- Multiple Sclerosis
So to understand addiction as a chronic health condition, it is imperative that people understand that there is no cure for addiction and that in order to achieve lasting, sustainable recovery, addiction requires appropriate long-term care, change in thinking, feeling, and behavior, and on-going disease management. This often appears in the form of addiction treatment and ongoing recovery support.
The issue, unlike most other chronic health conditions, is that those suffering from addiction are a resistant patient population. Unlike a cancer or heart disease diagnosis, where a patient would get their diagnosis, long-term treatment plan, and prognosis from a medical professional and then immediately engage in life-saving care, many that suffer from addiction do not believe that they in fact have a substance use disorder. They often require convincing. And even when they agree to seek help, often after a crisis, they often want to dictate the terms of their own treatment, negotiating levels of care, how long they are willing to engage in treatment, or prioritizing other life situations or circumstances (such as work, family, vacations, or education) above their own health concerns. Families too can play a part in these issues. The stigma surrounding addiction and mental health is so strong that many families find themselves in crisis, seek treatment for their addicted loved one, but then immediately begin to push their loved one back to work or school almost immediately. They want to know “how quickly” their child, spouse, or loved one can get back to college or back to work. Part of this is out of ignorance or lack of understanding of the nature of addiction, and part of it relates to the societal stigma surrounding addiction. Think about it: If your daughter was diagnosed with Stage 4 cancer, would you push for her to get back to school as soon as possible? Or would you tell her to take as much time as she needs to engage in treatment, to complete her treatment, and to find health (both physically, emotionally and mentally) before reengaging in school? Similarly, if you were diagnosed with heart disease, would you hide it from you job, or refuse to take time away from work to enter treatment? Would you say things like “I can’t get treatment for my heart disease because I can’t miss work?” Of course not, but often with addiction, a patient will negotiate their care, saying things like “I can’t let my job know” or “I can’t go away for 30 days, but I will do outpatient, because I need to work.” Again, part of that is due to stigma, as no job or boss would ever chastise an employee for seeking help for any other chronic medical issue. However, with addiction, it’s different. We hide it. We push our loved ones to get help, but immediately want them back to their everyday activities. We don’t allow those suffering the necessary time to overcome their addiction, because we worry that our other family members, or friends, or employers might find out about their substance use disorder and judge them or us. We don’t allow professionals to guide us in care that will ensure high success rates or recovery outcomes because such clinically appropriate long-term care is inconvenient to our daily lives. We fear telling our loved ones, our friends, or our employers of the issues that we are facing.
In conjunction with those issues, we must also understand that as a chronic illness, addiction requires appropriate long-term care. We don’t say to someone with diabetes, “Okay, now go away for 28 days and fix your diabetes.” We understand that such a chronic condition requires long-term care and ongoing disease management. However, related to addiction, we still believe that “treatment” = 28-day inpatient rehab. For too long, as a society, we have considered “addiction treatment” as that 28- or 30-day inpatient stay. We believe that “going to treatment” means going away for a month. However, like any other chronic illness, in order to ensure successful recovery outcomes, addiction treatment ideally must be through a comprehensive, long-term continuum of care. While every patient is different, and therefore may require differing or changing levels of care or might receive treatment through different access points (some may need residential treatment, some may start at an outpatient level), often that continuum begins with an inpatient or residential medical detox, followed by a 28- or 30-day inpatient or residential rehab stay. Next steps typically will involve a long-term extended care program (which may be a PHP or IOP program with a living component) or an intensive outpatient (IOP) program, potentially then followed by outpatient services, individual therapy and/or psychiatry, and/or a recovery home or sober living. Throughout this process, substance misuse issues must be addressed, but also addressed must be mental health or co-occurring issues, family and relationship issues and dynamics, trauma, attitudes, beliefs, behaviors, as well as life skills development, additional medical issues, and purpose-driven areas like education, vocation, or career paths. Throughout this entire treatment process, the patient should also, with guidance and support, begin engaging in and developing recovery support and community support systems (often in the form of 12 Step groups like Alcoholics Anonymous or Narcotics Anonymous, or SMART Recovery, Refuge Recovery, or Celebrate Recovery.) The entire biopsychosocial and spiritual aspect of life must be addressed, and issues must be uncovered, discovered, examined, and treated and then healthy coping systems, direction and purpose can be put in place of those old coping mechanisms. This is the ideal scenario in treating the chronic issue of addiction.
Like any other chronic illness, addiction requires long-term treatment, care, monitoring and support. We know what works. Long-term studies of medical professionals and pilots, that incorporated these aspects over 5-year studies, demonstrated 75-80% or greater recovery outcomes. So, we know that treatment works and long-term recovery is possible, but we must be willing to understand addiction for what it is: A chronic, progressive illness that requires long-term treatment, recovery support and ongoing disease management. If we change the paradigm from addiction being the problem of the induvial, a problem that is a moral failing or character issue, and a problem that can be “fixed” in 28 days, into an understanding that addiction is a chronic health condition that requires long-term care, we will begin to understand that true, long-term, sustainable recovery for individuals, families, and communities as a whole, is absolutely possible and the recovery rates will skyrocket. Not only that, but we will begin to see people truly finding a high-quality and purpose-driven life after addiction. We all need to be on the same page, with the same expectations, to make sure that those that need help not only receive it but receive it appropriately in order to overcome their addiction successfully and find happiness, purpose, meaning, and success.
If you or someone you know needs help for addiction or co-occurring disorder issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at email@example.com. For more information on all of our drug addiction, alcohol addiction and co-occurring disorder services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.