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Treating Addiction as a Chronic Condition

The American Psychiatric Association (APA) and the World Health Organization (WHO) define addiction as a chronic tenacious pattern of substance use and related problems.

According to the National Institute of Drug Abuse (NIDA), drug addiction is similar to other chronic diseases such as type 2 diabetes and cardiovascular disease. It also shares many features with other chronic illnesses including a tendency to run in families (heredibility), an onset and course that is influenced by environmental conditions and behaviors, and the ability to respond to appropriate treatment which may include long term lifestyle modifications.

Years of research have shown us that addiction is a brain disease that, like other chronic diseases, can be treated effectively. However, successful treatment may need to incorporate several components, including detoxifaction, counseling, and in some cases the use of pharmacological therapies. Multiple courses of treatment may be needed for the patient to make a full recovery.

Usually when an addict gets to treatment it is at a time of crisis. The traditional medical response is to provide treatment based on an acute model of care, but it may be time to shift to a chronic disease management approach. Several NIDA funded studies have addressed this question. Researchers cite decades worth of clinical experience and previous studies that affirm that substance use disorders typically follow a chronic course, often developing during adolescence and lasting for several decades. The result of several studies show that over 50% of people who resolve drug problems following treatment receive multiple episodes of care, usually over several years.

According to recent research conducted by the Office of Applied Studies (OAS), among people in publicly funded addiction programs in 2003, 64% were reentering treatment-23% for the second time, 22% for the third or fourth time, and 19% for the fifth or more time.

In one study the estimated median time from first use to at least one drug-free year was 27 years. The median time from first treatment to one drug-free year was nine years.

Despite knowledge of this trend, the results of a study from 23 states revealed that only 17% of persons discharged from intensive treatment were transitioned to outpatient continuing care.

Successful treatment systems and interventions should be able to address the long term aspects of the disorder. Unfortunately, the traditional acute care approach to substance use disorders has encouraged a cultural consensus that those receiving treatment for addiction should be cured following a single episode. This has encouraged policymakers and insurers to limit and restrict public health dollars and the number of treatment visits covered-despite economic evaluations indicating that costs for a full continuum of care were offset by significantly greater reductions in social costs over a similar time period.

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