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You are here: Science of Addiction > Addiction is a Disease > A Chronic Disorder

Treating Addiction as a Chronic Disorder

Drug "dependence" is a chronic medical illness comparable in its etiology, presentation, course, and treatment response to other chronic medical illnesses.    “The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. . . A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders.” 

Suggested Readings:
The Journal of American Medical Association: Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation
A. Thomas McLellan, et al.: Is Drug Dependence a Chronic Medical Illness: Implications for Treatment, Insurance and Outcome Evaluation

“All chronic treatments, regardless of disease, share three important features. First, they can usually remove or reduce the symptoms of the disease, but cannot affect the root causes of the disease. For example, beta blockers reduce blood pressure and insulin improves the body’s ability to digest sugars and starches, as long as the affected individual continues the treatment. However, these treatments do not return the affected individual to normal. 

The second feature associated with all chronic treatments is that they require significant changes in lifestyle and behavior on the part of the patient to maximize their benefit.   Again, even if individuals with diabetes regularly takes their insulin as prescribed, this will not stop disease progression if they do not also reduce sugar and starch intake, increase exercise and reduce stress levels.   

The third feature derives from the first two. Because of the complexity of factors that can lead to a chronic illness and because of the need for ongoing medical care and lifestyle change, it should not be surprising that relapses are very likely to occur in all chronic illnesses. For these reasons, most contemporary treatment strategies in chronic illness involve regular in-person and/or telephone monitoring of medication adherence, coupled with encouragement and support for pro-health changes in diet, exercise and stress levels.  Increasingly, family members are being trained to also provide continued monitoring and support for the behavioral changes necessary to maintain symptom remission and sustain good quality of life (White & McClellan, 2008).

Suggested Reading: Counselor Magazine: Addiction as a Chronic Disorder

Because of the relapsing nature of a chronic condition, what does Managing Addiction as a Chronic Condition involve? Historically, addiction treatment systems and research have been organized to provide and improve the outcomes of acute episodes of care. The conceptual model has been that an addicted person seeks treatment, completes an assessment, receives treatment, and is discharged, all in a period of weeks or months. This orientation stands at variance with clinical experience and studies conducted over several decades, which confirm that, although some individuals can be successfully treated within an acute care framework, more than half the patients entering publicly funded addiction programs require multiple episodes of treatment over several years to achieve and sustain recovery (Dennis et al., 2005; Dennis, Foss, and Scott, 2007).

Suggested Reading: Addiction & Clinical Practice: Managing Addiction as a Chronic Disorder

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