Published in The Doctor Weighs In, February 20, 2017. View the article here.
“Groundbreaking discoveries about the brain have revolutionized our understanding of compulsive drug use, enabling us to respond effectively to the problem .” 1
I have hope that someday we will live in a world where the above statement, from the National Institute on Drug Abuse, is true, particularly where we respond effectively to the epidemic of substance dependence across our nation (i.e., the problem).
However, despite almost a century worth of study, those who suffer from severe substance use disorders or addiction continue to be a marginalized population in our communities. This marginalization takes the form of continued stereotypes and myths about addiction, as well as what I consider unfair and unethical legal penalties for non-violent drug offenders. Another profound way those who suffer from addiction are marginalized is our collective snubbing of information, based on the science of addiction and recovery, on how to provide effective treatment for those who suffer.
Scientists have done their part and taught us that addiction is a chronic disease of the brain. According to the National Institute on Drug Abuse,
“As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior. We have identified many of the biological and environmental factors and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Scientists use this knowledge to develop effective prevention and treatment approaches that reduce the toll drug abuse takes on individuals, families, and communities.” 1
Despite our knowledge that addiction is a chronic disease, treatment providers and third-party payers (i.e., insurance companies) continue to treat the problem using acute care, or short-term models. For example, most insurance companies provide 28 days of coverage for addiction treatment. Some may extend treatment for 90 days which includes outpatient treatment, but these cases are rare. And, most disconcerting, the vast majority of people who meet the criteria of severe substance dependence do not have the resources to access treatment at all.
Continuing to treat addiction acutely is like stabilizing a diabetic patient in the hospital, giving them 30 days of insulin, and then sending them home to attend support meetings with other diabetics.
Nothing against peer support meetings, which I fully believe in, but it isn’t quite enough. If we treated the chronic disease of diabetes from this kind of acute model, we shouldn’t be surprised when the diabetic comes into the emergency room in a diabetic coma and/or needs emergent care continually. This makes absolutely no sense to anyone, would cost more money, and has terrible patient outcomes. Yet, this is how we continue to view and treat addiction sufferers.
The very nature of chronic diseases, like diabetes and addiction, is that they are always complex, moving targets that continue across a lifetime, and need consistent monitoring and support. Implementing chronic care models (or CCMs) to combat chronic diseases not only saves and improves the quality of life for individuals and families, it also saves money and resources for everyone over time. Proponents of CCMs advocate for a “ redesign of healthcare to provide continuous, coordinated multi-faceted systems of health service delivery.”2
A redesign is exactly what we need.
What would happen in a world where a chronic care model was applied to the chronic brain disease of addiction? In my estimation, implementing this type of model would have three important impacts.
I still hope that someday we live in a world where our “groundbreaking discoveries” about the chronic brain disease of addiction are translated into treating and supporting addicts and those who love them long-term. Extending the continuum of care long-term would have a substantial impact on individuals, families, communities, and our nation as a whole. If we continue to treat addiction through acute care models, we will continue to get the same devastating and epidemic outcomes.