by Lisa Frederiksen
You have probably been told something like, “Alcoholism / drug addiction is just like any other disease.” After which you have probably said to yourself or to whomever made the statement, “Like *!?!#! it is! People with diabetes or heart disease don’t steal money from me or endanger my children by driving while under the influence!” And, that’s because diseases like heart disease and diabetes are not brain diseases. They do not cause chemical and structural changes in the areas of the brain a person needs in order to think straight and act responsibly.
Addiction and other diseases, like diabetes and heart disease, share common characteristics true of all diseases:
- They are chronic .
- They have the potential to result in death if untreated.
- There is a genetic influence associated with vulnerability.
- They involve behavioral factors associated with the onset of the disease.
- They have the potential for relapse if treatment recommendations are not followed.
These similarities explain why effective addiction treatment requires a “disease management” approach, as opposed to an acute care approach (i.e., “28-days and you’re good to go”). While the components and deliveries will vary, because no single treatment component is appropriate for all individuals at all times, the overall objectives of a disease management approach to addiction treatment should involve three phases: 1) detoxification/stabilization, 2) rehabilitation and 3) continuing care.
So how did we get so stuck in the acute treatment model?
Secrecy and shame.
How many addicts/alcoholics and/or family members/friends with a loved one who has a problem with substance abuse actually talk about it — talk about it as they would if they or their loved one had cancer?
The founding of AA provided the first wide-spread effort to view excessive drinking as something beyond a “lack of willpower” and to approach treatment from the perspective of abstinence – not drinking any alcohol. Its fellowship viewed alcoholism as a “combination of physical, psychological and spiritual causes,” a combination that made alcoholics different from non-alcoholics.
AA provided a guide for how a member of its fellowship could achieve abstinence and a joyful life through its 12-steps and The Big Book. It proved to be life-changing then and continues to be life-changing now for the millions who grapple with alcoholism – today understood as one of the diseases of addiction. However, AA could not overcome the shame in which society had so thoroughly shrouded the problem, a shame so powerful it forced alcoholics to recover from their disease in anonymity, hence the name, Alcoholics Anonymous.
Treatment options for drug addictions took even longer. Narcotics Anonymous (NA) meetings patterned after AA did not appear until the early 1950s, and its guidebook, Basic Text, was published long after that.
Not until the early 1980s, with the co-founding of the Betty Ford Clinic by Former First Lady Betty Ford, did seeking treatment at a residential facility for alcohol and drug addictions gain public recognition. Today, there are more than 11,000 addiction treatment programs in the United States, according to the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Awareness Services (SAMHAS). And organizations, such as the American Medical Association, the National Institute on Drug Abuse, the World Health Organization and the National Institute on Alcohol Abuse and Alcoholism, are making significant advances in the prevention and treatment of alcoholism and drug addiction.
Yet, these major inroads have not been enough to overcome the secrecy and shame in which society has so thoroughly shrouded the problem. As a consequence, alcoholism and drug addiction continue to be misunderstood diseases. They continue to be diseases people try to conquer on their own or to recover from in anonymity for fear of the reprisals they may face socially, at school, in the workplace or within their extended families.
Thankfully, the new brain and addiction-related research is exploding our long-held beliefs about alcoholism and drug addiction being a matter of “choice.” Finally we can end the secrecy and shame! Finally, we can treat addiction (to alcohol or drugs) for what it is — a chronic, often relapsing brain disease. But first, we must TALK ABOUT IT!
