Requiring a person with heart disease to wait for treatment is impossible to imagine. It just wouldn’t happen. And, yet, people with a different chronic disease – the brain disease of addiction (aka substance use disorder) – experience this situation ALL THE TIME.
Not only that, trying to figure out where to go or take a loved one in the downward spiral of addiction, a spiral that can result in death, is overwhelming. And then, there’s the cost and what is and is not covered by insurance and the lack of understanding of what a person is supposed to look for in order to treat addiction that can slam the door shut on the moment the person with addiction has decided they need help.
And don’t even get me started on the notion that a person has to hit bottom before they can treat their addiction or that the first line of defense – a person’s primary care doctor – generally has little medical understanding, let alone medical school training, on how to screen for addiction based on symptoms and then make a referral to a medically trained addiction-specialist (of which there are few), the same way they’d screen and refer in the case of diabetes, heart disease, or cancer.
Would we even think of telling a person with diabetes, heart disease, or cancer, “I’m sorry, you haven’t hit bottom, yet, come back when you have.” Or, “Sure, we’ll take you, but no we don’t have a medical, science-based, treatment protocol in place, nor do we have the medical team that can diagnose and treat your chronic, often relapsing brain disease (the one that may be co-occurring with a mental disorder), but we do have peer support group meetings, comfortable accommodations, a top-notch chef, yoga, and exercise programs.” Now don’t get me wrong…all of the latter are definitely components of a treatment plan that can work for some people. And let me also be clear here, millions of people have succeeded in recovery from addiction through participation in a 12-step program or another peer support group. But like treating diabetes, heart disease, or cancer, it may take a medical evaluation and using the latest scientific research to best treat the complexities of addiction (aka substance use disorder) as it presents in other individuals, and for that reason, we must be aware of these complexities. There is no single way a person develops addiction, nor is there a single way to treat all people who have it. (See resources in next section).
And something else to understand, relapse can be part of this disease’s treatment/recovery process, as is true for diabetes, heart disease, or cancer. If, for example, a person with one of these other three chronic diseases relapses (has another heart attack or their cancer returns or they go into a diabetic coma), they are never blamed and told, “Sorry, you must not have wanted it (recovery) badly enough.” Instead, their treatment program is revised because what s/he has been doing isn’t working for them any longer! This same approach must be taken to effectively treat addiction.
Treating Addiction Like Other Chronic Diseases
Disease is something that changes cells in a negative way. When cells change in a body organ, the health and functioning of that organ changes. In the case of lung cancer, for example, cancer cells in the lungs change the health and functioning of the lungs. Addiction changes cells in the brain, which in turn changes the health and functioning of the brain. Given the brain is the organ that controls everything a person thinks, feels, says and does, and develops as the result of contributing risk factors and brain developmental processes that influence that particular person’s brain wiring and mapping, it is now understood that addiction is a complex brain disease. But it is a disease and like other chronic diseases, it’s treatable.
One of the difficulties for accepting this disease model of addiction vs. lung cancer are the symptoms. With lung cancer, the symptoms might be a cough (often with blood), chest pain, wheezing, and weight loss. The symptoms of addiction include: lying, cheating, verbal/physical/emotional abuse of loved ones, neglect, denying the use or blaming someone or something else for the use/misuse, drinking or using huge quantities of other drugs (far more than “normal” people), and repeatedly breaking promises to stop or cut down. These symptoms make it very difficult to feel sorry for or want to help the person exhibiting them.
So what can we do?
The same thing we do with other chronic diseases. We turn to the latest science and medical research and recommendations to understand the disease and learn what it takes to treat it. And like other chronic diseases, we accept there is no one, nor right, way to treat it. What works for one person may not work for another, and generally it’s a combination of things that can help. And like other chronic diseases, we accept that a relapse doesn’t mean treatment failed, it means treatment needs to be adjusted.
And like other chronic diseases, we take the 3-stage disease management approach to treatment:
- Stage 1: detox/stabilization
- Stage 2: acute care/rehab
- Stage 3: long-term continuing care.
In other words, we do what we’d do for the person presenting with a heart attack, which is: stage 1: stabilize the heart; stage 2: conduct a thorough medical evaluation to determine the best course of action – a bypass, for example, and then we conduct surgery (acute care) and keep them in the hospital while they get used to their new heart (rehab); and stage 3: send them home with a continuing care plan that may include medication, exercise, diet modification, therapy around their fear of it happening again, AND we monitor them, and if something goes wrong, we adjust their treatment, and we NEVER blame them for the reoccurrence. This is not to say everyone with addiction (substance use disorder) needs to go into detox for their stage 1 or into residential rehab for their stage 2 to be considered “in treatment.” Rather it’s the idea that treatment and recovery is a process that involves all three stage concepts.
As you’ll read in the next section in NIDA’s “Principles of Effective Treatment,” there are many ways to treat addiction. The point, here, is that addiction – a brain disease – is not treated (healed / fixed) in 5 days or 28 days. Neither is heart disease, diabetes, or cancer. That’s because addiction is a complex brain disease that needs attention and care that will likely vary over time but needs to happen over time. As I stated above, there are risk factors and brain developmental processes that contribute to a person developing addiction. These include:
- genetics (one can’t help their genetics but it explains a big piece of the puzzle of how one person develops addiction and another does not when both are using/misusing the same amount – in fact, genetics is 40-60% of the reason a person misusing alcohol or other drugs goes on to develop addiction);
- childhood trauma (verbal, physical, emotional abuse, neglect…for some this is also ACEs – adverse childhood experiences) which resulted in toxic stress, which can change a child’s brain wiring (brain architecture), and if not addressed during treatment and continuing care is often a trigger to relapse);
- social environment;
- mental disorder (also a brain disorder and one that needs to be addressed if it’s still present [co-occurring] so as not to be a relapse trigger to use/misuse because of the mapping of the substance as a soother of the symptoms of the mental disorder – 40% of persons with a substance use disorder [addiction] have a co-occurring mental disorder); and
- early use (the brain developmental processes occurring from ages 12 – 25 are deeply influencial in the development of addiction in the person misusing alcohol or other drugs during this time).
Then you add the characteristics of addiction (in other words, what makes it different than abuse): tolerance, physical dependence, cravings, and loss of control that also need to be addressed, and you can more fully appreciate what I mean – it’s complex 🙂
This is not meant to be gloom and doom because another little known fact is that more than 23 million Americans are in recovery from their substance use disorder (addiction)! Rather it’s meant to help people understand the complexities of treating this brain disease. The same complexities that present when treating an individual’s heart disease, cancer, or diabetes.
And we can do this now – treat addiction the same way we’d treat other chronic diseases.
The science is available, but it’s recent so not widely known. In fact, most of the addiction-related scientific findings are within the recent 10-15 years. To help you zero in on this research explaining the science of the brain disease of addiction (aka substance use disorders), check out the Executive Summary of The U.S. Surgeon General’s Report on Alcohol, Drugs, and Health, NIDA’s Drugs, Brains, and Behaviors: the Science of Addiction, and the American Society of Addiction Medicine (ASAM)’s Definition of Addiction. And for the latest on what comprises effective addiction treatment, check out NIDA’s Principles of Effective Treatment and ASAM’s Treatment for Alcohol and Other Drug Addiction. For help finding a medical practitioner trained in addiction medicine, check out the American Board of Addiction Medicine, whose mission is to provide “assurance to the American public that addiction medicine physicians have the knowledge and skills to prevent, recognize, and treat addiction.”
Over 20 million Americans are struggling with addiction (aka substance use disorders) and only 10 percent are getting the treatment they need. This 20+ million figure is 1.5 times the number of people who are living with all forms of cancer (meaning the people who got the diagnosis and treatment they needed to live). But it took new scientific discoveries and new treatment protocols based on that science to achieve the success rates with treating cancer that we see, today.
We finally have that for treating addiction. We just need to spread the word to make it widely known – treating addiction is like treating other chronic diseases. Most importantly, we don’t make the person seeking treatment or the family member trying to help them, wait.
One of the consulting services I provide is helping people become educated consumers of addiction treatment. For details, please email me at lisaf@BreakingTheCycles.com
©2016 Lisa Frederiksen