Embracing the idea of addiction management
I believe basic truths in life get repackaged in unique or creative ways throughout time, resurfacing in books, self-help strategies, stories, movies, or movements. When these things come on to our radar seemingly for the first time, we either embrace them and they become big hits, or we reject or dismiss the ideas because the timing is off - our society is not yet ready.
How to deal with addiction is one of these “basic truths.” Although mankind has behaved in excessive ways for centuries, only in the past couple-hundred years has society evolved the idea of excessive behavior being called “addiction” and requiring intervention. And, only in the past 5 to 10 years has society been ready to accept the basic truth that addictions are problems that we manage over long periods of time, similar to other chronic conditions. In 1955 the book Management of Addictions was published, offering a collection of treatment approaches for alcohol and drug abuse problems. Although the interventions outlined in the book provide significant evidence for how far we have come in our treatments, what I find most interesting is that over 50 years ago a collection of healthcare professionals embraced the idea of “management” in dealing with addiction.
Yet today, we give lip service to addiction being a chronic condition and still largely treat it as an acute problem, where average treatment stays can be measured in days or months. At an addiction treatment conference not long ago, I was frustrated by the complete lack of discussion about how to transform our current acute-based system into one that truly embraced addiction as a chronic condition. It was the elephant in the living room, yet folks went on and on about this ear and that toe…little incremental band-aid solutions to treatment - completely ignoring the opportunity to truly talk about how we might improve care for millions through systems-level change.
I don’t blame them. We have invested a lot in our current system, and many have built careers around the status quo. But the time is right to envision a new treatment enterprise that truly embraces addiction as a chronic condition and wisely utilizes resources to optimize long-term patient outcomes. Idealistic? Maybe so, but the status quo presently sees less than 10 percent of those in need of help, staff turnover in treatment programs is higher than in the fast food industry, and of those fortunate enough to have access to treatment, most do so multiple times. We can and we must do better.
What does it mean to manage addiction? We know manage is a verb that implies action. So, what actions are necessary to get us where we need to be, both with our treatment system and in helping individuals who struggle? Here are a few things to get us started:
- We know multiple treatment episodes are costly because often patients require intensive services (detox, residential, transitional housing, etc.) upon each admission. We should find creative ways to incentivize or reward treatment providers who can keep patients in treatment for years, decreasing costly hospital admissions and residential stays.
- We need to leverage technology and the fact that over 70 percent of folks in the U.S. have high-speed Internet, and many of those who don’t, can still access it now in many public places. Recent evidence suggests that computer-based treatments may be as effective as individual or group counseling. Are human counselors soon to be replaced by robots? Likely not, but there is little doubt that in the years to come computer/Internet-based interventions will play a critical role in healthcare delivery.
- Addiction treatment providers (and patients) should beg, steal (ok, maybe not steal), borrow, utilize, and adapt management interventions from diverse disciplines. Significant research has been devoted to the topic of how best to manage chronic conditions, such as the chronic care model. Let’s not reinvent the wheel, but seek out what others have done, and bring practical, useful, easy-to-implement behavioral management tools to those who need them now.
It’s your turn. What can we do to start transforming our current acute-based addiction treatment system into one that is similar to how primary care treats other chronic medical conditions? What self-management or disease-management tools do you believe are the most helpful? How might we package these tools to make them more accessible to the 90 percent who presently are on their own to deal with addiction?
No problem this big gets solved one clinician at a time. There are too many variables, too many invested parties and too much red tape. Our profession has recently just won the right to bill insurance in all 50 states…this took time. It also took a large population of professionals to join together, write letters, donate money and time to ensure that, through the legislative process, counselors received the same benefits as MSW’s. The NAADAC’s website states it supports a comprehensive approach, yet still identifies specific substance abuse without addressing overall addictive behaviors. NAADAC’s legislative committee even asks for funding that only addresses substance abuse without taking a holistic account of the disease.
$1.847 billion – Substance Abuse Prevention & Treatment Block Grant
$472 million – Center for Substance Abuse Treatment (CSAT)
$210 million – Center for Substance Abuse Prevention (CSAP)
$1.064 billion – National Institute on Drug Abuse (NIDA)
$464 million – National Institute on Alcohol Abuse and Alcoholism (NIAAA)
$441 million – Safe & Drug Free Schools/Communities
Based on this information I must assume that our society and addiction professionals are not ready for a holistic approach of addiction management. Addiction is the number one public health issue in the United States today. According to the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA), approximately 22.2 million people aged 12 or older needed treatment for an alcohol or illicit drug problem in 2003. Of those 22.2 million people – almost 10% of the US population – only 1.2 million received treatment for their disorder. Unfortunately, for our society the addiction problem may only get worse. Until we truly all get on the same page our fate looks bleak.
Response to “jryan says: October 26, 2009 at 10:36 am”
Your idea of adding social skills type classes into our school system is great, great and superb! Merely training students academically is setting them up for failure. Knowing how to read the periodic table of elements will avail you nothing when you get laid off the job and someone offers to get you high to take your mind off of it. This is program that would surely be beset by attackers on all side if introduced at the next PTA meeting. “Teach my kid about crack, prostitutes and finances?! Its my kid. I’ll tell them about them when it right and proper!” is something along the lines this program would be met with. But with time and patience it can see the light of day. Training our children to not only become a great student, to nurture their emotional I.Q and skills to be a better citizen in our society will only help us all in the long run.
Shannon’s post rings true because it addresses the fact that we as humans often and in many ways do not care for each other, and at times it feels like participation in this culture is hinged upon adopting uncaring attitudes towards people. For instance, how often do we “tune out” homeless people on the street, because there are so many of them and we can’t give them all money, so we might as well pretend we are blind to their issues, and their very existence. The sad part to me is, given this world we’re in, many of us find addiction to be an adaptive way of participating in the culture. It is possible to be successful with an addiction, in fact, I’d say sometimes addictive behaviors, such as womanizing, can help facilitate the versions of extreme power we see played out by “Great Men” who rule the world, who embody what seems to be a destructive power.
You asked what ideas we had about transforming our acute care model to a chronic care model for managing addiction. I don’t know of any specific interventions that would be most ideal, but the one thing that came to mind was the idea of providing a wide “menu” of options for people to choose from. If people are needing to manage a condition for the long term, they are going to need options that will work for them and that they are comfortable with. There also needs to be an opportunity to review their treatment plan frequently as their needs change over their lifetime of managing this condition.
I was really interested in the Internet-based interventions that were mentioned in the post. This seems like a great option to give people as part of a “package” of interventions, especially for people with various barriers to accessing more traditional treatments.
What sort of Internet-based interventions have been discussed in the literature?
Managing my addiction
This goes back to dealing with addiction as it really is to me. It is a chronic addiction that relates back to my childhood experiences. I have to every day do certain things that will allow me to stay drug free. I have to manage an addiction that never goes away. It has gotten less loud or less prevalent in my consciousness. I woke up every day and had to tell it to get out of my way. That No! I did not want a hit of dope or that I didn’t want to die or kill myself. Sometimes my addiction would be like a curtain that I had to push aside so I could start my day.
Then the daily work of managing my disease could begin. I would have a cup of coffee and cigarette and then I could meditate for about 30 seconds if I were lucky to be able to sit still that long. But I would make a connection with my god. I don’t smoke anymore so I don’t do that particular thing and I don’t have to shove my addiction out of my way anymore either. I would do plenty of 12 step meeting. I went to therapy. I exercised and I went to school. I was told early on that management of this disease was about mind, body and soul. To live with it, I would have to develop a program that would deal with all three.
Management today is about staying in touch and connected with my spiritual self. I have been relieved of the urge to use for the most part. It is a fleeting thought if it ever does sneak into my thoughts. I work hard at my recovery today. My life is about staying free of the power of my addiction. I do many things to keep it managed. It works though. I have been clean for 8 years consecutively and for all but two weeks out of the last 15 years. It is why I am alive.
This post has received so many really good comments, I am not sure what more I can add other than to share what changed in me, and why I would now agree with you that we DO need to move to a chronic care treatment system.
When I came into your class, I strongly felt that other than in cases where someone had a genetic predisposition to addiction, that it was largely a choice. It isn’t like 60 years ago when people weren’t informed about the impact of drugs and alcohol and the potential for addiction. There is so much information out there, and yet still people choose to become addicted. That is what I thought in my ignorance to the realities of addiction and he the constellation of factors that lead one there. So, my answer would be to educate the general public, the voters, the policy makers as to what addiction is, what leads people to addiction, and how ACE’S set people up to be future addicts. I think if we could change the perspective of people towards addicts and educate them that it is achronic illness that requires long term care, and get them to understand that relapses are not fatal failures but part of the road to recovery, than we could change what care systems are in place too. It is ike a line of a song on Depeche Modes “Black Celebration” album that says something to the effect of if you make somone think, than you can change their heart, if you change their heart you can change their mind, if you change their mind you can change their vote, if you change their vote than you can change the world.
I think that is where we need to start. I know my heart and mind were changed by what I learned in this class.
There is no doubt in my mind that this “chronic condition” requires a chronic cure. A cure that will attempt to be as holistic, systems-based, and long-term as possible. Of course, it must also be humane and understanding of the unique place we’re all in as co-inhabitants of this chronically ill community.
At the same time, I am reminded about the idea that diabetes, cancer, and hypertension have been thought of for years as “incurable” chronic conditions. And that cures have been found, albeit not through traditional means. I know that addiction is an incredibly different monster in its own right when compared to these other chronic conditions, but there must be a “cure.” Or a system that can help find the Achilles heel of this beast!
Maybe it is restructuring our communities to increase cohesion, communality, bonding, …love? Maybe it is by committing as a species to rid ourselves of highly addictive substances (including food!) despite the pain it might cause us in the short-term! Maybe it is by co-constructing ritual that can access altered states of consciousness with or without plant-based assistance in order to re-learn how to communicate with the plant-gods our ancestors used to speak to?
There is this plant known as Ibogaine which produces hallucinogenic dreams/visions that literally show a person using substances to lessen their pain the pain/hurt they are currently causing to themselves and what future hurt/pains await them should they continue using. At the same time, this powerful plant also assists in both the detox and abstinence process for opiate/non-opiate dependent individuals.
Not to say that this plant is a panacea, but it is definitely an “alternative” that has yet to be explored. This earth has EVERYTHING we need. All the creative processes we require to heal are HERE!
I enjoyed this article because of the fact that it’s looking at addiction as a true addiction and not just a small problem that can be fixed in a couple of weeks or months. In reality many people spend years and years becoming addicted to alcohol or drugs. This can come in place by being a victim of child abuse through their youth and then searching for a quick “get away” by drinking til they no longer remember or getting high til they feel no pain. We all know that those who abuse substances gain a tolerance level to them and being to use them more and more trying to get the same affects that they had first got from the drug or alcohol the first time they did it. This is where the addiction comes from and we need to take the proper steps to not only attempt to remove these drugs from their life but also the stressors that pushed them to use these substances. I feel that management is a very appropriate word for helping someone end their addiction.
Thanks for the feedback!
Doctors need to be educated on addiction. A patient with an addiction goes into the hospital, lists off symptoms (which they may or may not have) and the doctor prescribes them meds. This is how it works; we are in pain, we get prescribed meds to fix our pain. Doctors job is to treat patients (pain), but if they don’t know that a patient is an addict, they shouldn’t be giving them the pain meds. The doctor being uneducated on addiction feeds the patients addiction.
Your typical family practitioners, internal medicine doctors aren’t generally educated in addiction, however your emergency room doctors are educated in that they see addicts come in all the time for drugs.
The doctor-shoppers out there go from hospital to hospital, emergency room to emergency room, doctor to doctor getting prescribed meds from different people, doctors often not realizing this. In Oregon I am hoping that the amount of doctor-shoppers will decrease with the tracking system that is part of the states effort to combat prescription drug use. With this system, physicians and pharmacists can see patient’s records for signs of abuse or overdosing. I am wondering if this is going to bring a halt to prescription drug abuse, one of the fast growing health problems??
I’m a firm believer in that addiction is a life long illness. It can’t be treated in a matter of days, weeks, or months, but only years. It not only takes time in an addiction treatment program, but a strong support system which many recovering addicts need time to build. To achieve any desired outcome, it takes time.
I especially like this post because it looks at addiction as a chronic condition instead of an acute one. Unfortunately, like this post points out, our society doesn’t view addiction this way. I think the first step in transforming our addiction treatment system is to find the proper funding. In my opinion, money is the number one obstacle that is preventing a change in treatment programs. How are we going to support an addict for a lifetime? Could parts of the program be free? If enough people were concerned about this issue, perhaps a majority of it could be run by volunteers. These volunteers wouldn’t necessarily be paid in money, but perhaps in the satisfaction that they are truly making a difference in someone’s life. Another aspect to consider is the program itself. Because we are all so different, how are we to create a program that can cater to every type of addiction? I think it would require a lot of trial and error, but can we afford it?
I agree with the doctors post that addiction is a chronic disease. From what I seen through out the world, addicition is a disease. It is something that has to be fought everyday. Acute treatment is not the answer. A stay in a treatment center or hospital will not cure the patient who is suffering from addiction. There must be on going treatment because in everyday there are things that will make addicts go back to using there drug of choice. Learning way’s to treat addiction as an on going process is so important in making someone better. My favorite idea from this post is “Addiction treatment providers (and patients) should beg, steal (ok, maybe not steal), borrow, utilize, and adapt management interventions from diverse disciplines. Significant research has been devoted to the topic of how best to manage chronic conditions, such as the chronic care model. Let’s not reinvent the wheel, but seek out what others have done, and bring practical, useful, easy-to-implement behavioral management tools to those who need them now. ”
I personally believe that all models should be incorporated into treating addiction, what works best should be taken and used and modified for different patients.
Thanks for the feedback!
J