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, mgmt-of-addictionsonly 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 managing addiction as a chronic condition. 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.

Addiction as a chronic condition

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% 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?

3 things to get started

#1 Incent treatment providers
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.

#2 Leverage technology
Over 70% 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 or Internet-based interventions will play a critical role in healthcare delivery.

#3 Manage chronic conditions
Addiction treatment providers (and patients) should beg, 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% who presently are on their own to deal with addiction?


  1. Jessica VanDerVeen says

    The first step is to recognize how important a change is in our treatment methods, before any change can be implemented. There is such a negative stigma about addiction that, sometimes, people are reluctant to seek help, even for others, as they are afraid of what others will think. This will go a long way to helping those in need be willing to accept the tools and changes that are vital to getting a handle on addiction.

  2. Deena says

    I agree that reinventing the wheel is less than desirable. I have always felt, similarly, in the world of education ideas, or “basic truths” just tend to recycle themselves in “different packages” all too often. I too have seen the frustration in my career when something that seems to be a no brainer takes years for others to acknowledge. Perhaps the reason for that is because, both the counseling and educational fields are dealing primarily with people and people are all different and unique. Everyone needs something different and we struggle so much to make sure we have a system that catches all of them that we miss the boat on what really matters. In my experience with education it has been an eclectic bag of tricks and knowledge that has made my job more plausible. Perhaps the world of addiction is no different. So it would stand to reason that an attack on all fronts would be the way to go.

    The first front would be the insurance providers. If information comparing cost effectiveness of a chronic care system versus an acute care system were provided maybe things would change a bit. Just imagine if Blue Cross began covering addictions medications without a battle or addictions management like a routine physical to one’s doctor. If the research is out there the information needs to be put into the right hands. The second front would be the legal front. Considering a large portion of those managing addictions also have found their way through our legal system a time or two, it seems as if there is a valuable resource that needs to be utilized. What if a person had a doctor to report to monthly instead of a PO? Couldn’t part of probation be regularly taking medications, reporting to doctors, and seeing therapists instead of admittance into a program that lasts for only an acute period of time? Third, those very medical systems that manage other chronic medical issues need to be rewarded for stepping forward and offering preventive care. Wouldn’t it be ideal if doctors and primary care physicians were rewarded with incentive programs to deliver brief interventions? It seems that if such an easy and cheap intervention can provide so much headway then it should be tapped into somehow.

    The more there is out there addressing addiction as a chronic medial condition and treating it that way, the better the odds for the addict. Sometimes the old “basic truths” need newer packages in order to ensure we ‘catch’ as many patients as possible.

  3. Luis Sanchez says

    Great point here Dr. F. The “brush under the rug” society mentality needs to stop. WE have to take charge of our lives and help our neighbors who struggle with addictions. I always believed a permanent solution to addiction was found in something deeper than med treatment and easy short-term interventions. This is a great Public Health topic and cannot be overlooked.

  4. jryan says

    I believe that a great benefit would be seen if education was used to boost awareness in a few areas of society. It is obvious from reading the blogs and research articles that the evidence is present to demonstrate that addiction is a chronic medical condition, that addiction is based on problems with relationships, and that entire segments of the population are not provided with adequate treatment. The disconnection seems to be in the transfer of the evidence to those in a position to make decisions on the type of care/treatment that is provided to patients/clients with addiction behaviors.

    In addition to educating the insurance companies, the criminal justice system, and the current medical care delivery systems for treating addiction, it would be important to increase the time spent on addiction treatment in medical school training. Not only would this increase the knowledge of the chronic medical model view and treatment of addictions in a new generation of primary care providers, it could serve as a mirror for this highly susceptible group to monitor their own behaviors as well as the behavior of others in their field. In addition, the additional training would subsequently allow an opportunity for primary care and emergency care providers to initiate brief interventions to educate the patient and to facilitate longer-lasting behavioral changes by referrals to appropriate continuing care including individual therapy, group therapy, couples therapy, self-help programs, and psychopharmacology as needed.

    Another opportunity to reduce the attraction to addiction is to resolve the problems in relationships. Perhaps an ongoing series of mandatory classes in developing social skills and self-esteem could be implemented in elementary, middle, and high schools. These types of ‘real life’ skills could be coupled with personal finance, in age-appropriate scenarios, to help develop a growing potential for each individual to better understand and benefit from their relationships with other people and with money. Having better education and training in these two areas as a society would certainly reduce the overall anxiety and depression that often leads to addiction behaviors. I have no doubt that it would reduce the stigma as well.

  5. Dan J says

    When I read this blog I find myself asking two questions. What is effective? What is feasible?

    I can really get behind jryan’s idea about teaching interpersonal skills to students in schools. I wrote an essay on the effectiveness of Rational-Emotive Behavioral Therapy (REBT) and found several articles about using REBT in schools. The newest was written this year, 2009, by Ann Vernon and was named, Applying Rational-Emotive Behavioral Therapy in schools. A study by S. Vaida in 2008 showed that application of a two hour a week group session for just six months can significantly decrease “awfulizing” and “self downing”.
    Is this a new idea? No! In 1977 Carl Edwards published the similar article, RET in high school. Which brings me back to the original questions, effective? feasible? If we can prove that raising self-esteem will lower the chance of starting drugs than why isn’t implementation feasible?
    In this specific case I think the major issue is funding. If America’s standardized test scores are falling behind other nations how can we possibly justify teaching social skills instead of drilling in more math and English?
    So the question becomes how do we get everyone on board? How do we create coalitions? When over half of the population views addicts as delinquents whose programs are wasting tax dollars, how do you approve spending for innovative ideas? When we propose a shift in funding from detention facilities, harsh environments that increase the likelihood of drug use, to long-term therapy setting we ask people to invest more money in social work and less in criminal justice. How do we get people who draw a living from the criminal justice system on board with this?

    My immediate thought is that we do not increase or divert funding, but work with the systems in place. As much as I would like to see a class offered on REBT in high schools, maybe a more immediate answer would be to make REBT classes part of the teacher credentialing program. Credentialing would not have to turn every teacher into a therapist, but at least provide a little bit of training so that as teachers are teaching their regular courses, such as math and English, they can implement basic REBT techniques when they see students self downing or awfulizing.
    Prisons are a harder issue. I really believe that the chance of becoming a drug user increases in detention facilities. I think therapy clinics would be a much better place to work with first time drug offenders. But how do we get the detention facility workers on board with this? I am at a loss.

    For those of you interested in the article mentioned above, it can be found on PsycINFO

    Vaida, S., Kallay, E., Opre, A. (2008). Counseling in Schools. A rational emotive behavior therapy (REBT) based intervention – A pilot study. Cognitie, Creier, Comprtament/Cognition, Brain, Behavior, 12(1), 57-69.

  6. Dan J says

    Just read the link on Criminal Justice & addictions. It contains some really good info. I guess more work is being done in this area than I realized.

  7. Sarah Kinney says

    Through the studies I have read on recovery and trauma, treatment should include, but not be limited to: individual therapy, support groups, diet, exercise, and long term maintenence of substance abuse. One of the things I have found to be helpful is for the problem to be identified as SUD, or substance abuse disorder. Just in this simple way, the problem can be looked at as a disorder, which must implement various models of care in both the private and public sector. 12 step groups may need to be looked at as well, as many people seek out this model for care, and it may be somewhat outdated in various ways. As with recovery for any type of trauma, all aspects of a person’s life must be looked at in order for long term maintenence to occur. Instead of treating substance abuse as a disease that can be treated with a simple antibiotic (one-dose to cure), it needs to be seen as a disorder which can be kept stabilized when cared for properly.

  8. Chris Voss says

    At the age of 13, I watched my Mom check herself into a 28 day in-patient treatment center to battle alcohol abuse. My Dad and I would go and attend meetings for family members, as we saw it as something our whole family had to deal with, not just Mom. Mom got a sponsor when she came out of the hospital and went to AA meetings for years. We changed many things about our family and our behaviors, as we saw alcohol abuse as a long-term problem that required long-term maintenance. Mom was clean and sober for 22 years and passed away last May from health issues not related to alcohol abuse.

    I use this personal story simply to agree with your statement saying “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”. There is no quick fix solution to addiction and it would benefit a great deal of people, in my opinion, if there was a new treatment enterprise that thought of addiction in a long-term mindset.

  9. sthorpe says

    What keeps 90% of people with addictions from seeking help? Certainly part of the reason is similar to what keeps a person from, say, having a painful tooth extracted. I can recall numerous times when my own mother put off going to the doctor for various ailments, insisting that she was “fine”. She gave birth to 6 kids, she can handle symptom X, Y, and Z…or at least those were her thoughts. Regardless of whether a person with an addiction is aware of how her behavior is negatively affecting herself and those around her, she has learned to live with or manage this condition without any intervention or treatment. If one continues to meet daily responsibilities while managing the addiction (or chronic pain) despite the emotional and physical stress, what incentive does she have to change her behavior? Many learn to lower expectations for health and happiness in order to accommodate the addiction and the pain—all just to avoid the strain of an interruption in daily routine or any added discomfort. As part of the 90% of individuals managing addictions (albeit some very poorly), as a society, as counselors, as a national health care system, we do not address the elephant in the room because sometimes “getting by” is all it takes to be successful in this world.

    I sincerely appreciate your motivation and efforts to change the way we look at addiction and improve the standard of care. In addition to the many great ideas noted in previous posts, another way I see to promote lasting change is through a refined definition of an acceptable standard of living on the national level. Right now families down the street from me are malnourished, engage in domestic violence, and kids work as prostitutes. Until that’s not ok, people will continue to manage their addictions on their own. Why? Because they are surviving. Apparently, only those with addictions committing criminal acts or no longer capable of supporting themselves (or those with access to superior resources) are behaving excessively enough to justify treatment.

    While a consistent acceptance of the chronic care model for addiction would be beneficial to the 10% currently cycling in and out of treatment, the other 90% have no reason to seek treatment until they feel their “excessive” behaviors are socially unacceptable and toxic enough to themselves and those around them. In other words, there will be no change until we as a society show that we care, expect those with addictions to experience a high quality of life, and are willing to do what has been proven to work to support them in doing so. Currently, this is not our practice as our health care system continues to be completely reactive. A proactive approach complete with compassionate outreach, education, and long term care is crucial.

  10. Michael CR says

    The idea of awarding treatment providers with an incentive for treating clients over a longer period of time is a great idea. It could decrease hospital costs and provide better results for the clients. One problem I see is gaining societal support and recognition that longer-term care is the answer for this specific problem. After the social support is gained all we have to do is figure out where the money for incentives will come from. Money is easy to get if we have the support from the public. More organizations, corporations and individuals would be happy to give money and attach their name to a product if it is 1) proven to be effective and 2) is socially acceptable.

    One way to gain societal support would be to require this information to be taught in our schools. It may take a long time for the students we teach today to become the decision makers but I believe that youth have a lot of power and influence over their parents and those around them. Is this an unrealistic goal since, according to an article published in Perspectives on Sexual and Reproductive Health in 2006 stated that as of 2002, 1/3 of teenagers had not received formal instruction about contraception?

  11. Kelly T says

    Treatment programs seem to be very expensive and not really very affordable for those of modest or sparse means. Wouldn’t it be terrific if those facilities could provide care at a lesser cost? In essence managing addiction with more long-term, more effective treatment for all income and social levels.

  12. Justin Hubbenette says

    One of the most interesting points made on managing addiction is that the internet has provided a viable forum for providing widespread healthcare and treatment programs. This was not a point that I had ever really thought about before and it would make sense that it is a media with much potential. Undoubtedly the internet has numerous possibilities to provide convenient assistance to those in need who may have difficulty with seeking help, mobility for services, privacy issues or because of any number of reasons. I am also part of the 70% of American’s that use the computer on a regular basis and who also gets a copious amount of junk email, which could be a viable tool for future treatment programs. I for one would rather see something beneficial being sent out as junk mail and would not mind seeing a fully solicited or government subsidized treatment advertisement being sent out to counter all the unwanted junk mail that may actually reach and help someone in need.

  13. Jeanne Linn says

    Perhaps just as Weightwatchers has group meetings (including at work), along with online Weightwatchers that allows a person to do as much or little as he/she has time for or wants to; an online drug and/or alcohol treatment program could be developed bringing together experts, ideas from other addicts, blogs and even the opportunity to get together with others as needed. If you live in a city there may be opportunities for this type of get together but if you live in a small town or rural America etc, very doubtful to find this type of group. Insurances are now paying for people to belong to Weightwatchers with a certain amount of participation. I don’t know why this type of program couldn’t be used with addicts of other substances as well.

  14. Kelly Lash says

    To mend the problems we have created over decades of addiction management treatment systems it will take a lot of work. On the other hand, the starting point seems like a very simple solution. It is a simple approach to increase energy return on investment. Our economy is essentially the same as every organism, niche, population, community, ecosystem, and biome on earth. Newton’s first law of thermodynamics states that energy cannot be created nor destroyed. Money is exactly the same as energy. It is an imaginary concept created by our species to assign value to our lives. This value translates into meaning and global change. We simply have to take the energy we create from revenue from an an extra tax on addictive products and change that energy into money for free or affordable addiction treatment services. The most effective way to reach people that are not seeking these services is to make them more affordable to the poor, and include this type of work in health care plans.

    I propose that an additional tax on tobacco, alcohol, video games, cable tv, and pornography can generate more money for effective addiction treatment within the medical system. I recognize that this tax would be extremely difficult to pass and would take a lot of effort to gain enough support. I think that with proper evidence that supports the effectiveness of the tax, then people would support it. If people learn that addiction is a disease and therefor needs to be treated that way within the medical model, than they will begin to recognize and value the need for addiction treatment services to change.

    I also agree with those of you that propose prevention programs. Programs that I have been associated with and seen to be effective are non-convention forms of therapy such as music therapy, wilderness therapy, horticulture therapy and movement therapy programs. Wilderness therapy treatment programs can detox people and give them a new outlook on life. But prevention programs with hands-on approaches and skill-building can give people an outlet that replaces an addictive substance or excessive behavior.

  15. C. Tocher says

    There is so much truth to what you said. People look at addiction as something that can be treated quickly and solved within days to months. For as many different types of addiction there are it seems like there is also a generic or textbook way of treatment. I think you’re right about not “reinventing the wheel” but reintroducing or implementing what others have already started. A handful of treatments can’t treat the mass amount of addictions.

    Availability is very important. If only a small group has access to these programs then we are missing so many others. Some insurance companies offer a wellness program that include therapy and counseling, somewhere in there addiction programs should be included. Some of these services require just a small co-pay. And for those without insurance should have a sliding scale if anything at all. I think that we need to start younger too. Why not have high school and colleges implement treatment programs or just offer informational resources? This could even be a resource for younger people to get help or find out about help for older people that they know.

    I think that part of that 90% don’t know how to deal with their addiction because they don’t know where to go.

  16. Kevin Govro says

    I don’t think there would be too much difficulty in getting treatment providers to commit to a more long term treatment model. After all, this is the business they are in. However, how will people pay for it? The main stakeholder that needs to buy in is the insurance industry because most people can’t pay out-of-pocket for long term care. A continued effort to convince lawmakers that a shift in care for addictions is needed because the insurance industry will most certainly not change their practices unless mandated to do so.

    I think that having more educated counselors in addiction treatment centers will go a long way in increasing the effectiveness of that treatment. By educated, I mean having a solid understanding of many different, effective therapeutic approaches that can be tailored to the different needs of their patients. A “one-size-fits-all” treatment philosophy of the 12-step approach or nothing, for example, will not be able to help those people who aren’t able to appreciate or connect with that approach. Having many different counseling strategies can effectively help a greater number of people recover over the long term.

  17. Kendra says

    I think sthorpe hit the issue squarely. In order to encourage and enable those coping (or rather, not coping) with addiction to seek treatment, they need to be convinced that their standard of living should and could be better. They need to feel the distress of their addiction and crave the benefits of a managed addiction.

    The solution here is not clear-cut or easily attainable. I agree with Dan that teaching interpersonal skills in schools is a great place to start. I’m fearful that some teachers and schools don’t see this as a priority, and I wonder what it would/will take for schools to realize that this type of preventative education would be so beneficial.

    I also believe that training the next generation of counselors in this chronic-care model is essential. A new wave of professionals advocating for long-term care would go far.

  18. Jon Kilzer says

    I really appreciate Sthorpe’s observation regarding peoples low expectations for life and about the reactive nature of our health care system. I feel that this is the largest obstacle to changing the care for addictions. I believe the first step towards changing our addiction health care must be through challenging the status quo and providing evidence for a longer, chronic care model for addiction treatment. Once professionals recognize the value of a chronic care model and the system begins changing to reflect the new model, how do we get those that are “just getting by”, essentially skirting just outside the scope of our health care system, to utilize the new services? Sthorpe observed that our current system is reactive, and that the system should change to a more proactive model to reach out to those that don’t recognize their own problems because they are “getting by”. I guess I’ve nothing to add to Sthorpes post at this time, but felt like echoing their observations because I feel they are so important.

  19. lsever says

    Awareness and education are needed in order for there to be significant change. There’s clearly a lot that can be done, because so little is being done right now. However, I don’t believe we will ever have the resources to be able to cast a wide net to try and solve these issues, so I believe the effort needs to be very strategic and very focused. In reading one of the articles this week on Adolescent Substance Abuse, by Yifrah Kaminer, M.D., there was one statement that read “prior drug use predicts future drug use”. If we can focus in on trying to prevent or minimize addictions before they develop, I would highlight four areas for addressing addictions in youth: identifying and targeting high-risk groups (i.e.-African American or Native American youths); educating middle and high school youth on “Life Skills Training”; providing easy access to resources for substance abuse issues and co-occurring psychiatric disorders that typically accompany SUD in youth; and providing long-term aftercare.

    On another note, if anyone has read David Sheff or Nic Sheff’s books, Beautiful Boy or Tweaked – you can get an autobiographical look at adolescent addiction and how it develops through those formative years, often beginning as early as age 12. In reading these books, you will also get a sense of how a person with an addiction can not be helped if they don’t want to be helped – even if they have all the resources in the world at their fingertips as Nic Sheff did. They really need to get to a place where they – maybe – want to be helped. So while the statistic about 90% of people with addictions do not get or seek help, it makes me wonder how many of those want help but can’t get it – and how many are still so consumed by their addiction that they can not see any other way of living? When you are on the outside looking in at an addicted person, it’s difficult to believe they would choose a life with addiction, but where they are at that moment – it is their choice. Perhaps an impaired thinking choice, but their choice nonetheless. It’s one thing to take your adolescent child to rehab and admit them against their will, but what or how do you deal with adults who are not interested in “managing” their addiction? I can’t help but wonder, will providing access to addiction resources — through health care, treatment and education — be enough?

  20. Nikki says

    The most successful results with addictions, as discussed in class, have been with professionals (Doctors, etc.) over long-term treatments (5 years+), partially because these individuals have their careers and so much at stake. What if the stakes were raised for patients with long-term positive outcomes? Many new government funded programs like “Cash for Clunkers,” and the federal taxing house credit for first time homebuyers, stimulate reciprocal growth for all parties involved, and could be used affectively with addiction. What if the government proposed programs for long-term success that would provide incentive to the addict and ultimately contribute to a better society? Maybe marked success over a long period of time could be rewarded with funding for education and or property investments. This gets back to the idea of replacing negative relationships with new positive ones, and ultimately contributing to a better society.
    I was also trying to think of the word, “management,” literally and how it applies to business, and the role of a manager. In terms of addicts returning to their natural environment after treatment, being a “manager” of your disease is so complex, and overwhelming, that one is almost set up for failure. What if patients were assigned professional training and or specialists that could help them assimilate to their new sober lives in their specific natural settings. Trainers would go far beyond a “sponsor” or Case Manager, but would have a consistent, maybe even daily, educational, motivational presence in natural settings. Trainers could promote accountability, support, and stability for an at least a 90 day time frame.
    These ideas may be grandiose, idealistic, and rooted with problems; however, they are platforms to build on. I believe society is ready and able to embrace addiction as a chronic disease, but we need to make the information more available, highly advertised, and accessible. We can send information around the globe in an instant with the click of our fingertips, and this can be used to inform, support, and mobilize people on a grander scale. The abundance of awareness, and outreach is key to learning how to manage this disease on a long-term basis.

  21. Ludvigloki-luisg says

    I agree that switching to the long term care model is best for the client and society but such a drastic shift will take measured steps. The next DSM revision coupled with the potential for change in the potential systemic health reform facing us- has us in a very interesting time and place as healers in America. In ordinary times I imagine the steps towards change are usually steeped in red tape and bureaucratic affairs but if we play our cards right as counselors we should be able to have treatment plans and models ready to present to the new medical establishment once it gets a face lift. And if the system doesn’t change the economy will allow us another chance because money talks unfortunately and what money would say in regards to some of our new treatment models is that yes they sound crazy but they stand to save America tons of cash. this line of reasoning doesn’t always work though, for example the de-escalation of the war on drugs. Cutting back on this fight would easily free up the cash needed for our long term treatment models… maybe.

    let’s switch it up……………….

    In terms of ways that clinicians can use the web in treatment and recovery is in terms of increasing efficiency and the amount of resources for clients. For clients that are able to use these web tools fluently the computer becomes a medium that both the client and counselor can use to assist and enhance the counseling process.
    From access to journals, written media, daily coaching blogs, and feedback with assessments to go back and forth with mental status updates the possibilities are there to make this worth investigating.
    In non addictions counseling the boundary between counselor and patient is quite present and strong once the session ends. With addictions clients I wonder if the populations at large would be ok with examining a blurring of the lines. If the alternative is group homes where counselors and staff assist the clients with daily life why not open the door to where addictions staff work “longer” hours by taking shifts being available online on crisis call mode. Able to coach and direct clients to emergency facilities if needed? Logistically its a muddled mess but it does hold some positive implications.

    Well as always I’d write on and on but I must go, be well friends!

    Luis G

  22. says

    To start transforming the acute-based addiction treatment system we have to admit there is a need for change. Clearly evidence is supportive that addiction is a life long disease. There are currently not enough treatment providers to accommodate the growing needs. Chronic medical illnesses are often monitored, assessed and treated with a regimen of medication and/or diet. These treatments are needed to reduce pain or avoid discomfort and other changes associated with the illness. Like most chronic illnesses addiction is a lifelong disease which will need lifelong care. Addiction is an illness that is hard to self manage, it takes support and a behavioral change. The behavioral changes are hard for many people to adapt to without the proper tools, support, and the educational understanding of the process of behavior change.

    The internet is an excellent medium for providing and obtaining support. Many doctors, professors and treatment providers can provide lectures, tools and support on the internet and most everyone can access the web. It is important to look at the underlying issues when dealing with addiction and also treat what might have triggered the addiction in the first place.

  23. Gerald Flynn says

    Sometimes I wonder if the resistance to treat addiction as a chronic problem instead of an acute one stems from ego. From the individual and families who do not want to admit that they are in a chronic situation to the society and status quo that enforces the idea that if we just try hard enough we can make this ‘thing’ go away. The idea that addicts choose their sickness is a huge hurdle when it comes to eliminating the acute status of addiction. If it is my turn to try and change things, I think I would start with changing perceptions, if possible, that are associated with addiction. I would find ways to educate society on the chronic nature of addiction. Inform by any means possible the old school ways of thought in the media, hospital emergency rooms, law enforcement, and especially law makers who tend to be at least twenty years behind new thinking when it comes to medical change. It seems most of these areas are usually pressed into service by the consequences of addiction and rarely have the means or the information to institute change much less accept that change is needed. Somehow the word chronic medical condition has to overcome the notion that addiction is simply a matter of irresponsible living choices if whole sale change is to be accepted by society as a whole.

  24. Dina Soriano says

    History has demonstrated that paradigm shifting is difficult to achieve in our society. We love our institutions-schools, hospitals, prisons etc. These institutions are not run on best practice or research, but rather with the mentality, “That’s always how it has been done”. Re-inventing the wheel or starting over from scratch is not feasible or realistic. In regards to changing the way we manage addiction, I believe making some modifications to the existing system would be the most effective rather than a complete overhaul. This would allow the most buy-in by policy makers as it is more cost-effective than a complete systems’ change. The fact that only 10% of those struggling with addictions receive treatment provides a good starting point for change. If all those struggling with addictions demanded treatment then I believe the system would have to respond. Just as parents of special education students joined together in the 70s and 80 to demand equal rights and inclusion for their students, the education system had to respond or adapt. Similarly, if primary care physicians were mandated to perform Brief Interventions on patients who may demonstrate excessive behavior with drugs or alcohol on a typical intake form, then more people may then enter into the treatment. The entire treatment system would have to adapt to an influx of patients. New research-based and cost-effective treatments would have to be implemented in order to meet the demands of the increased influx of patients. For example, computer-based treatments may be useful for those in rural areas or those who would rather not enter a facility for a variety of reasons. Some patients may be better served by the mental health system. Others may be best served in more traditional residential settings with more long-term follow-up care. There are so many ways we could change or alter the way we manage addictions in our society. We live in a capitalistic-supply and demand-type country. The demand must increase in order for the current system to change in any way or we will continue living the basic excuse, “That’s the way we have always done it.”

  25. D Stanger says

    Although lots of Americans(approx 70%) have access to the internet, it seems like a way that would still disclude those that don’t, even if it is a small number of individuals.

    Management is indeed a good way of thinking, but some people don’t like to admit that they require to be managed. In certain cases, recovering addicts will still have to be more strongly regulated through the process, if not in treatment than in the court and corrections system….

  26. L. Ferreira says

    How can we effectively manage addiction and provide the best long-term care possible when addiction is still largely criminalized in the United States? Until we decriminalize the victimless crimes against society such as drug possession for use, addiction would continue to be treated as an “acute problem” and the lip service will continue. The most important support systems and relationships (family, friends etc.) a person struggling with addiction could have are being eroded by the criminalization of addiction through separation caused by incarceration. The addict is labeled a felon by the criminal justice system and a stigma attaches causing friends and families to withdraw or disassociate themselves from their loved ones.

    I propose that we tap into the large pool of the forgotten victims, the parents, sons, daughters, friends and other family members of those battling addiction. Let us use the internet to create more support groups to reach out to these individuals. By doing this we can create a larger body of supporters that would be willing to push for change, and spread the word that addiction is a real medical problem and not a criminal one.

  27. K Navarro says

    I believe that addiction needs to be a long term process. It seems that almost all the people who go in to programs such as rehab always seem to fall back and pick up there same habits because addiction is being treated as a short term illness. These people need more support such as family and also more available programs. There is more drug dealers than programs available to help people manage their drug addictions.

  28. Troy S says

    I believe that some of the work to change the system for the better has been implemented in the form of an increased reliance on evidenced based practices (EBPs). As Dr. Fitzgerald mentioned in his blog post, basic truths often get repackaged throughout time, unfortunately sometimes some effective and reliable “truths” are discarded for more popular approaches that seem to have intuitive value but may not in actuality be resulting in improved real world results. While requiring EBPs may result in the feeling that good ideas are being delayed by wrapping them in red tape, the benefit is preserving resources for the implementation of changes that are a step forward rather than another lateral or step backwards.

    For a short while I was involved in the psychology program at Oregon State Hospital in Salem, and EBPs are a major requirement of any newly introduced practices. The prevailing consensus among mental health specialists on the OSH campus seemed to be that adhering to EBPs was a pain, but if one looks at the history of mental health and all the ways that intuition and popular “reason” without scientific support has forsaken people in need of care, the focus on EBPs makes more sense. Hopefully a continued reliance on EBPs throughout other human service sectors allows the transition to a chronic oriented addiction treatment system as evidence exposes the need to change the status quo.

  29. Joseph McCarty says

    I think one of the biggest hurdles we have to overcome as treatment providers is the idea that we can’t just cure addiction as though it were an illness. Most treatment facilities, whether they treat addiction or injury, tend to put discharge as an end, while treatment is just the means to that end. In some treatment facilities it becomes difficult to judge whether addictions treatment works with an individual because there lacks the availability of the source of the addiction. For example, a patient at the Oregon State Hospital cannot readily acquire methamphetamine (in most cases). Judging success of substance abuse treatment when the source of addiction is unavailable is like treating the effectiveness of allergies in a sterile environment.

  30. Crystal Shipman says

    Dr. Fitzgerald,

    In your blog you asked “What self-management or disease-management tools do you believe are the most helpful?” My answer to this is availability of treatment. It has been my experience that treatment is very hard to come by for the majority of those in need. It is a rarity that an addict has access to health insurance or large sums of money, which are needed to access such services. For instance, in-patient rehabilitation costs an average of 100.00 per day. Now, I personally, don’t know of many addicts who have access to this amount of money, and yet, those charged with drug activity are often sentenced to access these services, which in turn causes the revolving door that we so often witness in the criminal justice system. This being said, I believe the first step in helping ‘manage’ this condition, is to ensure that treatment is readily available and accessible to those in need.

    Thank you,
    Crystal Shipman

  31. Amy H says

    I am so in agreement with you that addiction is a chronic condition, and it is distressing that it hasn’t been until recently that it has been recognized for that. Addiction has always been viewed as a “crisis” that the individual themselves, alone possess and that it is their problem to solve. I truly believe that it is a medical condition that needs to be addressed, and that with the proper medical care, and the awareness that it is a chronic condition, there can be more positive attention given to the addicted individual.

  32. says

    A major factor in addiction treatment is that it is difficult for addicts to spend 28 days in rehab. Family and work responsibilities, even though they are often harmed by the addict himself, still must be addressed. Many employers will not cover that much time away from work, and as a single parent or with 2 working parents in a household, child care suffers.

  33. Morgan Connner says

    Having a brother that has a drug addiction, I can agree with the fact that it is a chronic condition. Everyday is a struggle, though some more than others. A 60 day, 90 day, or even one year treatment program isn’t enough. Drug addiction is a problem that people need help with for the rest of their lives. I think the whole interent idea can be very promising. While more intense treatment may be needed initially, support and an outlet seem to be most needed later on. Having a support system available at any time with people all over the county, or even world, as on the internet could help people that may not have a great support system at home.

  34. Katrisha Wilson says

    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? Well for starters to transform it like the others first that needs to be done is to test and prove everything that will work for the situation. What self-management or disease-management tools do you believe are the most helpful? The best keys to be the most helpful is to make sure that whatever treatment that is used it is tested and works the best that is possible with less side-effects. There needs to be test done on multiple types of people that have the same problem but different reactions as you can say so that you can name to the person that uses it that what will happen to them based on their profile. 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? To make it accessible to most people is to make it affordable and available where they do not worry about going broke to get it.

  35. Angela B says

    I believe the first step is to make treatment more affordable. Many people do not engage in treatment because they simply cannot afford it. Who can afford to visit a therapist at $80.00 – or more per visit without medical insurance coverage? Not many people. I really like the idea of internet access to therapy for addicts. There needs to be a non-profit organization or professionals willing to do pro-bono work and donate their time to a cause like this. I know that everyone needs to earn a living, but we need to help those that cannot help themselves. I also think that the web based therapy may actually get more people to participate because it increases the confidentiality of the situation. If people feel more secure and less likely to be exposed for their demons, they may be more willing to participate. There is a certain stigmatism with addiction. People with addictions are often treated as second class citizens. We need to raise them up, back to their feet and help them build back the life that can be all they ever wanted it to be, only without their substance that they have defined in their mind as their saving grace – what gets them through, helps them cope. I come from a long line of alcoholics and I have chosen not to go this route. Rather than be an alcoholic, I have chosen not to and suffered severe anxiety for a good portion of my life, the first of which hit after I quit drinking at age 19. It is something that I am working through and getting stronger every day, but I have spent quite a large sum of money (more so my insurance company) on therapy. Acute therapy is not the answer. Addiction is chronic unless you are able to completely erase the factors in a person’s life that cause them to become an addict in the first place. This is not possible. Addicts need the tools to cope and to deal with life that were not taught as a child and show other ways of life and living that were not seen as a child. This is the direction. I enjoyed reading this blog and will continue to read more as my time permits. Thank you.

  36. Bill says

    I have to say that I agree with what you say about addiction. Coming from a family where my mother passed away because of her addiction to her pain medication, I too understand that it is a chronic condition. What amazes me more than anything is how until recently they considered addiction to be a crisis that individuals themselves had to figure out how to solve? I have always believed that this was a medical condition that needed to be addressed.

  37. Kim B says

    I think that it is really important that people see how serious a drug addiction is. We need to find ways to better manage the addiction. Rehab clinics have been doing the same thing for years and the majority of people just relapse. SO rather than spendy constant money over and over maybe we really do need to find a creative way to help these people with the addiction, this will better the, and the community.

  38. Dane Woolwine says

    I don’t think people want to addictions to be in the same category as chronic diseases such as diabetes and heart disease. They see chronic diseases as diseases that people have no control over and if they get this disease they are innocent victims. People want to see addictions as bad choices that people make. How often have you heard people say when they hear someone has lung cancer “were they a smoker?” As if someone who smokes deserves to get cancer.
    I think education is the key to changing everything. It will help the public be less judgemental. It will help friends and family recognize the signs of addiction. It will help people with addictions seek help and find it. As people become more educated and aware, they will push for policy changes.

  39. Molly says

    As John mentioned in class sometime ago, he’s looking at management of addiction much more in terms of a public health issue, and from all of the responses I read, we all seem to be on the same page. There are some concrete, short term ways that we may be able to start to change the system without starting from scratch, such as many of the ideas mentioned: get doctors on board with brief interventions, as well as juvenile systems, etc. Require health teachers to take and teach more effective courses, such as the one Dan mentioned, as part of the health education requirement. I also think the person that spoke about using the internet more effectively, is right on. This is a resource that is vastly underutilized. I have mixed feelings about incentive programs, as they always feel more like a band-aid than a treatment of the core issues.
    And then there is the issue of changing the system on a grander, more public health scale, and like several people mentioned this involves educating and changing people’s ideas about the nature and treatment of addictions, as well as providing adequate resources. As I mentioned in my past blog response, I think there is a general lack of self-worth in this country that is masked by some notion that we don’t want to be socialists, and lose our rights, but the issues surrounding addictions further convince me of the need of universal health care coverage. I feel like it is only then that overall, effective policies can really start to be implemented.

  40. Stephanie says

    The first step is education. In essence, our society as a whole needs to be educated on what addiction truly is, a chronic condition which requires long term care. The negative stigma on addiction effects the way that all people deal with the issue. Perhaps education could increase awareness on how addiction SHOULD be treated. Hopefully the current care system can open its eyes to what needs to be done. Changes needs to be made; care needs to be long term, access needs to be more financially feasible, and people need to accept and embrace those they love who struggle with addiction in order to support them through it. People also need to realize that the addict is not the only one who needs to change. The entire family system the addict is in should be involved in the treatment process and be prepared to make changes in their life. It is possible; those with the insight need to continue to spread the knowledge.

  41. Sara G says

    First, I think it’s important to point out that not all people who have a chronic condition receive treatment. Why? Health care costs and insurance. If we are truly to shift our paradigm of addition treatment, we also need to shift our paradigm concerning who deserves healthcare. Not only do we see addiction as a moral failing, but we tend also to see poverty as a moral failing. The “pull your self up by the bootstraps” is a cry that is heard far and wide not only addressing the working poor, single mothers, and those entrenched in generational poverty, but also those struggling with addiction.

    In order to change our acute based addiction treatment system into one with a more holistic view, we need to address how we are going to fund it. We are the only “first world” nation that disregards one of the basic needs of its citizenry. We need a nationalized health care system if we are to create change that is profound.

    On another note, the internet has great potential as a agent of change in addiction. A previous poster mentioned the Weight Watchers web site as a model, and I think that’s brilliant. Linking people with resources, enabling them to connect with others, and making a central hub where all the information can be found could be very helpful.

  42. says

    A center for addiction treatment is more than likely the best place to start if you’re in dire need of sobriety. Your blog brings up some interesting points. I’m not sure if I agree entirely, but new ideas are important.

    If you are having problems staying sober, I’d suggest attending a few 12 step meetings or entering directly into rehab.

  43. Anonymous says

    Aaron, appreciate the feedback. Great thing about a blog is that it allows for multiple opinions that I believe moves the entire field forward. I also would echo your suggestion that attending 12 step or other self-help meetings can be a wise place to start if you need immediate help staying sober, and treatment is great if you can get it. For those who cannot access treatment or cannot find a good fit with a self-help group I would also say all is not lost. We know there are many paths to moving ones life in a healing direction.


  44. Azusa says

    One of the positive trends that is helping increase acceptance of a medical approach to addiction is the growing awareness that addiction is not a moral failure, but rather a chronic medical disease with similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. However, as Dr. Fitzgerald pointed out in the blog, it is so true that yet, addiction is typically, largely treated as if it is an acute condition, altering perceptions to think of addiction as a chronic illness may change the way it is treated and insured.
    I propose that altering individuals’ perception and exploring their awareness toward addiction is a starting point for care, and once they are treated, chronic substance use disorder management should involve longitudinal care delivery; integrated, and coordinated primary medical and specialty care; patient and clinician education; explicit evidence-based treatment; and availability.
    Addiction treatment should also be held to the same standards used to judge treatment of other chronic diseases, where relapse and noncompliance with therapy and medication are common. Management of addiction should also include long-term care requiring patient progress be measured in predefined steps, and that relapse result in an intermediate step back, not removal from the program. Frequent contact by phone, or e-mails from care providers would be beneficial from both an outcomes and cost perspective, because this way clients can be kept at the low end of the continuum of care, not where it’s expensive.
    I also believe incorporating mental health and specialty addiction care, definitely holds promise for improving care for patients with substance dependence who often receive no care or fragmented ineffective care.

  45. MRW says

    I think one thing we all agree on first is that the perception of addictions being “their choice,” needs to change before treatment will actually be effective. In line with that the current system of treating it as an acute problem. I think our treatment system, detox, self-help groups, residential care, CBT, are “good” at least overall, but it’s the foundation of each that need to change and that is where we need to start looking at this as a chronic condition and not a “that’s their choice/problem,” way. I think about detox, you go in for a few weeks, get meds, detox…and then you’re out of there? This just isn’t effective…so I think we do have “good” treatment BUT in each method need to redesign it so that it is effective.

  46. Meghan Greider says

    As many people have already said, education is a huge aspect of viewing addiction as a chronic problem. I admit that before starting this class I was not aware of all of the aspects of addiction and primarily perceived it as an acute problem that lies within the individual. However, we have to move away from this view (all of society, not just health care providers) in order to change how addiction is treated. I believe that addiction is stigmatized in the same way that HIV/AIDS was (and still is) and many people see the illness as the person’s fault. Yes, maybe some responsibility lies in the individual but does that mean he or she does not deserve to get the best care possible? Perhaps if addiction is better understood then shifting treatment focus to long term care rather than a short fix will be more plausible

  47. R.J. says

    It has been mentioned in many of the previous posts…the issue of funding. There is a surprising lack of funds available for those who need treatment but who cannot pay for treatment and in this economy those who can afford treatment are dwindling by the day. The cost of treatment is a clear roadblock to moving towards a chronic care system of treatment.

    Cost of treatment, who will pay, for how long, and for what is a consistent concern of those accessing treatment. Though our jails, courthouses, and budgets are crowded by those who have committed crimes associated with alcohol, drugs, gambling, and other excessive behaviors, our government spends a pittance on prevention services for and the funding of treatment for those in need. Our private insurance system that generates billions of dollars does it’s very best to ensure that they are able to excuse themselves from paying for treatment. Most who don’t have private health care can’t access public care because, you guessed it, there’s a lack of public funding.

    The very fact that there is a blog like this and that current research is beginning to lean towards a chronic care model is indeed a good sign. We have to remember that counseling, therapy, and the treatment of addiction is a relatively new field of study and profession. As technology, research, and acceptance of addiction treatment progresses, there is hope that our society will begin to put a premium on the prevention and treatment of a truly chronic disease. The problem is that it will take MORE time and a LOT more money!

  48. AnneW says

    I agree with Sara G that many of the problems associated with access to addiction treatment stem from a lack of access to health care in general, especially for those at a lower income. Unfortunately, it is these same folks that addiction so often afflicts and therefore a greater percentage of addicts cannot afford quality addiction treatment. This automatic barrier certainly impacts the 90% of folks that never receive treatment. In an effort to preserve the welfare of our country, it seems logical that our government’s top priority be to provide health care for of ALL of its citizens, not just those privileged few who can afford it. Additionally, as addiction has been noted as the nation’s #1 health care problem, the treatment of addiction should in turn be viewed as our government’s chief health care concern. Once universal health care, specifically for addiction treatment is seen as worth investing in, we can begin to look at how we can further prevent and manage its treatment.

    I believe that for health care professionals to perceive addictions as a chronic disease requiring long-term medical attention, it would require a sea change in the way our nation views and responds to individuals with addictions. I agree with sthorpe that raising the societal and individual standards for both mental and physical health is key to increasing access to treatment for individuals suffering from addictions. Evidence shows that an individual’s level of self-efficacy and sense of belonging in the world play a major role in their interest in and motivation for seeking help as well as in producing more positive treatment outcomes. Perhaps if the stigma associated with addictions was lifted, we would be able to deal more effectively with the serious health issues associated with the disease. How do we do this? Could it start with grassroots efforts to create awareness around addiction and the complicated physiological, psychological, and social factors associated? When I look at HIV/AIDS, another incurable chronic disease with a similarly hefty stigma, I can see the progress made with just this type of grassroots movement.

    Similar to how addictions are currently perceived, HIV/AIDS was once viewed as a disease of degenerates, only afflicting the weak and morally reprehensible. Although this stigma still exists, much progress has been made and today HIV/AIDS is viewed in a much more tolerant and compassionate light. Currently, most health care facilities view HIV/AIDS as a worthwhile health care challenge and major medical breakthroughs have been made in the management of the disease. Much of this change has to do with education and grassroots organizing to raise funds for treating and awareness about the disease. Considering that most, if not all, of us have been touched in some way by addictions couldn’t we work in solidarity to create a positive “addictions culture” whose mission is to raise consciousness about and provide support for victims of addiction. I long to see addictions walks, bake sales, and auctions all to support people with addictions. Perhaps then we could help reduce the terrible stigma and resulting shame associated with the illness and the real healing could begin.

  49. Nicolea says

    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.

  50. luis g says

    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.

  51. Haley Weiner says

    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.

  52. Katie Lynett says

    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?

  53. dpoole says

    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.

  54. brandeis says

    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.

  55. Edgar Frias says

    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! :)

  56. Jasmine F says

    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.

  57. Megan W says

    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??

  58. Madison s says

    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?

  59. says

    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.

  60. Julie Konidakis says

    I believe the statement that we should treat addiction as a chronic condition. Whe you look at how fast treatment centers bring patients in and spit them out you wonder how they will stay sober, plus, the change in environment from the treatment center to the outside world is against them. I believe that private practice and alternative treatments would be the answer to finding change. Once the mainstream starts catching on to the success rate and patients start choosing the longer term treatments I think insurances will start to notice and cover some of the cost. Don’t take me wrong and think that I think it will be a quick transition. I know this kind of change can take years upon years. It seems such a shame to put people in short-term treatment let them out and watch them relapse. The overwhelming fact that someone relapes is enough to make them relapse again. The transitional housing seems like it is added to treatment centers to prolong the support that the centers are not able to provide due to such short time frames. So, here we realize that we need to be spending longer with patients of addictions, but we send them on to live with other addicts and hope that they do not relapse.

  61. Lexie L. says

    I find the idea of online treatment especially intriguing. It is true that in our modern society, technology is taking a greater and more significant role in daily life and interaction. If we can communicate, attend classes, and even participate in counseling through the internet, who is to say interventions cannot take place using the same methods?

    That being said, I am interested in the process and the parameters that would need to be in place in order for online-based intervention to be successful. I believe one of the significant elements of intervention is support from others. I am not sure I am convinced that online support is the same as face-to-face support.

    There is also the issue of confidentiality. As we are reminded time and time again, the web is not secure! How would something so private as an intervention process be kept confidential over the web?

    I definitely foresee the potential of online intervention becoming very popular. So long as the proper steps were taken, I think it would be a wonderful tool for those who might not have access to a traditional intervention process. Thank you for informing me of this possibility Dr. Fitzgerald!

  62. gabrielle lange says

    I agree that addiction can be a chronic disease for many people, but not necessarily for all people. For my husband, who was a heroin addict for over 15 years, it was important for him to know that one day he would be fully recovered. Today, after over a decade of sobriety, he considered himself fully recovered and not in need of any further care. It is interesting to me that no one from his past recovery groups is willing to accept this. They feel very strongly that he is just on the verge of relapse because he no longer goes to meetings, no longer works the steps. For my husband, he felt there is a time to leave the “rooms” and start living a new life. I am aware that there are those who will need long term, maybe life-long, treatment and management. However, there are those that reach a point where they are done with the recovery process and move on to other things.

  63. admin says

    I could not agree more! Sounds like your husband is one of those who found a way to move beyond addiction to a new level of consciousness where life takes on a deeper and more powerful purpose. Appreciate much the comment.


  64. Jacob says

    This article was awesome, John. Too many times we focus on the present now and try to fix things that will make us feel better at this present moment in time. You hit the nail right on the head when you said that we need to take further long term solutions to help treat addicts. I agree with you when you said that robots will probably not take the place of human advisors. I think that online treatments can be helpful and are worth a try, but in my head, I have the feeling that addicts may be more likely to blow off treatment if it is online because it is so easy to avoid. If you were getting treatment in person, you would be forced to attend meetings and get your butt off your bed. But if treatments move specifically to online, addicts may put off the treatment and say “eh, I’ll log on tomorrow” and go back to bed. This may be completely wrong but just thought I’d voice my input! Great post.

  65. Leyna Le says

    I do not know much about the addiction, especially the treatment process. Obviously, you have given some of the most important tools for the treatment. I really like the idea of using internet or internet-based treatment which can be more effective. In reality, cost and patience aer some of the most challenging issue to stop patients to due with addiction problems. This can be considered to be the potential and effective tool in the future.
    Great post!

  66. Tosha Jones says

    For starters, I think providing treatment-base education to personnel will improve the quality of care and staff turnover rate. Being well equipped to perform a task makes the job easier and more desirable. In addition to educating the staff, patients need to be education on their condition and treatment plan. For instance, if your doctor informed you that you had heart disease and specific medications and exercise techniques will heal it, would you not feel confident and willing to comply with his treatment plan? Sure you would. Same is true for persons who know of their addiction and seeking help. Treatment programs cannot be standard (one style fits all), instead it should vary based on the type of addiction, gender and age of the addicted, longevity of addiction and resources available. Also, I would take into consideration the circumstance of the addicted, for example, is the person a single person or employed. For many addicts, rehab has a negative ring to it and is considered a waste of time. I think the patient should have the choice of residential treatment, group-therapy (like AA meetings), or specialized treatment physicians (like HMO doctor) that will focus on their particular addiction. In addition, technology provides easy access to a wealth of information and support.

  67. Mark U says

    This posting is an excellent Public Health subject because this has been ongoing and our society overlook topic. Not only should we assume that addiction is just a behavioral disorder; it can also be seen as a neurological disorder. But people look at addiction as something that can be treated quickly and solved in short-term. For example, some assume that alcoholics will be “cured” by attending free alcoholics anonymous meetings. Its not the case really. In my remote past, I attended several of these meetings in 2009 to support an alcoholic friend. From my observations, I noticed each alcoholic shared story’s about what “bad behavior” they did while intoxicated and why they regret it. I never sensed real remorse nor any stories about self-improvements. My friend at that time still drank before and after sessions. In fact, she still does. I do recall the person running the program talking about how members who have been attending these meeting for many years would disappear and re-appear at intervals. This is a prime example of this is not an acute matter as well as that they’re looking at the problem itself while overlooking the fine line of the person alone. In addition, I used to work for a pain clinic where I have seen addicts undergo detox programs—and that’s it. Eventually, some patient would reinvent their own wheel and restart at stage one of addiction. If I recall, the reason for restarting included financial stress-related factors.

    Within the healthcare system, the partnership is generally between a patient, their insurance company and their physician. Our society sees addiction as a bad symbol and so people suffering with an addiction are hesitant to seek help. If society recognizes the importance of changes in treatment methods, perhaps their support may encourage instead. Maybe those suffering will have a change of thought. We cant make them go into treatment, but we can certainly help with encouragement. If cost effectiveness data was presented for how this being a chronic care system as oppose to an acute care system, then maybe it will persuade them to come on board. In addition to educating the insurance companies, educating addiction treatment in during medical school and residency would be considerably beneficial. Although this is not the entire painted picture, change isn’t that easy. We would have to include the criminal, legal, and educational systems.

  68. Thanh T says

    I do agreed with you that addiction is a chronic illness and need long-term care. In order to embrace the idea of addiction management, I think that first we need to recognized that addiction is not an acute-illness, and it is not ended when the patient is discharged. This can be changed by making public speakings, fliers, and anything that can educate addicts and their family members about this issue. Hopefully, with the knowledge they will seek out programs with long-term management and eliminated short-term rehab facilities. I also think that making affordable long-term treatments available to addicts is also an important. This can be made by creating funds, and encouraging the government to invest more on drug treatments rather than spending money on enforcement against illicit drugs use.

  69. Nadine Edwards says

    Dr. Fitzgerlad brings up interesting points on the topic of managing addiction. The traditional acute-based system that is often used to treat the status quo embraces treatment programs design for acute problems. Dr. Fitzgerald challenges the traditional acute-based system by affirming that addiction is a chronic condition and that health care must be transformed to a chronic care model. The chronic care model would create longer programs that teach patients how to adequately manage their conditions and provide care coordination along with active follow-ups to ensure the success of patients. Support and education play important roles in the chronic care model of health care.

  70. Cicilio Goodlance says

    After reviewing the article I am pleased to see that Dr. Fitzgerald addressed addiction as a long term chronic condition rather then an acute problem. Growing up my mother suffered from alcoholism and participated in short-term treatment. The treatment she received did help but after a year or two of sobriety she relapsed and her addiction was revived. Her outpatient AA meetings apparently weren’t enough to keep her sober for our desired length of time. Till this day my mother suffers from addiction and lets it control a portion of her life most of which only brings negativity. I support Dr. Fitzgerald proposal in addressing addiction as a chronic condition because I know people who battle addiction on a day to day basis, even after years after being clean and sober.

    I simply found that utilizing the internet as a source of treatment can be a key change in attempting to reach out the the 90% of individuals who battle addiction on their own. The article stated 70% of people have access to the internet whether it is readily available at home or not. I feel this approach has much potential in treating addiction management more as a chronic condition. Addicts can participate in their counseling/ group meetings and refer to the online programs when they deem is necessary or it can be a step after short- term programs are completed. This way individuals can continue to receive support in a way that is more convenient to them, and the chronic condition’s rehabilitation process continues. I suggest this because not all people are going to be able to miss work to participate in counseling sessions.

    I feel it is crucial to implement a more long-term approach in properly addressing addiction. The only way this can begin is if we accept that addiction is not a acute problem but more so a chronic condition that needs proper attention from the health care systems. This way our society can decrease the retention rate of returning addicts.

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