For individuals struggling with addiction, their families that are affected, and the doctors and therapists looking to treat this disease, it can be discouraging when a recovering addict relapses or struggles to maintain sobriety. In fact, 90 percent of alcoholics will experience one or more relapses during their first four years of treatment, according to the National Institute on Alcohol Abuse and Alcoholism (2000). These statistics are far from where they should be today. Of course, finding the right treatment plan will always be a trial-and-error process, but how are doctors and therapists so clearly missing the mark?
The typical forty-five-day treatment plans that exist today follow the kind of thinking that once individuals become “clean,” then they are essentially “recovered” from addiction. Most doctors will note addicts are “clean” once they have successfully remained drug free for a certain amount of time, completed a type of Twelve Step program, and continuously attended community therapy.
Yet, addiction is not a curable disease or an acute disorder treated in a single episode. This is where doctors and therapists are missing the mark. Addiction is a chronic illness of the brain that requires long-term care. People with addiction disorders will always have to protect and address their recovery, no matter how long they have remained sober. In order to improve the success rate of today’s addiction treatment programs and put people with addictions on the path towards successful sobriety, we must rethink the disease of addiction as a whole, restructure our approach to treating addiction, and reeducate society around this newfound understanding.
In order for doctors, facility managers, and therapists to successfully treat addiction, they must first adopt its true medical definition. The American Society of Addiction Medicine defines addiction as “a primary, chronic disease of brain reward, motivation, memory, and related circuitry” (2011). When we adopt this definition, there are two areas that must be incorporated into today’s current understanding of addiction: addiction as a brain disease and addiction as a chronic illness.
Addiction is a Disease of the Brain
The brain is the organ that impacts our physical and emotional well-being. As such, when addiction treatments fail to address the things in life that impact physical and emotional well-being—anxiety, poor eating habits, depression, and others—then the only things being treated are the symptoms of addiction, not the disease itself. Critical criteria involved in treating other mental and medical diseases, such as holistic approaches addressing the mind, body, and spirit, are lacking in today’s existing addiction treatment programs.
Addiction is a Chronic Illness
This is a tough concept to grasp for those who truly want to get better or help their loved ones get better. However, in order to move the addiction recovery movement forward, individuals, families, doctors, and therapists must accept that addiction recovery is a lifelong journey with trial-and-error processes.
The goal of a basic diabetes treatment plan is to control blood sugar and glucose levels so as to prevent complications. The disease really never goes away, it is simply maintained. In the same way, the ultimate goal of all addiction treatment plans are to keep individuals from using and abusing drugs and alcohol. Yet, the actual disease will not disappear, and individuals will consistently address the disease their entire lives in order to manage it. If diabetics are considered “cured” after they’ve managed to keep their blood sugar low for a certain amount of time, does that mean they should stop taking medication and end treatments created to improve their health? Those dealing with an addiction will always have the addiction and need long-term care to keep it under control, not for just forty-five days or a few months.
Restructuring Research, Education, and Treatment
Redefining addiction as a chronic illness is the first step towards providing more successful treatment options, but it is not enough to simply understand that addiction needs long-term care. The medical field, doctors, therapists, and the insurance sector must restructure how they conduct research, provide coverage, and offer treatment to those living with this illness.
The sad truth is that there is limited research and few programs that focus solely on today’s definition of addiction as a chronic illness. According to the Treatment Research Institute, less than 10 percent of medical schools in the US offer addiction courses (Cornish, 2016). This means very few are certified in modern addiction treatment practices.
As we look to restructure our approach towards addiction, we must also not overlook the need to offer better treatment options than what is currently available. Most rehabilitation facilities today are run by recovering addicts who lack the proper training and expertise, implementing processes that are based on what they “feel” will help treat addiction instead of offering treatment programs backed by evidence.
Group therapy and Twelve Step meetings are recommended as long-term solutions, yet neither of these options address the addiction symptoms of the brain. Treatment such as medication-assisted treatment (MAT), therapy that addresses co-occurring disorders, relapse prevention programs, yoga, equine and arts therapy, nutrition plans, and programs that address core issues, must be incorporated into traditional rehabilitation programs to ensure long-term sobriety for clients.
Restructuring the education sector, existing rehabilitation programs, and postrehab therapy with treatments that offer long-term support for addicts is key to improving success rates. Yet, we must also look to reeducate society—our family members and friends—that addiction does not have a cure and is a lifelong journey for those who are diagnosed.
Most individuals today look at addiction as a moral defect or criminal problem, and rightly so. When people are abusing drugs, they lie, steal, and promise they will do things they end up not doing. In fact, for hundreds of years, society understood addiction as a character disorder or flaw. A few misconceptions of addiction that exist today include:
- “Only bad people use drugs.”
- “If someone wanted to stop using drugs, they could.”
- “Individuals who use drugs use them because they do not know any better.”
- “Addicts who are ‘clean’ and relapse do so because they really did not want to get ‘clean’ in the first place.”
- “People who cannot stop using drugs just do not have enough willpower.”
These common misconceptions play a major role in why addicts struggle to maintain sobriety or are afraid to speak up about their addiction to friends and family. One would never suggest that individuals struggling with diabetes should just lower their blood sugar, because “What’s wrong with you?” One would never assign blame to bad choices for someone diagnosed with arthritis. Yet, mainstream society believes that addiction is a choice and addicts can simply “just stop” using after detox. In order to create a supportive and encouraging community for those struggling with addiction, treatment centers, doctors, and the Al-Anon and Twelve Step program community must create greater awareness around the true definition of addiction.
Helping society understand that addiction is a chronic illness will also improve family dynamics among those affected by addiction. It can be mentally, physically, and emotionally exhausting to support family members who are in and out of rehab, relapsing multiple times, and simply unable maintain sobriety. Parents blame themselves, siblings blame one another or their parents, and the entire family dynamic is easily torn apart. As families begin to understand and accept that addiction is a chronic illness requiring long-term care, loved ones will have a greater understanding of the disease and can provide better support for the right kind of care.
The Way Forward
Without question, what has been done in the past to treat addiction is lacking successful results. Doctors, therapists, case managers, and loved ones view addiction either as a moral defect or an acute illness with a cure, which is why current treatment programs have low success rates. In order to provide more effective treatment options and improve addiction as a whole, we must adopt the medical definition that addiction is a chronic mental illness that requires lifelong treatment. We must conduct more medical research around addiction as a chronic illness and restructure rehabilitation treatment programs and postrehab therapy around this understanding. The addiction recovery community and treatment centers must also help educate society that addiction is a lifelong journey. Then and only then, can we put individuals on the path towards a more successful life of sobriety.
American Society of Addiction Medicine (ASAM). Definition of addiction. Retrieved from https://www.asam.org/quality-practice/definition-of-addiction
Cornish, A. (2016). Treating addiction as a chronic disease. Retrieved from http://www.npr.org/sections/health-shots/2016/02/25/468085130/treating-addiction-as-a-chronic-disease
National Institute on Alcohol Abuse and Alcoholism (NIAAA). (2000). Relapse and craving. Alcohol Alert. Retrieved from https://pubs.niaaa.nih.gov/publications/aa06.htm