The treatment of addiction is a marathon, not a sprint. Often, people think of addiction treatment as detox. They believe that once someone is detoxed, they should be on their merry way to sobriety. When that doesn’t happen – as it often doesn’t – family and friends are disappointed. They begin to blame the patient. “He just wasn’t ready to get sober,” they believe. Or “She really didn’t want it. She wants to live her life of addiction,” they think.
The American Society of Addiction Medicine defines addiction in the following way:
“Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.
Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.“
- The ASAM Criteria, 2013.
In other words, addiction is not just a weakness. Once it is established, it’s a brain disease. When people don’t respond to a cancer treatment or hypertension medication or an antibiotic for an infection, we don’t trash the patient. We don’t accuse the patient of really wanting to stay sick. We change the treatment. We, as physicians, re-evaluate the treatment, assuming that the treatment is the problem, not the patient. Although addiction treatment is changing, the concept of fitting the treatment to the patient rather than the patient to the treatment is still somewhat new.
Traditionally patients have gone to a three-to-four day detox followed by a referral to an outpatient or residential facility. They often don’t make it to the first outpatient appointment. They might have more success in a residential facility if they agree to go and if there is an opening. However, many of these facilities are quite structured, which is good in some ways. But when a patient makes a mistake by relapsing or violating some rule, they are out on the street and the cycle of addiction starts over.
We have made strides in addiction treatment. Studies are showing that getting patients to treatment is the hard part. Once they get there, new treatments, including medications, are available. Researchers are continuing to try to understand which treatments work for which patients. However, some addiction treatment providers are still rigid in their belief that treatment has to be done a certain way, and if it isn’t done that way the person with addiction is really not sober. Unfortunately, that thinking often keeps patients from getting the treatment that they need. It perpetuates the idea that everyone should get sober the same way, and if they can’t, it’s their fault. I think we need to focus on what works and what keeps people with this deadly disease alive. We use medication for other medical diseases such as diabetes. Addiction has much in common with other medical diseases, and should be viewed that way. It is true that most people with the disease of addiction need more than medication, however, to put their lives back together. They usually need counselling or some strong social support such as AA or NA.
People DO recover from addiction, but they don’t all recover in the same way. In our clinic at the UofL Physicians – Psychiatry, we work with patients to individualize treatment. We offer medication when needed as well as therapy. We realize that patients come to us in different stages of motivation to recover, and we work with them wherever they are on that journey.