Brain research breakthroughs have revolutionized our understanding of drug addiction, allowing us to respond effectively to the problem. 1
I have hope that we will one day live in a world where the above statement from the National Institute on Drug Abuse is accurate, especially if we respond effectively to the nationwide epidemic of substance dependence (i.e., the problem).
Despite nearly a century of research, however, those with severe substance use disorders or addiction remain a marginalized population in our communities. This marginalization takes the form of persistent addiction stereotypes and myths, as well as what I consider to be unfair and unethical legal punishments for nonviolent drug offenders. Collectively ignoring information based on the science of addiction and recovery about how to provide effective treatment for those who suffer from addiction is another significant way in which addicts are marginalized.
ADDICTION IS A CHRONIC BRAIN DISEASE.
Scientists have contributed by teaching us that addiction is a chronic brain disease. According to the National Institute on Drug Abuse, addiction is a disease that affects both the brain and behavior as a result of scientific research. We have identified a number of biological and environmental factors that contribute to the development and progression of the disease, and are now searching for genetic variations that play a role in this process. Scientists use this information to develop effective drug abuse prevention and treatment strategies that reduce the negative effects of drug abuse on individuals, families, and communities. 1
Despite knowing that addiction is a chronic disease, treatment providers and third-party payers (i.e. insurance companies) continue to employ acute care, or short-term models, to address the issue. For instance, the majority of insurance companies cover 28 days of addiction treatment. Rarely, treatment may be prolonged to a total of ninety days, which may include outpatient care. Worst of all, the vast majority of people who meet the criteria for severe substance dependence do not have the means to receive treatment.
Continuing to treat addiction in an acute manner is analogous to stabilizing a diabetic patient in the hospital, prescribing them insulin for 30 days, and then sending them home to attend support meetings with other diabetics.
I have nothing against peer support meetings, in which I firmly believe, but they are insufficient. If we treated diabetes as an acute condition, we should not be surprised when a diabetic enters the emergency room in a diabetic coma and/or requires emergency care continuously. This makes no sense whatsoever, would cost more money, and would result in terrible patient outcomes. Yet, we continue to view and treat addiction sufferers in this manner.
Chronic diseases, such as diabetes and addiction, are perpetually complex, moving targets that persist for a lifetime and necessitate ongoing monitoring and care. The implementation of chronic care models (or CCMs) to combat chronic diseases not only saves lives and improves the quality of life for individuals and families, but also saves money and resources over time for everyone. CCM proponents advocate for a redesign of the healthcare system to provide continuous, coordinated, multifaceted systems of health service delivery. 2 Redesign is precisely what we require.
WHAT IF THE MODEL OF CHRONIC CARE WAS APPLIED TO ADDICTION?
What would occur if the model of chronic care were applied to the chronic brain disease of addiction? In my opinion, the implementation of this type of model would have three significant consequences.
Increasing the continuum of care Providers and third-party payers would support and implement extending the continuum of care for a number of months, and if necessary, years, following treatment. Long-term post-treatment support and care has a game-changing effect when it comes to providing care for this population. By extending the continuum of care, for instance, recovery professionals could intervene and prevent use events/relapses in advance. Equally crucial is providing support and care immediately after a use event to prevent further decompensation and complication. By maintaining contact with recovering individuals and providing them with support, these types of preventative measures occur naturally, thereby preventing possible severe consequences and death from relapse. Extending the continuum of care saves money by keeping patients on the path to recovery and decreasing the frequency and need for emergency care.
Providers and third-party payers would support the coordination and communication between multiple healthcare providers/systems so that all professionals providing care would be on the same page and have access to the same data. Coordination of care between treatment professionals, primary care physicians, psychiatrists, therapists, counselors, nutritionists, and peer support providers would reduce confusion and maximize effectiveness, resulting in improved outcomes and decreased decompensation/progression of addiction. Absent this coordination, care providers operate in silos, oblivious to the perspectives and efforts of other potential care team members.
Extending the continuum of care enables recovery professionals to collect longitudinal data for the purpose of refining treatment models and enhancing support. The use of telehealth and/or video health makes data collection more efficient than it was in the past due to technological advancements in recovery support. In addition to these active methods of data collection, data can now be passively collected through computer software platforms, mobile phone applications, and online surveys, making it even simpler to collect real-time data. Collecting and analyzing recovery data is a crucial but rarely discussed aspect of chronic care models.
I still hold out hope that one day we will live in a world where our ground-breaking discoveries about the chronic brain disease of addiction will be applied to the treatment and long-term support of addicts and their loved ones. Extending the continuum of care would have significant effects on individuals, families, communities, and the nation as a whole. If we continue to treat addiction with acute care models, we will continue to experience the same devastation and epidemic.
NATIONAL INSTITUTE OF DRUG ABUSE: HTTPS://WWW.DRUGABUSE.GOV/PUBLICATIONS/DRUGS-BRAINS-BEHAVIOR-SCIENCE-ADDICTION/PREFACE .
MARTIN, C. M. (2007). CHRONIC DISEASE AND ILLNESS CARE: APPLYING FAMILY MEDICINE PRINCIPLE TO CONTINUOUS HEALTH SYSTEM REDESIGN. CANADIAN FAMILY PHYSICIAN , 53 (12), 20862091.
THOMAS G. KIMBALL, PHD
Thomas G. Kimball, Ph.D., LMFT, is the George C. Miller Family Regents Professor and Director of the Center for Collegiate Recovery Communities at Texas Tech University. Dr. Kimball has been a member of the MAP team since 2012 and serves as Clinical Director, where he supervises and consults on the implementation of extended recovery modalities, techniques, and practices for individuals undergoing Substance Use Disorder treatment (SUD).
His courses on families, addiction, and recovery have garnered him a number of teaching awards. He is the author of several peer-reviewed articles on addiction and recovery published in prestigious medical journals, a frequent contributor to leading online addiction and recovery publications, and co-author of the Hazelden Press book Six Essentials to Achieve Lasting Recovery.
In addition to consulting and presenting on recovery-related issues throughout the United States and abroad, he frequently writes articles on emerging addiction recovery data, recovery techniques and modalities, the science behind addiction, the addiction crisis, and long term treatment for the chronic disease of addiction.
Dr. Kimball has devoted his career to the study of collegiate and long-term addiction recovery by focusing on factors that promote long-term recovery and improve the local, national, and international treatment industry. Follow him on Twitter at @drtomkimball
Scientists have done their part and taught us that addiction is a chronic disease of the brain. Continuing to treat addiction acutely is like stabilizing.