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Treat Addiction Like Any Chronic Disease

13 April 2017 Written by 

We all know that chronic diseases can be inherited via gene process, and they can be acquired through lifestyle and self-determination (free will). Addiction, now called Substance Use Disorder (SUD), has been said by the pros to have both the possibility and probability of both gene and lifestyle acquisition. What does that mean for how we perceive it and treat it?

Chronic Disease Risk Factors

It’s not unusual to see a family of addicted people, and we ask is this due to the gene pool or being part of that culture and seeing those you love and look up to be involved in that activity. It may be considered “normal” for the family. So is there a “personality” that becomes addicted? Does it happen due to stressors that take the individual looking for release? More likely it has to do with the person’s risk factors to develop the disease. 

Psychological

Other risk factors are psychological issues that make one prone to seek refuge to make the world go away. Psychiatric disorders are often seen in patients with the chronic disease of alcoholism or addiction. Risk factors for addiction and alcoholism (considered a type of addiction) include family history and often genetic background.

Cultural

Certain genetic backgrounds can create the physiological inability to handle alcohol.  American Indians, aboriginal tribes, Asian Indians, Chinese, Japanese and Koreans are some examples that due to lack of, or production of different amounts of Alcohol dehydrogenase (ADH) and Aldehyde dehydrogenase 2 (ADH2). These are enzymes necessary to break down alcohol in the body.

Other Chronic Diseases

Let’s compare risk factors for other chronic diseases such as hypertension and diabetes. Hypertensive patients often have a genetic disposition to the disease as do different genetic types as in the example above. It is understood in the field of medicine that African Americans are more prone to hypertension and obese people are more likely to develop non-insulin dependent diabetes mellitus. A person’s family history can also make them more likely to get both hypertension and diabetes.

Lifestyle Factors

Lifestyle factors such as exercise and dietary preferences can make one prone to both diabetes and hypertension. So genetics plays and big role as does lifestyle. This is the old “nature vs. nurture” argument.  If a child grows up in a home where no one exercises or plays sports but sits around and plays video games or watch TV, and meals are mostly simple carbohydrates and fast food with little in the way of fresh fruits and vegetables, then they are likely going to develop the diseases that come from this type of lifestyle.

SUD as Chronic Disease

Similarly, the person who grows up surrounded by drinking, drugs, abuse of each other and lack of emotional support is more likely to develop an adult pattern of similar activity. Yet we know there are people who don’t follow the family mold, or who do everything wrong yet don’t become an alcoholic or a diabetic or a hypertensive person. Is it self-willpower or something different at work here?

Developing Dependence From Injury

We have seen where a person has an injury and is placed on narcotics and maybe benzodiazepines short term for medical needs. They then become used to the pain relief and continue to take the pills because they find it “makes the world go away” and gives a reduction of stress. It puts them in “better place”. Remember the old opium dens where people went to smoke opium and zone out. For that period of time that they were under the influence of the opium they had no worries.

“The vast majority of people with chronic pain do not go on to develop an opioid addiction, so it’s important for patients to understand that if this medication benefits you, it’s not necessarily a concern.” (1)

Substance Use Disorder for the purposes of this article is defined as alcohol and medications (narcotics and benzodiazepines). The use of chronic narcotics and associated drugs is currently a medical specialty—pain management—and patients seen by that specialty often receive oral medicates such as narcotics, benzodiazepines (think of Valium, Xanax, Ativan) and muscle relaxers. These medications can also be given via an indwelling pump.

Pain Management

Also used here are treatments such as spinal cord stimulators. Many patients who seek pain management specialists are not addicted, but they are dependent just as patients with hypertension and diabetes are dependent for their medications. And patients who truly do have chronic pain do not feel the “high” that is felt by those who do not have a legitimate reason for taking the medication.

Developing Tolerance

Patients who take these medications for a legitimate reason do become dependent and as they develop tolerance to the medication they may need higher doses. Like a hypertensive patient whose health parameters change (gain weight, develop other heart problems) and may need a different medication or a higher dose; or a diabetic who may need a different method of delivery for their medications. Patients addicted to narcotics or benzodiazepines often are already taking higher doses to get that “high” that they want. If they suddenly stop the medication for whatever reason (can’t get it, decide to stop, etc.) they will go into acute withdrawal and it can be life-threatening.

Addiction Versus Dependence

 “One of the challenges is that we don’t have good estimates of how common it is for chronic pain patients to develop problematic opioid use” says Jennifer Potter, PhD, MPH, in the Department of Psychiatry at the University of Texas Health Science Center in San Antonio.

“The question of the difference between tolerance and addiction gets at how we define addiction and how we distinguish appropriate medical use.” (2) “Tolerance is an absolutely normal expected phenomenon when people take many pharmacological substances on a regular basis. As your body adjusts, you need more of a dose to get the effect you’re looking for,” explains Compton. (2) “Addiction is when we organize our lives around a substance and continues it despite it causing problems, or when we use more than we plan or intend to,” says Compton. (2)

Substance Use Disorder Has Not Been Treated Like Other Chronic Diseases

An important and possibly main reason that addiction has not been treated or viewed as any other chronic disease is because of the mental disease appearance of this problem, complicated by insurance companies refusing to fully cover the medical and psychological needs inherent in treating the disease. But that is changing. Mental health disorders and addiction require lengthy treatment plans that often are defined in months; particularly in rehabilitation in an in-patient facility is needed. Other chronic diseases like hypertension, Diabetes, lung and cardiac diseases may need more expensive care and different treatment regimens. With the passage of the Parity Act in 2008, Substance Use Disorders and Mental Health problems have to be covered the same as physical chronic diseases. Insurance companies are now developing guidelines for SUD coverage. 

From a physician’s viewpoint, well managed addiction can be much less expensive than other chronic diseases

Other parameters have gotten in the way of appropriate treatment for this chronic disease. Patient fear of being ostracized by medical health communities, friends and family as well as by employers can come between patient and treatment. Changing the lifestyle and family dynamics can appear nearly impossible to change and fix, or at least seem that way. And the fear of legal attention and complications can prevent necessary treatment. All chronic diseases need and require all that modern medicine can provide including monitoring, treatment, therapy, medication if necessary, and long term support. 

Content Originally Published By: Dr. Gail Dudley @ Reach Out Recovery

Read 6679 times Last modified on Friday, 14 April 2017 11:24
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Dr. Gail Dudley

Dr. Gail Dudley, DO, MHA, FACOFP, is board certified in four areas of medicine. For more than twenty years Gail Dudley had a busy family practice with a hospital and nursing home component. Gail also obtained a MHA (Masters of Healthcare Administration) and completed a year-long health policy fellowship. Dr. Gail has worked in quality assurance and utilization review, hospice practice, and now works full time for a company that has contracts with Medicare and Medicaid to evaluate fraud, waste and abuse in the medical world.
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