The Surgeon General's landmark report came out in November 2016. It is a lengthy document of which the recovery section consists of the following listed sections: preview, recovery definitions, Values and controversies, recovery-related values and beliefs, conceptual controversies in recovery, perspectives of those in recovery, estimates of the number of people “in recovery,” recovery-oriented systems of care, recovery supports, social and recreational recovery infrastructures and social media, specific populations and recovery and recommendations for research.
The Medical Perspective
While I was reading through this chapter I couldn’t help but relate it to medical practice and medical education and how things have changed and evolved over the years but ultimately come back to the same theory. I kept thinking to myself thoughts such as “Duh!”, common sense, the cyclic nature of medical practice, there’s more than one way to get a job done and this is a chronic “disease” that needs chronic and ongoing treatment and care. Whether it is a disease or not is a cyclic theory as well.
Life After Addiction
The other main points of this chapter are that there is life after addiction for those who can succeed in recovery. It’s what you make of it and there are many ways to reach recovery and work towards keeping it successfully. What I saw from the medical perspective is that addiction is like a chronic disease. A chronic disease can affect and be effected by other aspects of the person’s overall health and social circle. Also, a chronic disease needs ongoing care and treatment that is multi-focal, requires multiple sources, resources and specialties of care.
Let’s start with some word definitions so the rest makes some sense, and while the article defined certain terms by looking at connections and theory, I found that unhelpful.
Addiction: habitual psychological and physiological dependency on a substance or practice that is beyond voluntary control. (Dependence and Tolerance while not discussed in this chapter are relevant and previously defined in another article I wrote)
Recovery: (Recover): to get back, to regain, to bring back to normal position or condition, to save from loss and restore to usefulness
Remission: abatement or lessening of symptoms of a disease; major disease symptoms are eliminated below a pre-determined, unharmful level.
Abstinence: the unofficial would be to think of what priests are supposed to be while the official Stedman’s Medical Dictionary defines it as: refraining from the use of certain articles of the diet, alcoholic beverages, illegal drugs (I would add here legal as well), or from sexual intercourse.
Everyone Needs Help From Many Sources
This chapter focuses on all manner of the recovery process and points out repeatedly while discussing several factors of recovery that it rarely is a one-person show. Most people need help and this help is available from many sources including the well-known AA (alcoholic anonymous) and NA (narcotics anonymous).
Recovery As An Organizing Framework For Approaching Addiction
According to this article, “policymakers and health care system leaders in the US and abroad are beginning to embrace recovery as an organizing framework for approaching addiction as a chronic disorder from which individuals can recover, so long as they have access to evidence-based treatments and responsive long-term supports” (Preview paragraph). While this is true, it’s not a new concept. The medical profession has understood this for some time but getting the supportive network of medical help became difficult with the advent of managed healthcare in the late 80’s when HMO medicine became an entity of medical care.
Recovery Represents Positive Change For The Whole Person
In the recovery section it states that “recovery goes beyond the remission of symptoms to include a positive change in the whole person” (p. 5-2). It then states that abstinence while necessary is not often enough. This is very true and this is where these folks need all the help they can get. An addict needs intention, the drive to succeed and the ability to work constantly on this goal. According to the article it can take years and several remissions and treatments to succeed. If you stop treatment you get behind.
Mental Illness Component
There was only a brief mention in the chapter about those with both addiction issues and mental illness, and I think this was unfortunate as in the medical profession we see many patients that have both. The two unfortunately reinforce each other. I won’t quote percentages as the chapter lists those. Having both an addiction problem and a mental illness certainly increases the difficulty of treatment and in a medical insurance system such as ours, getting the help these patients need is nearly impossible. And while remission is possible with addiction, you don’t “get over” mental illness; you treat it and hope to keep it stable. I certainly hope the surgeon general decides to bring attention to this issue.
Recovery means you go to the other side and are done with it, unless it re-occurs like cancer or obesity. So while recovery is a sought after destination, there are many ways to get there and all require help.
The rest of the chapter focuses on the types of treatments that are available from the typical AA 12 step programs to live-in treatment programs. Some can be individually driven but the more successful programs include multiplicity of design, living arrangements, types of treatment and are a lifelong endeavor. No quick fixes here. This is not a new concern, nor is it a new subject from surgeon generals and other medical spokespersons. It’s about time it is to be recognized as a chronic medical problem but let’s hope the government and medical insurers step up to the plate with availability of the resources mentioned in this report.
Reach Out Recovery Exclusive by Gail Dudley, DO, CHCQM, MHA, FACOFP