Managing Addiction as a Chronic Condition

Despite decades of using a chronic disease metaphor for alcoholism and, more recently, drug addiction, we continue to provide treatment based on an acute model of care. Is it time to shift to a chronic care approach similar to disease management models?

To explore this question, a recent study analyzed data demonstrating the chronic nature of addiction.

• Over 50% of people who resolve drug problems following treatment receive multiple episodes of care, usually over several years.
• Data from 2003 from programs receiving public funds revealed that 64% of people were readmissions to treatment and 19% had more than four admissions.
• In a study of 448 persons following treatment, 82% transitioned at least once between relapse, treatment re-entry, incarceration, and periods of abstinence over a 2-year period.

Alarming results of a study from 23 states revealed that only 17% of persons discharged from intensive treatment were transitioned to outpatient continuing care. Several emerging practices for a chronic care model and their results were also reviewed, revealing the following:

• telephonic follow-up resulted in fewer positive cocaine urine tests;


• assertive continuing care for adolescents demonstrated greater access to and participation in continuing care as well as greater abstinence;


• recovery management check-ups at 90-day intervals combined with motivational interventions for those who had relapsed provided a faster return to, and greater participation in, treatment as well as a lesser need for treatment at 2-year follow-up.

The authors discuss the need for substantial system changes required across all elements of the addiction treatment system if a chronic care model is to be implemented.

Comments by Michael Boyle, PhD:Providers do what they are paid to deliver. If we want to change to a potentially more effective model of addiction treatment, the funding bodies must implement new billing codes and rates for continuing recovery management. Providers need to strive to remove any sense of failure, shame, or guilt persons may have regarding their return to use and need for additional assistance.

Reference: Dennis M, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007;4(1):45-55.

Taken from: Join Together Newsletter

Addiction FAQ's

Q. What types of addictions to you treat?
A. Primarily we treat drug and alcohol addictions (chemical dependency), but as a by-product of many dependencies such as meth and crank, there are sexual addictions that directly correlate, and many people struggle with shopping, gambling, food and professional burnout.

Q. Where do your patients come from, and how do they find you?
A. Being a very exclusive and private rehab center that primarily focuses on genuine recovery, almost all of our patients come from word of mouth. But with the recent change in the treatment of Hollywood notables, as well as different understandings on what kind of treatments are being provided, I felt it necessary to come forth and share what I know are the most helpful methods to achieve a sustainable recovery.

Q. How long have you been specializing in the field of rehab?
A. I literally did all of my early master’s degree intern work in the field of addiction. Once I received my master’s and was out of graduate school, my first internship was as a primary therapist for a residential treatment center for court mandated clients. My specialization in addiction and treatment started during my master’s degree program, which required 3000 hours of individual & family work, as well as program direction in the area of rehab. Then, I continued to specialize in addiction in my private practice as well as working in various other addiction treatment establishments.

Q. You’ve been successfully rehabilitating drug and alcohol addicts for more than 20 years – what do you attribute your success rate to?
A. I attribute my success to the individuals and families who have been willing to stay in the process with me. Those who have the courage to do the work are the ones who benefit from the all we now know about the treatment process. I am merely the facilitator of sharing in that process which is as individual as the individuals themselves.

Q. What is the most common barrier to recovery for addicts?
A. It remains imperative to treat the biological components and to guide each client to an internal navigation. Not doing the necessary and difficult work with core issues makes behavioral tools much too limiting.

Q. Tell us about your hallmark Archetypal work that you individualize for each client as part of their overall treatment:
A. I guide each client through a process that allows for enormous self-discovery by differentiating all of who they are, from the critic that lives inside each of us to the addictive side of themselves. Each archetypal table is as unique as the person being guided, and each aspect of the process draws from the subconscious and conscious material. In the end, my clients develop an extraordinary awareness that gives them a solid center to draw from, and a heightened coping ability that was never experienced previously.

Dr. David E. Smith, speaks at Stone Eagle Retreat in Malibu

DR. DAVID E. SMITH, RENOWNED ADDICTION TREATMENT SPECIALIST
& FOUNDER OF HAIGHT ASHBURY CLINIC SPEAKS AT STONE EAGLE RETREAT

New State-of-the Art Addiction Rehabilitation Center Hosted an Open House Event on
January 17, 2008

Dr. David E. Smith, Founder of the famous Haight Ashbury Free Clinics of San Francisco and Executive Medical Director of the Prometa Center, was the keynote speaker at Stone Eagle Retreat’s Open House event on Thursday, January 17. Pictured here (middle) with Nancy Szakacsy, Clinical Director (left) & Doug Szakacsy, Director of Health & Wellness (right).

Dr. Smith is a national leader in addiction medicine, and has been honored as one of the “Best Doctors in America.” He is a Fellow and Past President of the American Society of Addiction Medicine, Past Medical Director for the California State Department of Alcohol and Drug Programs, Past Medical Director for the California Collaborative Center for Substance Abuse Policy Research, and former advisor to the Betty Ford Center. Dr. Smith is also the Founder and Publisher of the Journal of Psychoactive Drugs, has authored/co-authored 26 books, and has served as a technical consultant for 28 drug abuse related films. He has also been featured in a documentary called, “The 60’s,” hosted by Tom Brokaw, which is currently airing on The History Channel.

In 2006, Dr. Smith founded the Free Clinic Cooperative, a non-profit organization whose mission is to reach out to and support free medical clinics nationwide. Dr. Smith has also recently opened medical clinics in Santa Monica, CA (2006) and San Francisco, CA (2007) that use the PROMETA Treatment -- an innovative anti-addiction protocol that successfully treats drug and alcohol dependencies. Stone Eagle Retreat is the first residential & outpatient rehabilitation center to partner directly with The Prometa Center of Santa Monica.

Dr. Smith, along with Dr. Matthew Torrington, Medical Director at the Santa Monica Prometa Treatment Center, discussed cutting-edge treatments for addiction disorders. He also spoke about new medical discoveries that are uncovering the psychopharmacological truth behind substance abuse, and what can be done to stop it.

A Familiar Friend: Painkiller Addiction

Teens & the Infirm at Risk for Developing Prescription Drug Addictions

After years of reoccurring kidney stones and regular surgeries, Jared Hess became addicted to painkillers. After a monthlong stay in the hospital and being prescribed the powerful painkiller Oxycontin, Hess continued to use the drug against his doctors' orders, surreptitiously obtaining pills. Within a year of first being prescribed the painkiller, he found himself in rehab. He was just 19 years old. "I was in college when it first became a real problem. I lost interest in school, stopped going to class, my relationships with friends and family deteriorated," Hess, now 24, "I was doing it every day and by myself. My life revolved around getting the drug and using it," he said. Hess now works for the nonprofit Faces and Voices of Recovery, which advocates for substance abusers, who like Hess, often have a hard time getting insurance companies to pay for their treatment. Hess embodies the two groups experts say are most susceptible to painkiller abuse: patients prescribed drugs who later become addicted, and young people who generally begin using the drugs recreationally and not for medical reasons.

An estimated 5.2 million people used prescription pain relievers in 2006 for nonmedical reasons, up from 4.7 million in 2005, according to the Department of Health and Human Services. That's more than twice the 2.4 million people the department estimates use cocaine nationwide.
According to statistics compiled by the Partnership for a Drug Free America, nearly one in five teens, or a staggering 4.5 million kids age 12-19, reportedly abused prescription medications to get high last year. Despite an overall downward trend in overall drug use among teenagers, painkiller abuse is up, according to a White House report released by President Bush last month.
What makes opioids (the class of common pain drugs like Oxycontin and Vicodin) effective pain relievers is also what makes them so highly addictive, said Fred Berger, medical director of the Scripps McDonald Center, the drug rehabilitation center at Scripps Memorial Hospital La Jolla, Calif.

"Opioids are chemicals that attach to certain receptors in the brain. These drugs both prevent pain and stimulate the pleasure center in the brain. Those drugs that are the most effective in terms of attaching to those receptors give the most relief from pain as well as the most pleasure." Berger described a wide range of people who become addicted to painkillers from "little old ladies who fractured a vertebra, are placed on meds and then can't come off them or don't want to," to "teenagers looking through their parents' medicine cabinets in order to get high." The most common medical problem abusers who get hooked typically have is lower back pain, he said.

"These drugs serve a purpose and that's to deal with short-term pain. There are physicians who prescribe drugs chronically and after a while patients become habituated. Patients need more medicine to have an effect, but the pain doesn't get any better. They become dependent and if they try to stop withdrawal symptoms set in and the pain becomes more accentuated," he said.
Of those patients legitimately prescribed painkillers, people with addictive personalities or who have been addicted to other substances in the past are particularly prone to developing addictions.

"Some people are more prone to addiction," said Joseph A. Califano Jr., chairman and president of the National Center on Addiction and Substance Abuse at Columbia University. "People who are depressed, prone to anxiety or alcoholics are more likely to develop an addiction to prescription drugs." Doctors, he said, have to know their patients' histories with substance abuse and remain involved in their treatment while taking potentially addictive painkillers.
"Part of any physician's responsibility is to carefully watch their patients. It is vital they question their patients enough to determine if they might become addicted. If a doctor focuses on an alcoholic's pain, or anxiety, or sleeplessness, and ignores his alcoholism, there is an increased chance of developing a prescription drug addiction," he said.

Unlike Hess, the majority of teenagers who become addicted to painkillers were never prescribed medication by a doctor. These kids instead find the drugs in their parents' medicine cabinets, get them off friends or purchase them off the Internet. "There has been an explosion of prescription drug abuse among teens," Califano said. "They see their parents using these drugs and they think they are using a clean pill approved by the FDA [Food and Drug Administration]. They think the drugs are safe because they're not buying it from dirty drug dealers on dirty corners. The increase in prescription drug abuse has wiped out any of the modest decreases among teen users of marijuana."

Teenagers looking to get high often crush and snort pills, quickly releasing the drug intended to be spread throughout the body during 12 to 24 hours. Users report a high similar to other opiates like heroin that can "really affect their functioning," said Berger. The visible effects on a typical painkiller abuser, however, are subtle and family members of addicts sometimes rarely know. "There is very little medical damage that goes along with opioid addiction," Berger said. "It's destructive because it gets you by the throat in terms of addiction potential. Your life becomes consumed with worrying about how to get the medication. It is an ongoing process centered on getting drugs, maintaining your supply and worrying little about the other important aspects of your life."

As seen on "Faces and Voices of Recovery" - Russell Goldman ABC News January 4, 2008