Acute vs Chronic Care: Why Addiction Isn't a Broken Leg
Rick Baumgartle CADC II
In this country our medical system has two main models. One is acute and the other is chronic. Acute care is what you get when you have a problem that can be remedied such as an infection, a cold, or even a broken leg. You have a problem, the doctor or provider identifies that problem, provides a solution, usually short term, and then you get better. Chronic care is where you receive ongoing treatment or therapy for a condition, such as cancer, diabetes, and yes even addiction. A chronic condition is one that persists even though you might not have symptoms. Take Type One Diabetes (one of my favorite go to diseases to compare addiction to, as they have so much in common) for example. A person who is taking insulin to manage their blood sugar and who's blood sugar is under control, does not experience the symptoms of unmanaged Type One Diabetes. That doesn't mean the disease is gone. Ask any type one diabetic who ever stopped doing the things necessary to keep their disease under control, and in remission, what happened and they will tell you that things got bad in a hurry.
It's the same way with addiction. Diabetes is a more biological condition. Addiction is what we call a biopsychosocial disease in that it effects people in more ways than just physically. It also effects them mentally and socially as well. However, just like diabetes, it is chronic, progressive, and left untreated can be terminal.
The fact that addiction, is in fact a disease, isn't really up for debate, It's a scientific fact based on mountains of research and evidence based practices. In the words of Neil Degrasse Tyson, “Scientific facts aren't interested in your opinion.” It is what it is.
Problems can arise when people get in the mindset (usually due to people lacking an understanding of addiction telling them nonsense) that addiction is an acute condition and they just need to “fix it” and move on.
This attitude usually comes to the surface in a few ways. The first way, at least in terms of medication assisted treatment, is when people come in with an idea already in mind that “I don't want to be on this stuff long term.” Well, guess what? Neither do we, if that is your goal, and after a period of time there is no medical need for you to be on it. However, putting some kind of timeline on ones self in terms of when you are going to be done, just adds anxiety as the day approaches, unnecessary feelings of guilt when you aren't complete by that date, and a very real danger of relapse if you try and rush it. I tell people all the time, “You will be off when you are ready to be off and not a day before.” Added pressure from friends and family with a limited understanding of addiction, and more so of medication assisted treatment, just compound the problem. So for all you family members (and we love you and welcome you into the treatment process with your loved ones), please get off their a**! You're doing way more harm than good. It's not motivating, it damaging. Go to an Al-Anon meeting and let your loved one work on themselves.
Another way this idea of addiction being an acute issue shows up is in the lack of participation on the therapy side of treatment. Suboxone (and it's generic equivalent Burprenorphine, as well as a couple other alternatives we have) as amazing at it does at treating the symptoms of opioid withdrawal, is not a cure for addiction. Despite what my buddy (insert sarcastic emoticon here), Pax Prentiss ,and his koolaid cult in Malibu, want to tell you, there is no cure for addiction. Suboxone may work too well, as people begin to feel immediately better and then, mistakenly assume, because they feel better, they must be fixed. It's an understandable thought process our brains trick us into. If after several weeks of wearing a cast from a broken bone, your leg is mended, and you feel better, than there is no reason to continue any type of treatment for it. You're done. Have a nice life. Addiction doesn't play by those rules.
Part of the problem of this acute viewpoint, is caused by the medical and therapeutic community ourselves. Look at inpatient treatment programs that hand people graduation certificates, or when people complete outpatient, or some form of medication assisted treatment, and we wish them “good luck.” Any other chronic disease and the treatment provider might not have to see you as often, but they for sure would want you to come back for follow ups to make sure you were still doing well. Cancer survivors do follow ups for years after, a lot of times for the rest of their lives, because they want to make sure they remain cancer free. They know that just because they don't have anymore symptoms, doesn't mean that there is no chance that it could come back. They do what they need to do to protect themselves. All of us in the addiction services community need to do a better job at getting people to continue with after care of some kind in order to help prevent relapses to active addiction.
That last piece of why people tend to get into the mindset of addiction being acute is due to the addictive brain itself. Man, what a pain in the a** the addictive brain is. Addiction may be the only disease in the world where one of the primary symptoms is not acknowledging you have it in the first place. Even when people do acknowledge it, they just want it fixed so it goes away and they don't have to deal with it anymore; but it doesn't work that way.
People with addiction issues need to get to the place where they understand that they have a disease that requires life long monitoring. There is no quick fix, no cure. That doesn't mean people need to have some intensive program that never ends. In early recovery, sure, but not as they move forward. Much like cancer or diabetes, once the initial treatments show progress and things seem to be progressing well, a less intensive and less structured regiment can be put in place. People with diabetes, after a time don't stress as much every day about their blood sugar or food intake. They have been doing it awhile. It's a routine that they keep up and don't need to make major changes unless something happens. Addiction is the same way, except people have this need to skip steps. They want to go from quitting, to having that unstructured, not as focused on the issue itself, lifestyle; and like all good addicts, they want it now! That inevitably leads to relapse. Every time, without fail, if someone disappears and comes back, or starts to spiral downwards in treatment, all I have to do is look at how engaged they were in treatment. If they were just showing up to get their medications and nothing else, then that is a solid indicator that they weren't doing what they needed to do. Or, in the case of those that leave, and come back, I inevitably hear, “Well I figured I was good and I could just drop off (medications) and make it through it on my own.”
In both the cases above, people became victims of unreasonable expectations of addiction and recovery. Maybe, if they had just done what was suggested, and come to therapy, learned some coping skills, gotten some information and education, then they wouldn't find themselves in trouble, and their lives once again spiraling out of control.
I tell people often, “Treatment is DISCOVERY. RECOVERY, is what you do outside of treatment.” But, you can't recover if you haven't discovered. As a person in long term recovery myself I understand the want to have this just not be an issue anymore. Wanting to be, for lack of a better term, “normal.” But were not normal. We have a very serious, life threatening disease that will kill us if we continue to look at it's treatment in short term solutions. It's a life long effort.
Look, some diabetics can't have donuts. Some people with heart conditions shouldn't have sex. People with addiction issues can't have drugs and alcohol. Personally I am doing ketogenics and am single, so I am screwed all the way around, but I can pretty much guarantee my life wouldn't spiral out of control because I had a Voodoo Doughnut (Portland reference for all you non Oregonians reading this). I can't say the same for alcohol and drugs.
Here at Recovery Works NW we have a team of doctors, and clinicians with decades of combined experience in treating addition issues. We treat it as a disease and a chronic one at that. We can't promise you a cure (there is none, Pax!), but we can promise we will work with you to get your life headed in a direction that feels healthy and maybe even normal, and we will give you some of the tools you can use, if you choose to do so, to keep living that life, even after you leave treatment with us. Give us a call. We'd love to help.
If you want a Dr. who will tell you what you need to hear, and not want to hear, then go to him. He will help you, but you have to want to help yourself! I give him TEN STARS! I appreciate him and his staff more then he will ever know.