Why We Need to Treat Substance Use Disorder as a Chronic Condition
Too often, substance use disorder (SUD) is treated like an acute condition—a disease that develops suddenly and lasts only a short time. It’s also often assumed that a stay in a rehab facility is a one-and-done treatment that can “cure” an individual with SUD.
These assumptions are largely incorrect, and they’re preventing those with SUD from receiving the ongoing care and support they need to maintain sobriety and live a more fulfilling life.
It’s time that we shift the public mindset to the fact that SUD is a chronic condition that, in most cases, requires long-term management.
Why SUD Is Considered a Chronic Condition
Substance use disorder (SUD) is a chronic, treatable condition with biological, genetic, psychological, environmental, and social components. It’s characterized by a problematic pattern of drug or alcohol use, leading to noticeable impairment or distress.[1]
SUD is not a moral failing or a choice. Rather, increasing evidence suggests it’s a chronic medical condition that causes long-lasting changes in the brain’s structure and functioning.[2] These changes aren’t “easy come, easy go.” They often take months or years to develop and can persist, in many cases, for years—even after recovering patients have stopped using substances.
The good news is that the brain can change thanks to a concept called neuroplasticity, but achieving these changes and making them stick requires long-term, sometimes life-long, support and lifestyle modifications.[3]
Why Treating SUD as a Chronic Condition Matters
The traditional care approach for acute, problematic alcohol or drug use encourages the belief that patients entering SUD treatment can be cured and maintain lifelong abstinence following a single course of specialized treatment.
For the vast majority of individuals with SUD, this narrative is false. It also generates significant issues:[4]
- Families and the public become impatient when patients return to use, or “relapse.”
- Patients’ confidence and hope are slashed when they struggle or return to use.
- Policymakers allocate limited public health dollars for addiction treatment.
- Insurers restrict the number of patient days and visits covered.
- Treatment centers cannot provide ongoing the monitoring and support that most individuals with SUD need.
We Need to Shift the Public’s Mindset Surrounding SUD
To address the issues above, we must shift the public’s perception of SUD and think of SUD management similarly to how we manage other chronic medical conditions.
For example, think of SUD like diabetes. A person with diabetes can’t take one course of medication or change their diet for a month and be cured—they need to manage their condition for months, years, or even life.
The same is true of SUD—with proper support, it can be managed successfully and drastic improvements can be made, but it’s ultimately a chronic condition that requires ongoing care and diligence.
Here are a few comparisons between diabetes and SUD to help you better grasp this concept:
- Potential for relapse: Both conditions have a potential for relapse. For diabetes, it’s a 30-50% risk and for SUD, it’s 40-60%.[5] This is why we can’t treat these patients once and send them on their way. They require long-term support to reduce relapse risk.
- Medication therapy: Both conditions utilize medication for disease management. People with diabetes typically take insulin, while those with SUD have the option of Medication Assisted Treatment (MAT) with medications like buprenorphine and suboxone.
- Behavioral/lifestyle changes: Those with diabetes adopt specific lifestyle changes, such as adding exercise to their routine or modifying their eating habits and nutrition. Those with SUD learn skill building and trigger/craving management, and typically change various aspects of their lifestyle to reduce their exposure to substances.
- Co-occurring conditions: Both conditions commonly have co-occurring conditions. For diabetes, heart disease is common and for those with SUD, mental health conditions, such as anxiety, depression, and PTSD, are prevalent.[6][7]
How Can We Make SUD Treatment More Successful?
With over 107,000 fatal drug overdoses in the U.S. in 2021—the highest number of overdose deaths ever recorded in a single year—the time to change people’s understanding of SUD and the treatment approach is now.[8] How can we achieve this? Here are some potential areas for improvement.
Reducing the Stigma
SUD sufferers have experienced decades of stigma—and this has to change. People with SUD, especially those who inject drugs, are often treated by health providers in a demeaning way. This is part of the reason why only 18% of people with drug use disorders receive treatment for their addiction.[9]
Not only that, but it’s generally accepted that past practices of marginalizing and punishing people for addiction-related behaviors haven’t worked—and have disproportionately impacted people of color.
Just as patients with chronic diseases like diabetes, hypertension, or asthma receive non-judgmental treatment for their conditions, so should those with SUD. This would make those struggling feel more comfortable and motivated to seek treatment for their medical condition.
Identify and Overcome Barriers to Screening and Treatment
We can also improve treatment rates and outcomes by arming clinical practitioners with better screening and treatment tools.
- Screening: As with other chronic conditions like diabetes, identifying SUD early through screening is key to better treatment outcomes. Clinicians need to develop better knowledge surrounding how to effectively screen for SUD, how to recognize diagnostic criteria, and where to refer patients for treatment services.
Through our ePrevention solution, CHESS Health offers a fully integrated digital platform to help clinicians streamline the screening process, including SBIRT (screening, brief intervention, referral to treatment).
- Treatment: Many physicians are limited in how they can help their patients with SUD. One way to improve their treatment impact is to encourage clinicians to seek certification for “MAT waivers.” (MAT stands for Medically-Assisted Treatment).
This allows clinicians to prescribe and dispense buprenorphine, a medication approved by the FDA to treat opioid use disorders. To provide MAT, physicians must become certified by completing the required Drug Addiction Treatment Act 2000 waiver training.[10]
Invest in Continuity of Care
As mentioned earlier, completing an inpatient SUD treatment program often isn’t enough to sustain long-term recovery.
Unfortunately, most people who go through a treatment program don’t continue on to outpatient care. In fact, a study of discharge patterns in 23 states showed that although 58 percent of patients successfully completed detoxification, hospital, residential treatment, or intensive outpatient programs, only about 17 percent proceeded to regular outpatient care.[11]
This is far from ideal, as after-treatment support, such as self-help groups and peer support, have been shown to promote longer periods of recovery.[12][13]
Accordingly, we need to improve access to outpatient care, be it through the treatment programs themselves or complementary apps like Connections and Connexions. These apps provide ongoing support and relapse prevention to people recovering from SUD. This may be particularly helpful to those with limited access to in-person support due to location, stigma, finances, or other barriers.
Help Change the Game with CHESS Health
At CHESS Health, we collaborate with health plans, state and local governments, other public sector organizations, and individual clinical providers to get our life-saving apps on to the smartphones of those struggling with SUD.
If you’re interested in learning more about the groundbreaking technology we offer and how it can improve the treatment rate and success of SUD, get in touch with CHESS Health today.
References:
- https://www.cdc.gov/drugoverdose/featured-topics/recovery-SUD.html
- https://www.nejm.org/doi/full/10.1056/NEJMra1511480
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3181920/
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797101/
- https://www.addictionpolicy.org/post/chronic-disease-management-for-sud
- https://www.cdc.gov/diabetes/library/features/diabetes-and-heart.html#:~:text=Over%20time%2C%20high%20blood%20sugar,and%20can%20damage%20artery%20walls.
- https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health
- https://www.cdc.gov/nchs/pressroom/nchs_press_releases/2022/202205.htm
- https://nida.nih.gov/about-nida/noras-blog/2021/08/punishing-drug-use-heightens-stigma-addiction
- https://www.naabt.org/index.cfm
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797101/#b90-ascp-04-1-45
- https://www.tandfonline.com/doi/full/10.1080/01609513.2022.2057393
- https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.201400047
