Chronic Disease Management for SUD



Addiction is a Chronic Disease


Too often substance use disorders are treated like an acute issue instead of a chronic disease in the United States. Movies, TV and commercials often reference “rehab stays” or one month treatment programs that sound like a cure. But unlike a common cold, the flu or pneumonia, addiction does not resolve quickly or just disappear.


A chronic disease or illness is persistent or otherwise long-lasting. While they often don't have a cure, you can live with them and manage their symptoms. According to the Centers for Disease Control and Prevention (CDC), chronic diseases are defined as conditions “that last one year or more and require ongoing medical attention or limit activities of daily living or both.” Common chronic diseases include heart disease, asthma, and diabetes.


Dr. Richard Saitz explains in the Journal for Addiction Medicine: “Like other chronic diseases (eg, diabetes, congestive heart failure), substance dependence has no cure and is characterized by relapses requiring longitudinal care.”[1]


He adds that “medical and psychiatric comorbidities are the rule rather than the exception."


Common chronic diseases include heart disease, asthma, and diabetes.




Acute vs. Chronic Diseases


Healthcare providers often categorized conditions as either chronic or acute. So what’s the difference?


  • Acute illnesses generally develop suddenly and last a short time, often only a few days or weeks. Examples include the common cold, flu, bronchitis, pneumonia, strep throat or a heart attack.


  • Chronic conditions develop slowly and require a longer term treatment and management strategy. Examples include Alzheimer’s disease, depression, diabetes, heart disease and obesity.



Chronic Disease Management for SUD


Our current system of care for addiction is often fragmented and not coordinated to provide chronic disease management. Because of this, family members or the individual themselves often must piece together each of the needed components to create an adequate care plan for a chronic SUD. Efforts are underway to change this in our healthcare system, but progress is slow.


Learning from models of other chronic diseases will help both providers and patients/caregivers understand better approaches.


For example, a chronic care plan for a type 2 diabetes patient (diabetes mellitus) may include insulin, medication monitoring and adjustments by the physician, control of blood glucose levels through regular testing and glucometers, consulting with a nutritionist on healthy eating habits, physical exercise and modified eating habits. And diabetes patients are taught that long-term adherence is key. When a patient is stable or has managed their symptoms, it doesn’t mean they are cured or can discontinue their treatment regimen. In other words, normal blood sugar levels doesn’t mean a patient can discontinue their medication, diet and exercise regiment. They continue their care plan and have regular visits with the primary physician to monitor their symptoms.



For the chronic disease management for addiction, many care plans will include the use of medication or psychiatric counseling, and will recommend abstinence from alcohol and drugs.



Experts recommend that care plans include treatment and management of other diagnoses or health concerns (comorbidities).


Many patients with a SUD also struggle with depression or an anxiety disorder. Others have experienced trauma or PTSD, or have physical health disorders that range from diabetes to infectious diseases that require attention. Treatment and management of these conditions should be built into the care plan to treat the whole patient.


Addressing social needs is another critical component of a care plan. Building positive relationships with peers and others also in recovery who abstain from alcohol and drug use creates a significant protective factor for the patient. Addressing coping skills and alternate social skills is also helpful to patients, from mindfulness training (dialectical behavioral therapy) to retraining behavior patterns (cognitive behavioral therapy) to developing new social skills.


How to Respond to a Relapse/ Recurrence of Use


Managing slips or relapses is also a key component of a chronic care plan. Though addiction has similar relapse rates to other chronic health conditions like asthma and diabetes, there is a general lack of understanding about how to address relapses and understand their occurrence as part of a chronic health condition.[2]


For a person recovering from addiction, returning to drug or alcohol use after a period of remission does not mean that the patient or the treatment has “failed.”[3]


Relapse — or “recurrence of use”— is better understood as an important indicator that the care plan needs to be adjusted to better align with the patient’s needs. Setbacks should be met with a modification in the care plan to help the patient restabilize and continue their chronic disease management course.




If your loved one experiences a relapse, don’t be discouraged. The treatment of chronic diseases involves changing deeply embedded behaviors. And healing in areas of the brain and body affected by substance use takes time.


Patients are at the highest risk of relapsing during the first 90 days after their initial treatment intervention as they are experiencing major changes within their body, mind, and social context.


Often, people start misusing substances as a way to cope with life’s challenges. When substance use is stopped, individuals may lack the skills needed to cope with everyday stress.


As a patient progresses through treatment, they develop these skills and become more confident in their ability to handle stress without using substances. It’s important to remember that people being treated for a substance use disorder require extra support during the period of early recovery.


Patients are also at risk when specific triggers occur, whether a job loss, relationship change, loss of a loved one or physical injury. These stressors should be met with open dialogue with your loved one and engagement with the care team to determine if more wraparound support is needed.




An excerpt from Navigating Addiction and Treatment: A Guide for Families, Addiction Policy Forum, 2020.




A Note From Addiction Policy Forum


Substance use disorders get worse over time. The earlier treatment starts the better the chances for long-term recovery. Many families are wrongly told to “wait for rock bottom” and that their loved one needs to feel ready to seek treatment in order for it to work. The idea that we should wait for the disease to get worse before seeking treatment is dangerous. Imagine if we waited until stage 4 to treat cancer. Decades of research has proven that the earlier someone is treated, the better their outcomes—and that treatment works just as well for patients who are compelled to start treatment by outside forces as it does for those who are self-motivated to enter treatment.


Help is Here


If you have questions or need to speak with someone for support, call or text (833) 301-4357 today. Our staff of trained counselors at Addiction Policy Forum provides free, confidential support to anyone in need of help with a Substance Use Disorder issue, including patients, families and healthcare providers.




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References:


1) Saitz, R., Larson, M. J., Labelle, C., Richardson, J., & Samet, J. H. (2008). The case for chronic disease management for addiction. Journal of addiction medicine, 2(2), 55–65.  https://doi.org/10.1097/ADM.0b013e318166af 74

2) McLellan A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation. JAMA. 2000;284(13):1689–1695. doi:10.1001/jama.284.13.1689

3) National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Treatment. Retrieved from www.drugabuse.gov/publications/principlesdrug-addiction-treatment-research-basedguide-third-edition/preface

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