Has the Disease Definition of Addiction Prevailed?

Bill_C_Info-Pic.fwIt’s been eight years since the Mental Health Parity and Addiction Equity Act (MHPAEA) became law. At its core, the law was intended to ensure that insurance providers who offer mental health or substance use disorder benefits don’t impose any limitations on those benefits that differ from what is offered for primary care.

There was also an inherent hope among substance use treatment providers that the disease definition of addiction would prevail. But has it? That was the central question of a discussion led by Michael Weiner, Ph.D., CAP, ICRC, at the just-concluded National Conference on Addiction Disorders (NCAD) in Denver. Dr. Weiner is Educator/Consultant at Behavioral Health of the Palm Beaches/Seaside. The question and the myriad of responses rightfully gave me pause – perhaps they will for you too.

There was general agreement that the concept of addiction as a chronic disease is being embraced initially when a person enters treatment. Our actions at that point indicate that we have truly embraced the American Society of Addiction Medicine’s (ASAM) conclusion that addiction “affects neurotransmission and interactions with reward circuitry of the brain, leading to addictive behaviors that supplant healthy behaviors, while memories of previous experiences with food, sex, alcohol and other drugs trigger craving and renewal of addictive behaviors.”  But our collective approach to and perception of aftercare shows that we still aren’t treating addiction like we treat other chronic diseases such as diabetes and hypertension.

One clear example is that persons diagnosed with diabetes or hypertension have periodic checkups for the rest of their lives. In contrast, the treatment of addiction is heavily focused on a three to six month period. In most cases there is no monitoring, review or check-up by any type of professional after that point. I am proud to say, however, that Netsmart has proactively been working to address this issue, providing tools like Netsmart CareManager to coordinate care across providers and track outcomes in an ongoing fashion. Still, there is much work to do.

(How does addiction compare to other diseases? This EveryDayMatters Foundation video explores.)

Perceptions about and characterizations of addiction, even among clinicians, haven’t fully evolved either. For example, when a person with diabetes eats a donut, we don’t refer to them being “off the wagon,” nor do we view the instance as a total failure. By using different language and reacting to mis-steps in absolute terms, we perpetuate stereotypes.

And finally, addiction treatment continues to be poorly funded, in part because it’s viewed by many as a waste of time. We typically don’t have the same attitude about funding for diabetes and hypertension. But, as Dr. Weiner illustrates with relapse data from the Journal of the American Medical Association, the “What’s the use?” mentality about addiction treatment isn’t warranted.

Percentage of Patients that Relapse

  • Type I Diabetes – 30 to 50 percent
  • Drug Addiction – 40 to 60 percent
  • Hypertension – 50 to 70 percent
  • Asthma – 50 to 70 percent

Self-evaluation of the addiction treatment community is vital. I’m grateful that NCAD and Dr. Weiner facilitated such a thorough and thoughtful analysis. We’re faced with an extensive population in need of our services and the tools to monitor their ongoing care. A non-judgmental approach to treatment that embraces the disease definition of addiction and focuses on continuing care and is vital to our long-term collective success.