Evolution of Concept, But Not Action, in Addiction Treatment

Abstract

The Western approach to addiction treatment involves a medical or disease orientation to understanding the onset, course, and management of addiction, and a clinical goal of abstinence or very significant reductions in drug use, usually with a combination of behavioral and pharmacological interventions. Even within this Western approach, and despite several consensually accepted features of addiction, a significant mismatch remains between what this culture has come to accept as the nature of the disease and how that same culture continues to treat the disease. This paper discusses the evolution of these Western concepts over the past decade without a corresponding evolution in the nature, duration, or evaluation standards for addiction treatment. Here, we take the position that continuing care and adaptive treatment protocols, combining behavioral therapies, family and social supports, and, where needed, medications show much promise to address the typically chronic, relapsing, and heterogeneous nature of most cases of serious addiction. By extension, methods to evaluate effectiveness of addiction treatment should focus upon the functional status of patients during the course of their treatment instead of post-treatment, as is the evaluation practice used with most other chronic illnesses.

Keywords :

• addiction
• treatment
• chronic illness
• evaluation
• healthcare
• relapse
• continuing care
• continuum of care
• heterogeneity

THE AUTHORS

Amelia M. Arria, PhD, is the Director of the Center on Young Adult Health and Development at the University of Maryland School of Public Health and a Senior Scientist at the Treatment Research Institute in Philadelphia. Her research interests span several areas of the alcohol and drug field, including understanding the patterns of use, health consequences, and effective methods for treatment and prevention. She is involved in studies examining the antecedents and consequences of adolescent and young adult high-risk behaviors, as well as access and utilization of addiction and mental health treatment. She is the Principal Investigator for the NIDA-funded College Life Study, a 10-year prospective study of health-risk behaviors among a sample of 1,253 young adults who were originally recruited as first-year college students. She received a BS in Human Development and Family Studies from Cornell University, a PhD in Epidemiology from the University of Pittsburgh Graduate School of Public Health and completed post-doctoral training at the Johns Hopkins University Bloomberg School of Public Health.

A. Thomas McLellan is the CEO and Founder of the Treatment Research Institute (TRI) and an experienced addiction researcher. From 2009 to 2010, he was Deputy Director of the White House Office of National Drug Control Policy (ONDCP), a Congressionally confirmed Presidential appointment to help shape the nation's public policy approach to illicit drug use. At ONDCP, Dr. McLellan worked on a broad range of drug issues, including formulation and implementation of the President's National Drug Control Strategy (including the much-heralded end of the War on Drugs) and promotion of drug treatment through the broader revamping of the national health care system. Dr. McLellan has more than 35 years of experience in addiction treatment research. In 1992, he co-founded and led (until his ONDCP appointment) TRI to transform the way research is employed in the treatment of and policy-making around substance use and abuse. In his career, he has published over 400 articles and chapters on addiction research. From 2000 to 2009, he was Editor-in-Chief of the Journal of Substance Abuse Treatment, and he has also served on several other editorial boards of scientific journals. Dr. McLellan is the recipient of several distinguished awards in the addiction field.

GLOSSARY

• Addiction: A chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.

• Continuum of care: A spectrum of services for addiction treatment that addresses the changing needs of patients as they move through periods in which their symptoms improve or worsen.

• Monitoring: The act of observing and keeping record of an individual's compliance with addiction treatment and progress toward recovery, which can include both urine toxicology screening and various forms of communication between the patient and their healthcare professional.

• Recovery: A voluntarily maintained lifestyle composed and characterized by sobriety, personal health, and citizenship.