In my previous post, I began a discussion on the ASAM definition of addiction, and its nature as a primary disease, which means it can manifest in the body without any other accompanying disorders.
The second characteristic of addiction is that it is a chronic disease. There are two types of medical conditions: chronic and acute. Chronic conditions are long-term and persistent, and there are no permanent cures for them, but they can be brought into remission and kept there indefinitely when properly managed. Acute conditions have a rather rapid onset and a short duration. An example of an acute disease would be the common cold. You sense when it starts, you experience it when it is at its peak, and you know when it has run its course. The significant factor in determining if a condition is acute is whether it can be cured, and the patient can return to their previous state of health.
Chronic diseases are different. Once you have been diagnosed with a chronic disease the typical course of treatment will include: stabilization, education, and lifestyle change. These elements are designed to help the patient effectively manage the disease and avoid any additional consequences associated with the disease remaining untreated. When you follow the recommendations of your healthcare providers you are deemed to be “compliant with your treatment plan.” You will hear me use that phrase a lot as we go forward. That’s because being compliant with your treatment plan is the way to successfully manage the disease of addiction. Being non-compliant in most cases results in symptom reemergence and a return to active addiction.
Let’s look at a chronic disease that closely parallels addiction: type 1 diabetes. It is associated with a family history of diabetes and there is no cure for it. The treatment protocol starts with stabilization. That means quickly bringing the patient’s blood sugar levels to a normal range and treating any ancillary condition, such as poor circulation.
Once the patient is stable and feeling better, education begins. The patient is taught about how diabetes affects the body; typically, diabetes damages the blood vessels, which affects the heart, lungs, brain, kidneys, eyes, feet, and nerves. Next, the patient is shown how to manage the disease. This includes learning how to check his or her blood sugar levels, which medications to take and when, and the proper way to self-administer insulin. The patient is also taught the importance of a healthy diet and regular exercise, what the early symptoms of unregulated diabetes are, and what to do to quickly get his or her symptoms back under control.
Then the treatment team works with and monitors the patient to help in turning the tools of diabetes management into long-term lifestyle changes. This is easier said than done, which is why the treatment plan non-compliance rate for people with diabetes is similar to that of those with addiction. This period of lifestyle change has the highest risk for relapse. Accordingly, the treatment team is ready to repeat the process of stabilization, education, and lifestyle change as many times as needed.
Addiction treatment follows that same set of steps: stabilization, education and lifestyle change.
The stabilization step oftentimes involves detoxifying from the substances being used. Depending on the severity of a patient’s active addiction this may be accomplished in an inpatient hospital setting or an outpatient clinic setting. It is best to get an assessment using ASAM’s criteria from a trained clinician to decide which setting is indicated. This is also an element of treatment for patients who are experiencing post-acute withdrawal symptoms. This may occur in a patient’s first six months of treatment. Strong and consistent clinical and medical interventions are indicated during this “high-risk” period.
The education step encompasses learning about the disease of addiction, exploring and experiencing the various tools that patients use to achieve and maintain recovery, learning how addiction can affect a patient’s physical and mental health, spiritual life, and relationships.
The lifestyle change step involves taking the tools and concepts the patient has learned in the education phase and putting them into action. It involves changing one’s thoughts and behaviors for a long enough period for them to become second nature. 
For those of you who have struggled with the disease of addiction or have loved ones who are suffering with addiction, you may find what I just wrote rather glib, or “easier said than done.” I wholeheartedly agree! What I wrote might sound simple and straightforward, but let me assure you, I understand how difficult doing this can be. Many people struggle with the process of maintaining long-term recovery, only to find themselves back in relapse mode. Relapse is an element of any chronic disease, not just addiction.
If you have tried to stop in the past only to relapse, I strongly urge you not to give up. Many people have achieved long-term recovery after numerous attempts at treatment. We really don’t know why one attempt works when previous ones have not. There are so many moving parts of treatment; it’s hard to identify which components need to be changed. It might be because of a difference in the treatment team or clinical approach. Perhaps the patient’s personal situation has changed and they are looking at their disease from a different perspective. Another possibility is that the patient’s disease has progressed to the point where physically and psychologically the patient wants to fully embrace the process of lifestyle change. My experience indicates, most times, it’s a combination of them all.
This brings us to the third characteristic of addiction: its progressive nature. I will discuss that in my next post.
 I will discuss these topics in relation to addiction in future posts.