Addiction has a devastating impact on the physical, psychological, and social health and well-being of its victims. And while individual stories can powerfully highlight the harms of addiction, recent statistics on life expectancy in America demonstrate the true scale of the impact of this deadly disease.
In August 2022, the CDC revealed that life expectancy in the U.S. dropped for the second year in a row. As predicted, COVID was the main contributing factor, but the next leading cause was a sharp increase in drug overdose deaths (more than 109,000 in the 12 months prior).
Unfortunately, as any experienced substance use recovery provider knows, these statistics only represent the tip of the iceberg of addiction related.
For the 46.3 million people in the U.S. living with substance use disorder, challenges around stigma, access to care, and discrimination cause untold amounts of needless suffering and health complications, for what is ultimately a very treatable medical condition.
To improve health outcomes for people with addiction, it’s time to let go of the idea that substance abuse is a moral flaw or personal failing—and start treating addiction like the disease it is.
Despite consensus among experts that addiction is a brain disorder and chronic disease, many aspects of treatment, legislation, and societal attitudes are still influenced by outdated beliefs that addiction is a moral deficit or social problem.
Some current examples of this include:
- In the U.S., SUD treatment services are still largely separate from the mainstream health system that treats and manages all other diseases.
- The Americans with Disabilities Act (ADA) contains several exemptions precluding people who are using illegal drugs from being covered by the act.
- A 2020 review into stigma against SUD patients noted, “It is [stigma] a pervasive phenomenon that has had detrimental effects on treatment outcomes, healthcare providers, treatments, research, policies, and society as a whole.
While progress has been made over the past two decades, there’s no denying the fact that health systems, lawmakers, and society as a whole are still playing “catch up” to a degree, after over a century of mischaracterizing addiction as a personal failing, rather than a chronic medical disease.
The landmark 2016 Surgeon General’s Report on Alcohol, Drugs, and Health called for “A public health model for addressing substance misuse and related consequences”. The report explains that by adopting a public health lens, similar approaches to those used with other widespread health concerns, like diabetes, heart disease, and cancer could be applied.
Just some of the benefits of this approach are:
- The development of a nationwide consensus on the scope, characteristics, and consequences of the problem.
- Identifying risks and protective factors, which could inform research and public health prevention efforts.
- Working across the public and private sectors to test treatments and interventions to develop best practice guidelines.
Fortunately, there have been encouraging developments on the legislative front in this area in recent years. In response to the growing opioid crisis, the Comprehensive Addiction and Recovery Act (CARA) was passed in 2016, followed in 2018 by the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act.
Both of these pieces of legislation have ushered in a new era of opioid addiction management, where the gold standard of treatment, medication-assisted therapy, is easier to access for patients from a wider variety of providers. It also helped change the discourse about the opioid epidemic to a shared national emergency, rather than an isolated issue that only impacted certain segments of the population.
There are many benefits for patients when addiction is treated like the disease that it is. This perspective change allows substance use recovery treatment to be integrated into the mainstream healthcare system, providing better access to treatment, improved quality of care, and reduced stigma. We’ll explore each further below.
For better or worse, the healthcare system in the U.S. operates within a disease-focused medical model. That means, for an individual to access treatment within the public or private system, they must have a diagnosed medical condition that can be treated—aka, a disease. By recognizing addiction as a disease, patients can be confident that once they have a diagnosis, they will have coverage to access treatment, just like if they had diabetes or high blood pressure.
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Evidence-based practice guidelines ensure patients get high-quality care when they’re treated by a registered medical professional. While there is some variation, any patient who has a heart attack or stroke can be assured that whatever hospital they attend for emergency treatment, protocols will be followed in line with the latest research in evidence-based medicine. The difficulty is, such guidelines are only created for recognized medical conditions with a reasonable evidence base, where consensus exists about treatment and management. Due to the legacy of historical beliefs about addiction primarily being a social problem, evidence-based treatment guidelines lag far behind other diseases. By recognizing addiction as the disease it is, the important work of establishing gold-standard treatment guidelines can continue to progress.
Treating addiction as a disease is an essential step in changing the dialogue from addiction being a moral flaw and problem to be solved, to a medical condition that needs treatment. This change in perception benefits patients through less discrimination from healthcare staff and the wider community. Plus, it reduces the internal shame and guilt many people feel because of their drug use.
When addiction is recognized as a disease, providers can conduct their daily business with confidence and clarity, knowing there is consensus and a shared vision for how addiction treatment should be covered and managed. Some additional flow-on benefits for providers are discussed below.
When addiction is managed with a similar approach as other medical conditions, providers can utilize clinical support platforms like EHR systems that handle electronic records, billing and insurance, lab orders and results, telehealth, financial reporting, and more. This allows providers to focus their efforts on clinical care, in the knowledge that administration, financial, and compliance procedures are being looked after. Because we understand that addiction is a disease, we’ve created our all-in-one EHR solution for behavioral health practices, Procentive, with ready-to-use forms and templates that are DSM-5 compatible. We’ve even included a DrFirst integrated e-prescribe feature that lets you review existing medications, check for drug-to-drug and drug-to-diagnosis interactions, create new prescriptions, and process renewals, so you’ll always know your client is in safe hands.
Contemporary management of chronic disease (e.g., asthma, heart disease, diabetes) is proactive and individualized, involving a combination of treatment with medications, psychosocial support, patient and family education, and holistic care from medical and allied health professionals. Care is also long-term, in the recognition that chronic conditions generally require ongoing treatment. When addiction is treated as the chronic disease that it is, providers can utilize the full spectrum of psychosocial and allied health services available to support their patients. They can also be confident they will be reimbursed for ongoing care and management, not just a brief episode of care.
Finally, when addiction is treated like a disease, providers from any location can initiate treatment for substance use disorder, safe in the knowledge that a patient can continue accessing suitable care from another medical provider. UC Davis has seen success with this approach through their Substance Use Navigator Program, where patients with opioid addiction are started on medication-assisted treatment in the emergency department, then care is transferred to primary care physicians and community support services for ongoing management. Their next phase is expanding the program to primary care and community health services, so people across the state can seamlessly receive combined treatment with medication and behavioral health interventions, which is currently the most effective treatment approach for opioid addiction.
While there’s still a way to go, if the pace of progress over the last decade continues, the goal of addiction being treated, insured, and evaluated like other chronic diseases could be possible in the coming 10 years. Such a change would bring massive benefits in terms of access to care, quality of treatment, and improved outcomes for the tens of millions of people in the U.S. currently struggling with addiction.
For this lofty goal to be achieved, continued health system reform, legislative progress, and public health initiatives will be required. And all stakeholders, treatment providers, and the wider community will need to come together as a unified whole, in agreement that addiction is a chronic disease that needs treatment, not a personal problem that needs solving.
To get a head start on bringing your practice in line with the contemporary disease model of substance use recovery treatment, book a demo now to see how Procentive can transform your business. Our all-in-one EHR solution for behavioral health practices is integrated with the latest in evidence-based addiction treatment guidelines, providing everything you need to support the delivery of high-quality clinical care.