Addiction as a chronic disease and options for treatment of opioid or heroin dependence
Thanks to the expansion of brain imaging research to study the neurochemistry and neuroanatomy of addiction, the medical community has been offered a bulk of evidence that depicts addiction as “a primary, chronic disease of brain reward, motivation, memory and related circuitry.” (American Society of Addiction Medicine Public Policy Statement, 2011).
Most of us are familiar with the idea that addiction involves the brain’s reward system, and most would agree that there is at least a chemical basis for addiction.
What has been less commonly accepted (or known) is that the chemical changes that take place over the course of hours and days following the ingestion of an addictive substance result, over the course of weeks to years, in changes to the user’s actual brain structures.
The implications of recognizing this process are broad: 1) Someone who has developed physiologic dependence on a substance (experiences withdrawals without it) may already be considered to have a chronic disease; 2) “curing” addiction is probably a myth. A better goal might be to manage the addiction.
Addiction as a Chronic Disease
We can look at other chronic diseases to help us understand addiction. For example, we know that diabetes has a genetic component, so it occurs more frequently in certain families. We also know that diabetes has a behavioral component, so that on top of whichever genes an individual inherits, their food choices and exercise habits contribute to the likelihood they will develop diabetes in their lifetime.
Finally, we know that some people with diabetes in America can achieve excellent control over their disease with lifestyle changes alone, but that most need medication plus lifestyle support to achieve their goals.
Those who are diagnosed early, and who achieve and maintain healthy blood sugar levels quickly have the best chance to reduce the risk of future health complications. Those for whom the diagnosis is delayed, or whose disease is very severe, are most likely to require medication for the rest of their lives to manage their health risks.
Parallels may be drawn with addiction at each level: 1) there is a genetic component, 2) early life experiences and lifestyle choices over time moderate your risk of developing an addiction, and 3) some can achieve control over the disease of addiction through varying degrees of lifestyle changes. But most will achieve their goals more quickly and with fewer health consequences through a combination of lifestyle changes, counseling, and, in the right situation, medication.
Depending on the type of substance, length or frequency of exposure, and genetic or psychosocial factors, different people experience structural brain changes at different rates. So the most effective balance between lifestyle changes and medication will be unique for each person seeking care.
What Medications are Available?
There are two first-line medications for the treatment of Opioid Use Disorder: Methadone and Suboxone. Methadone must be prescribed in a highly regulated environment by a qualified MD or DO.
Unfortunately, there are no methadone clinics at this time in Southeast Idaho. Suboxone, because it carries a much lower risk of overdose and abuse, is an accessible alternative. It is available through several clinics in our area.
Treatment typically starts with a primary care provider (PCP) or behavioral health provider, who will refer a person who is motivated to start treatment to a Suboxone prescriber. Quality treatment of addiction nearly always involves an individual or group therapy component.
Often, visits with the medical provider and counselor are weekly for the first phase of treatment, then become less frequent as the patient starts to meet their health goals.
Each clinic has its own guidelines regarding who may qualify for treatment and what treatment looks like, but all share the goal of helping people find a healthier, more balanced way of managing their chronic disease.
The first step, which is always hard because of the stigma that still surrounds addiction, is being willing to speak with a PCP or counselor about substance use. Medical and behavioral health providers are trained to provide sensitive and quality care, and there is plenty of science to support current treatments for anyone seeking care for addiction.
For information about establishing care with a PCP, you may contact Health West, or contact the Idaho BPA for resources for treatment of opioid dependence.
Heather Schaper is a bilingual primary care Physician Assistant and the Midlevel Medical Director for Health West, Inc. She provides primary care to clients through the Aberdeen Health West Clinic, treats Hepatitis C at the Health West Pocatello Clinic, and provides primary care to HIV positive clients at the Ryan White HIV Clinic at Health West ISU. She has a Master’s degree in Medical Anthropology from Idaho State University, and enjoys exploring themes of health and illness across class and cultural spectra.