Managing addiction as a chronic condition

Abstract

This article reviews progress in adapting addiction treatment to respond more fully to the chronic nature of most patients' problems. After reviewing evidence that the natural history of addiction involves recurrent cycles of relapse and recovery, we discuss emerging approaches to recovery management, including techniques for improving the continuity of care, monitoring during periods of abstinence, and early reintervention; recent developments in the field related to self-management, mutual aid, and other recovery supports; and system-level interventions. We also address the importance of adjusting treatment funding and organizational structures to better meet the needs of individuals with a chronic disease.

FIGURE 1

Substance Use Disorders Begin in Adolescence and Last for Decades In the U.S. household population in 2001, the percentage of people who reported substance dependence or abuse rose through the adolescent age groups to peak among the 18-to 2o-year-olds, and declined through subsequent age groups (OAS, 2002).

FIGURE 2

The Pathway to Recovery Is Cyclical Over a 2-year period, 82 percent of drug users transitioned one or more times between use, incarceration, treatment, and recovery. An average of 32 percent changed every 90 days, with movement in every direction and treatment increasing the likelihood of getting to recovery (Scott, Foss, and Dennis, 2005).

FIGURE 3

Time to Readmission to Treatment by Condition. In the 24 months following discharge from an index episode of care, the rate of readmission was higher (64% versus 51%) and the median time to readmission was shorter (376 vs. 600 days) among patients who the received recovery management checkup intervention, compared to controls. [Adapted from Dennis, Scott, and Funk, 2003; with permission from Elsevier.]