A Chronic Care Approach to the Prevention, Treatment, and Management of Addiction

Abstract

Raymond V. Tamasi

Addiction is a chronic health condition that affects 40 percent of the American public. It costs society more than $400 billion annually (excluding nicotine), is responsible for up to 45% of all hospital emergency room admissions and is implicated in 66% of incarcerations [1,2]. Of the estimated 23-25 million people who need addiction treatment, about 2.5 million (10%) receive it [3]. Stigma, insurance barriers, and the perception by many that they don’t have a problem have limited access to care. Efforts to reduce stigma through awareness programs, the 2008 Mental Health and Addiction Parity Act, and the influx of newly insured patients through the ACA have sparked investor interest and led to rapid growth of inpatient rehabilitation programs. However, despite wider acceptance of addiction as a chronic brain disorder, treatment systems continue to be developed and defined by an emphasis on acute, time-limited treatments. For more than forty years, addiction treatment has been defined and judged by this misplaced perception that a fixed duration of treatment will “fix the problem”. Patients and families have been led to believe that a month in rehab would “take care of the problem”. This fragmented approach fails to provide the life-long management necessary to ensure sustained remission. The greatly underemphasized problem is the absence of substantial and comprehensive community based continuing care and the paucity of prevention, early identification and intervention efforts. Relegating follow-up care, prevention and early intervention to the sidelines contradicts the standard treatment of chronic disease. New ideas, innovative service delivery methods, alternative clinical interventions, and technological supports are not robustly developed, tested, and integrated. It is time for a new vision that addresses addiction as the chronic disease it is. This paper will describe an approach that incorporates prevention, early intervention, and extended engagement with traditional models of care to create a seamless, integrated system of care that addresses addiction as a chronic condition that can produce more favorable long term outcomes.

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