In the first article in this series, we discussed the complexity of addiction and how it remained in obscurity until the latter part of the 20th century. Its obscure and confusing nature confounded early attempts at treatment, with wild claims that addiction was everything from a dietary imbalance to demonic possession (White, 1998). As we learn more and more about the brain, it has become increasing clear that addiction is a brain disease and must be treated as such (Leshner, 1997). Like many other illness that are difficult to treat, addiction is a chronic disease and, like all chronic illnesses, is either active or in a state of remission (also called “recovery”).
Despite this recent progress, our lack of clear consensus-based definitions, a science-based assessment and defined treatment protocols have prevented a systematic approach to addiction care. Addiction requires a coordinated effort between medical and psychiatric care, medication management, psychotherapy, skill building and work with family and other support systems. Many believe its victims benefit from attention to spirituality as well. Each discipline in addiction treatment sees their piece of the puzzle; a unified approach has proven to be elusive. The addiction illness interacts and is intertwined with other medical and psychiatric diseases, psychological traits and personalities, family systems, and one’s world view and spiritual beliefs. It is no wonder that effective treatment has proved elusive and our care fragmented.
In many ways, addiction is at the same juncture of cancer treatment in the 1960s. In that era, committed physicians understood that cancer was a difficult problem with many different forms (lung, breast, prostate, skin cancer, etc.) and severities. They knew that cancer acted in different ways in different people. The solution was to better define the types and stages of cancer and to regiment treatment. This mandated a national, coordinated effort, resulting in the National Cancer Institute. Cancers were staged and treatments defined. Results were collected and reported using standardized methods and results. As a result, today we have vastly improved outcomes for this complex group of illnesses.
Addiction care must follow this model. We are making strides in this direction. An exacting definition of the disease of addiction and addiction recovery is a start (American Society of Addiction Medicine, 2011; White, 2007). The American Society of Addiction Medicine (ASAM) has published standards that define the types and intensity of treatment. This work, the ASAM Criteria, is in its fourth edition (ASAM, 2013). To effectively treat a disease, you must begin with a thorough and systematic assessment. An assessment based upon the ASAM Criteria has been programmed into two software packages; over a decade of international validity research has proved its efficacy (Gastfriend, 2005; Turner, Turner, Reif, Gutowski, & Gastfriend, 1999; Stallvik & Gastfriend, 2014). More recently, ASAM has released a pilot version of a their standardized ASAM Criteria Assessment Software that every treatment program across the United States (and indeed the world) should use. Standardizing the assessment will generate data; this data will drive research which will, in turn, guide precise matching of a patient’s condition to the proper care.
Using our lessons with cancer treatment, we know that this is just the beginning. Treatment itself must be better organized into modules, goals and specific measurable objectives. One such system is called RecoveryMind™ Training. We will discuss this model in our next installment in this series. Combining each of these tools will, over time, revolutionize the treatment of addiction and reduce the suffering of millions.
American Society of Addiction Medicine. The Definition of Addiction. 2011. Retrieved from http://www.asam.org/advocacy/find-a-policy-statement/view-policy-statement/public-policy-statements/2011/12/15/the-definition-of-addiction American Society of Addiction Medicine. (2013). The ASAM Criteria: Treatment criteria for addictive, substance-related and co-occurring disorders (3rd ed.). Carson City, Nevada: The Change Companies. Gastfriend DR. Addiction Treatment Matching. Haworth Press; 2005. Leshner AI. Addiction Is a Brain Disease, and It Matters. Science. October 3, 1997 1997;278(5335):45-47. Stallvik M, Gastfriend DR. (2014, May 2) Predictive and convergent validity of the ASAM criteria software in Norway. Addiction Research & Theory. http://informahealthcare.com/doi/full/10.3109/ 16066359.2014.910512 Turner WM, Turner KH, Reif S, Gutowski WE, Gastfriend DR. Feasibility of multidimensional substance abuse treatment matching: automating the ASAM Patient Placement Criteria. Drug and alcohol dependence. 6/1/ 1999;55(1–2):35-43. White WL. Slaying the dragon : the history of addiction treatment and recovery in America. Bloomington, Ill.: Chestnut Health Systems/Lighthouse Institute; 1998. White WL. What is recovery? A working definition from the Betty Ford Institute. Journal of substance abuse treatment. Oct 2007;33(3):221-228.