Understanding Addiction as a Chronic Illness

By: Peter Gannon, ARNP, CARN, MSN, BC

For generations, there has always been great debate regarding the nature and cause of addiction. Many saw, and continue to see addiction as a moral failing or weakness of character. Theologians propose the ideas of demonic possession or that it is the result of living a sinful, immoral life style and that God has turned his back on the individual. Many still hold on to these beliefs despite evidence to the contrary. Research and experience has led most healthcare professionals to regard addiction as a disease of the brain. This disease concept of addiction has given science and medicine a foundation for the study and treatment of the illness. The result of this is that there is now hope for those thought to be hopeless.

Why should we believe that addiction is a disease? Disease, by its very definition is a disorder in humans, animals, or plants with recognizable signs and often having a known cause. Illnesses such as diabetes, high blood pressure, and asthma are common examples of a disease process. They all have very specific signs and symptoms which, when evaluated by a trained clinician, can lead to the appropriate diagnosis and treatment of the illness.

Like other illnesses, addiction brings with it its own set of signs and symptoms. The primary characteristic is that there is an on-going pattern of cognitive, psychological, physical, and behavioral problems brought about by the substance abuse. Equally important is the fact that the individual continues using the substance despite these negative consequences.[1] Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response.

A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects.[2] Chronic illnesses are responsible for 70% of all deaths worldwide annually. These are conditions which can be controlled but never cured. One of the classic characteristics of a chronic illness is the presence of periods of remission followed by relapse. The chance of relapse is greatly reduced when the individual adheres to their prescribed treatment. Even with adherence however, relapse is always a possibility. Like other chronic diseases, addiction often involves periods of relapse and remission. Even if the individual remains abstinent from the substance, the disease process can progress, especially if there is no supportive treatment to help correct the medical and psycho-social damage that has been done.

Research shows us that while the abstinence rate of individuals completing inpatient drug and alcohol treatment remains relatively high for several months, there is a significant increase in the relapse rate thereafter. One study suggests that after two years following treatment, approximately 50% of those individuals had relapsed.[3] Other studies are even less optimistic showing relapse rates ranging from 40-90%. These results appear to be in line with relapse rates from other chronic illnesses.

What the research fails to indicate however are the length of the relapse and any co-morbid factors which could have contributed to it. There is a significant difference between a onetime “slip” and an all out relapse during which time the physical, psycho-social, relational, and spiritual consequences reappear. Experience shows us that many individuals who re-enter treatment do so with a very different outlook and level of motivation. Many have proven to themselves the chronic nature of their illness and are ready to do the work needed to control their symptoms.

While many treatment centers and 12-step support groups purport to embrace the concept of addiction as a disease, they seem to lack the understanding of its chronic nature. This is demonstrated, many times, by an attitude of intolerance and judgment of those individuals who may have experienced a relapse. Oftentimes it may be said that the individual wasn’t working a program of recovery when in fact they were doing everything suggested to them. This contributes to the individual’s existing shame and guilt and prevents him from seeking the help he needs.

As a nurse, I have worked with patients who have relapsed after having up to 20 years sober. These were people who had been working good programs of recovery, were mentally stable, and had achieved a level of social standing. Why does this happen? From my experience and observations, stress appears to be an underlying factor. The stressor may be an acute episode but can often be a long standing, low level stress which goes unnoticed by the individual. This is not the only reason for relapse of course. Fear of success, fear of failure, anxiety, co-morbid physical and psychiatric problems all factor in to the relapse process. The important issue here is that we are dealing with a chronic disease of the brain which we still do not fully understand. Our knowledge of addiction has increased significantly over the last two decades but out treatment methods and philosophy are still based upon recommendations established over 60 years ago.

The idea that addiction, as any chronic illness, can be treated successfully in 30 days is quickly becoming outmoded. Research is demonstrating that chronic illness, including addiction, requires treatment and attention throughout the lifespan. The goal is to help the individual learn to understand and detect the signs and symptoms of a relapse before the condition requires hospitalization. In the past, as in the present, the individual being discharged from treatment would simply be told to get a sponsor and go to 90 meetings in 90 days. While these suggestions are still pertinent and valuable, they are insufficient for sustained recovery.

Many support the idea that the substance abuse is simply the symptom of other underlying issues. While I support this idea I also believe that the substance abuse itself has changed the circuitry of the brain itself. These changes can take years to correct during which time feelings of emptiness, boredom, depression and hopelessness experienced by the individual can easily lead back to the substance abuse or even death.

Ongoing treatment addressing the medical, psychological, spiritual, and social needs of the person must be a priority. Nutritional services as well as case management services, which have been woefully neglected in our system, need to be incorporated into a comprehensive, team driven approach for recovery. Family involvement is of paramount importance and has been proven time and time again to be a primary factor in an individual’s recovery.

Those in the medical and social professions need to re-assess our definition of success regarding treatment for addiction. If, as the evidence supports, addiction is a chronic illness of the brain, should treatment be focusing on the idea that the individual can never use a mood altering substance again. On the other hand, however, we cannot be giving the message that relapse is an acceptable outcome.

We as healthcare professionals must start by examining our own feelings and prejudices regarding the chronic nature of addiction. We cannot allow ourselves to judge the patient who is coming into detox or treatment for the tenth time. There must be an attitude of understanding, compassion, and hope. Our treatment for the individual must be based upon the reality of the current evidence, not what we would wish it to be. Treatment should incorporate a comprehensive education of the neurologic basis of addiction and medical options available in healing it.

Lastly, the patient and healthcare professional need to understand that guilt and shame have absolutely no place in the recovery from relapse. These negative emotions indicate a moral failing on the part of the individual. Chronic illness is characterized by relapse and remission. Our goal needs to focus on utilizing incidences of relapse as a teaching tool for future recovery.

Peter Gannon is the VP of Medical Services at New Beginnings Recovery Center in Palm Beach Gardens, Florida.  He is an experienced and clinically competent Psychiatric Practitioner with proven accomplishments in the evaluation, assessment, diagnosis and treatment of psychiatric and substance abuse disorders in the adolescent and adult populations. Peter received his Masters of Science in Nursing at FIU in 2004., a Masters of Public Administration at Golden Gate University in 1988 and graduated cum laude with a BS in Science in Nursing at the University of Bridgeport in 1981. Peter’s many years of experience in the addiction and psychiatric field gives NBRC’s patients the advantage of having co-occurring disorders treated under a single roof. He is board certified by the ANCC, a member of the American Nurse Association, a member of the American Psychiatric Nurse Association and holds a U.S. Army Good Conduct Medal.    

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