LESSON 5.7 WORKBOOK Is addiction a chronic disease?

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1 DEFINITIONS OF TERMS Addiction is a disease idea that states drug addiction is no different from other chronic diseases, like diabetes and heart disease, and thus needs to be treated as a distinct medical disorder. For a complete list of defined terms, see the Glossary. LESSON 5.7 WORKBOOK Is addiction a chronic disease? In this last lesson, we will explore the idea of addiction as a chronic disease. Drug Addiction as a disease Throughout much of the last century, scientists studying drug abuse labored in the shadows of powerful myths and misconceptions about the nature of addiction. When scientists began studying addiction in the 1930s, people addicted to drugs were thought to be morally flawed and lacking in willpower. Those views shaped society s responses to drug abuse, treating it as a moral failing rather than a health problem, which led to an emphasis of punitive rather than preventative and therapeutic actions. Today, thanks to science, our views and responses to drug abuse have changed dramatically. Groundbreaking discoveries about the brain have revolutionized our understanding of drug addiction, enabling use to develop more effective responses to the problem. As a result of scientific research, we know that addiction is a disease that affects both the brain and behavior (Figure 25). We have identified many of the biological and environmental factors, and are beginning to search for the genetic variations that contribute to the development and progression of the disease. Using this knowledge, scientists are developing more effective prevention and treatment options that reduce the toll drug addiction takes on individuals, families and communities. Figure 25: Addiction is a disease. PET scans comparing decreased metabolism in diseased brain and diseased heart. Just as a heart attack causes decreased metabolism in the heart, Why would the myths and misconceptions about drug addiction in the 1930s hinder research on and treatment of drug addiction? Why is drug addiction considered a disease? Lesson 5.7 addiction causes decreased metabolism in the 171 brain.

2 Can addiction be treated? Yes. Addiction is a treatable disease. Discoveries in the science of addiction have led to advances in drug abuse treatment that help people stop abusing drugs and resume their productive lives. Like other chronic diseases, addiction can be managed successfully. Treatment enables people to counteract addiction s powerful disruptive effects on the brain and behavior and regain control of their lives. Figure 26: Comparison of relapse rates. Relapse rates for drug-addicted patients compared with those suffering from diabetes, hypertension and asthma. Relapse is a common and similar across these illness (as is adherence to medication). Thus, drug addiction should be treated like any other chronic illness, with relapse serving as a trigger for reinstated or adjusted treatment. Figure 27: Medications used to treat drug addiction. With scientific research, we ve been Relapse does not mean treatment has failed. The chronic nature of addiction means that relapsing back to drug abuse is not only possible, but likely. Relapse rates for drug addiction are similar to those for other well-characterized chronic medical illnesses, such as diabetes, hypertension, and asthma, which also have physiological and behavioral components (Figure 26). Treatment of chronic diseases involves changing deeply embedded behaviors, and relapse does not mean treatment failed. For the addicted patient, lapses back to drug abuse indicate that treatment needs to be reinstated or adjusted, or that alternative treatment is needed and again, not that treatment has failed. Research shows that combining treatment medication, where available, with behavioral therapy is the best way to ensure success for most patients. Treatment approaches must be tailored to address each patient s drug abuse patterns and drug-related medical, psychiatric and social problems. How can medications help treat drug addiction? Different types of medications may be useful at different stages of treatment to help a patient stop abusing drugs, stay in treatment, and avoid relapse (Figure 27). When patients first stop abusing drugs, they can experience a variety of physical and emotional symptoms, including depression, anxiety, and other mood disorders, restlessness, and sleeplessness. Certain treatment medications are designed to reduce these How can drug addiction be treated? How can medications be used to help treat drug addiction? able to develop a variety of medications to symptoms, which makes it easier to stop abuse. Lesson 5.7 aid in the treatment of addiction. 172

3 Some treatment medications are used to help the brain gradually adapt to the absence of the abused drug for example nicotine patches or gum in the case of cigarette smokers, or methadone in the case of heroin addicts. These medications act slowly to stave off drug cravings, and have a calming effect on body systems. They can help patients focus on counseling and other psychotherapies related to their drug treatment. Science has taught us that stress, cues linked to drug experience (for example people, places, things, moods), and exposure to drugs are the most common triggers for relapse. Medications are being developed to interfere with these triggers to help patients sustain recovery. How do behavioral treatments help drug addiction? Behavioral treatments help engage people in drug abuse treatment (Figure 28). Behavioral treatments aim to modify attitudes and behaviors related to drug abuse. They also focus on increasing life skills to handle stressful circumstances and combat environmental cues that may trigger intense drug cravings and prompt another cycle of compulsive abuse. Moreover, behavioral therapies can enhance the effectiveness of medications and help people remain in treatment longer. How do the best treatment programs help patients recover? Getting an addicted person to stop abusing drugs is just one part of a long and complex recovery process. When people enter treatment, addiction has often taken over their lives. The compulsion to get drugs, take drugs, and experience the effects of drugs has dominated their every waking moment, and drug abuse has taken the place of all the things they used to enjoy doing. It has disrupted how they function in their family lives, at work and in the community, and has made them more likely to suffer from other serious illnesses. Because addiction can affect so many aspects of a person s life, treatment must address the needs of the whole person to be successful. This is why the best programs incorporate a variety of rehabilitation services into their comprehensive treatment regimens. Treatment counselors select from a menu of services for meeting the individual medical, psychological, social, vocational, and legal needs of their patients to foster their recovery from addiction. Figure 28: Variety of behavioral therapies. A variety of behavioral therapies aim to help drug addicted patients beat their How do behavioral treatments help to treat drug addiction? Lesson 5.7 addictions. 173

4 Summary Research has shown that addiction is a disease that affects brain structure and impacts behavior. Many of the biological and environmental factors that contribute to addiction have been identified, and the search has begun to identify the underlying genetic variations that predispose and contribute to its development and progression. Addiction occurs when the activity of the reward pathway is disturbed. The reward pathway is composed of the connections between the ventral tegmental area (VTA) and the nucleus accumbens (NAc). Drugs of abuse act on this pathway in various ways to increase dopamine neurotransmission across this synapse. Dopamine neurotransmission can lead to transient effects on the postsynaptic cell membrane, but also effects gene transcription. Effects on gene transcription result in longer acting effects on neuronal structure, including building more synapses on the post-synaptic cell. Finally, addiction is considered a chronic disease because it causes long term changes in the brain, it is characterized by the compulsive, non-voluntary use of drugs, and people are never completely cured of their addictions. Lesson

5 STUDENT RESPONSES Remember to identify your sources Pretend you are an advisor to a government agency that needs to decide whether or not insurance companies should be required to cover treatment for addiction. Write an opinion piece to help the agency make the right choice. Lesson

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