Treating addiction as disease

Those of us who have worked for years in psychiatric medicine have been participants in developing the ever-growing body of knowledge surrounding mental illnesses, their causes and their treatment. And we have witnessed the growth over the years of understanding and hope in the process of recovery.

Although, as professionals in the field, we understand this progress, there are still many individuals in our society who believe, for example, that depression is caused by a character defect of some kind. People are still blamed for being mentally ill, stigma still occurs, and there is not parity in insurance payments for these illnesses.

When we see the disease of addiction it may occur as a single disorder or as a co-occurring disorder with mental illness. Addictive disorders produce even stronger feelings for many in our society, as well as to people who work in the field.

The central issue for many people is whether people with an addiction should be treated at all. People may say, “Didn’t they do this to themselves?” We are learning more about this disease every day and I feel compelled to share some of what we now know and discuss why The Acadia Hospital takes such a strong stand and a leading role in substance abuse treatment.

It is true that most individuals initially make a voluntary decision to use drugs or alcohol, but once addicted it is no longer a simple matter of choice. Prolonged drug use actually changes the chemistry of the brain in long-lasting and fundamental ways that result in truly compulsive, often uncontrollable, drug craving, seeking, and abuse, which is the essence of addiction. We also know that many of the newer drugs are extremely addictive in a very short amount of time. Once addicted it is nearly impossible for most people to stop using drugs without treatment.

Anyone who has ever smoked cigarettes habitually, or cares about someone who does, knows that recovery from addiction is often a process of trying and failing and trying again. Even when abstinence is achieved, desire often remains. We must think of addiction as a chronic illness. No one expects people with diabetes, asthma, or hypertension to go for treatment once and come home cured. As with any chronic disease we understand more and more that longer term treatment and

management is required to get better and to recover from addiction.

As a diabetic may relapse into shock from eating a forbidden piece of cake, the substance abuser may relapse into substance abuse. Just as the diabetic must be taught new habits of diet and exercise, so must individuals who abuse substances be taught to establish healthier activities and relationships.

Thus for either disease, progress must be measured in terms of functional improvements. Science has brought us to a place where the questions of drug treatment and moral imperative converge. The very same body of scientific data that demonstrates the effectiveness of treatments in reducing an individual’s drug use also shows the enormous benefits that drug treatment can have for the client, his or her friends and loved ones, and the community at large.

Here’s a fact you may not know: Maine is one of the hardest-hit states in the nation relative to opioid abuse, with approximately five times the national average of clients seeking treatment.

It is clearly in everyone’s best interest to get people living with an addiction into drug treatment. If we are ever going to reduce the tremendous price that addiction exacts from every aspect of our society, drug treatment will need to remain a core treatment strategy of hospitals like Acadia. We are seeing an epidemic of drug addiction in Maine and in the nation. The professionals at Acadia and elsewhere are working very hard to offer treatment services to all who need them.

Sometimes we are able to treat one person for addiction while his or her partner is still waiting for services. Some people who come for treatment are still using while they stabilize on the medications we give them. We believe in working with the client to set realistic goals and we believe in the intentions of our patients to seek help and treatment.

We’re proud to say that Acadia is seen as a premier center for treating substance abuse as well as mental illness. Many of our patients have both disorders. Our treatment philosophy requires that we not judge our patients on present or past behavior and that we seek to understand human behavior as well as the biological underpinnings of illness. We are doing our part.

However, the need to treat individuals living with chemical dependency has to be addressed on a societal level. The Acadia Hospital stands ready to advocate for our patients now and in the future. In this season of hope that comes with the beginning of a new year I look forward to The Acadia Hospital playing a key role in enhancing understanding, changing attitudes, and increasing access to the most effective treatment for our neighbors in need.

Dorothy E. Hill, RNC, is chief executive officer and chief nursing officer of

The Acadia Hospital in Bangor.