Thu. Sep 16th, 2021

Addiction is a Chronic Disease

Many Factors are Involved in Addiction

 

Flowchart

 

Drug addiction shares many features with other chronic illnesses, including a tendency to run in families (heritability), an onset and course that is influenced by environmental conditions and behavior, and the ability to respond to appropriate treatment, which may include long-term lifestyle modification.1

Addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease.

Human studies of addictive behaviors have clearly implicated both environmental and genetic influences, as well as interactions between the two. While genetics play a major role in defining who we are, the environment in which we are raised is just as influential.

 

Addiction, Like Cardiovascular Disease, Has Genetic Contributions figure

Evidence from adoption and twin studies demonstrate that addiction, like other chronic diseases, is a heritable disorder and that genes play a role in vulnerability to addiction. Genes can also play a role in protecting individuals from addiction.

 

Addiction, Like Cardiovascular Disease, Has Envoronmental Contributions figure

As with all complex diseases, environmental risk and protective factors interact with genetics to determine the course and outcome of disease. Identifying and modifying environmental factors that contribute to health and disease are part of NIDA’s mission, as well as that of the other NIH Institutes and Centers.

Addiction is a chronic disease similar to other chronic diseases such as type II diabetes, cancer, and cardiovascular disease.

Healthy Lifestyle Choices figure
Healthy Lifestyle Choices

No one chooses to be a drug addict or to develop heart disease.

Sometimes people do choose behaviors that have undesirable effects. Personal responsibility and behavioral change are major components of any credible treatment program. Addiction, like heart disease, cancers, and type II diabetes, is a real and complex disease.

Addiction and Cardiovascular Disease Change Biology

 Decreased Brain Metabolism in Drug Abuser figure
Sources: From the Laboratories of Drs. N. Volkow and H. Schubert

 

Imaging studies have shown evidence of tissue malfunction in the brains of those with addiction, and in the hearts of people with heart disease.

Relapse is Common in Addiction and Other Complex Chronic Diseases

Relapse Rates Are Similar for Addiction and Other Chronic Illnesses graph
Relapse Rates Are Similar for Addiction and Other Chronic Illnesses
Source: McLellan et al.

Drug Treatment Works

Research has revealed a number of basic principles that underlie effective drug addiction treatment, as highlighted in NIDA’s Principles of Drug Addiction Treatment: A Research-Based Guide.

Principles of Drug Addiction Treatment: A Research-Based Guide

NIDA’s Principles of Treatment

  • No single treatment is appropriate for all individuals.
  • Treatment needs to be readily available.
  • Treatment must attend to multiple needs of the individual, not just drug use.
  • Multiple courses of treatment may be required for success.
  • Remaining in treatment for an adequate period of time is critical for treatment effectiveness.

Drug addiction can be effectively treated with behavior-based therapies and, for some drugs, such as heroin or nicotine, with medications. Additionally, treatment reduces the risk of HIV infection and can improve the prospects for employment.

 

Treatment for Drug Abuse and Addiction is Delivered in Many Different Settings

Treatment Works Pre- and post-treatment self-reported changes among those in long-term residential TCs graph

Pre- and post-treatment self-reported changes among those in long-term residential TCs
Source: Hubbard et al., 19971

Therapeutic communities (TCs) focus on the community as the therapeutic ingredient for facilitating change. The treatment usually consists of full-time engagement with a community of peers and staff members, in a residential setting. Most therapeutic communities consider 6 to 12 months to be the recommended duration of treatment.2

 

 Behaviors of Adolescents Before and One Year After Treatment graphSource: Hser et al., 2001 3

Programs tailored to treating adolescents can reduce drug use and criminal activity and improve school performance.

 

Medications Can Be Useful

 

Buprenorphine Works!
Source: Ling et al., 19984

An increase in the percentage of opiate-free urine specimens is associated with higher doses of buprenorphine. Such pharmacotherapy for the treatment of addiction is now available in medical office settings.

Studies have shown long-lasting effects with continued treatment. In one study, those that stayed in treatment had urine samples that tested negative for opiates 36-65% over a one-year period.4

The Food and Drug Administration’s approval of buprenorphine (subutex and suboxone) for treating addiction to heroin or other opioids, including prescription painkillers, on October 8, 2002, marks a milestone in NIDA’s medication development program.

Drug Treatment During and After Imprisonment Not Only Increases the Number of People Who Are Drug-Free., but Also Increases the Number of People Who are Arrest-Free

 

Delaware Corrections-Based Therapeutic Community Treatment Continuum
Delaware Corrections-Based Therapeutic Community Treatment Continuum
% Arrest-Free Since Release at 42-Month Follow-up
Source: Inciardi et al., 2002 5

A Continuing Care Strategy is Needed for Addiction as in Other Diseases

Ongoing Treatment Works for Addiction and Hypertension, as Illustrated in this Hypothetical Example
Ongoing Treatment Works for Addiction and Hypertension, as Illustrated in this Hypothetical ExampleSource: McLellan et al., 2002 6

Many chronic conditions such as diabetes, depression, hypertension, and asthma require continual care in order for treatment benefits to be sustained.

Addiction is similar to other chronic diseases in this regard. It requires monitoring of patient status on a regular basis, early intervention regarding possible problems, and proper referrals in order to maintain positive treatment effects.

Drug abuse is chronic in most cases. It can’t be treated like a broken leg or appendicitis.

Drug Abuse and HIV/AIDS are Intertwined Epidemics

 

4 out of 10 U.S. AIDS deaths are related to drug abuse
4 out of 10 U.S. AIDS deaths are related to drug abuse.
Estimated AIDS Incidence in the United States among Adults and Adolescents, by Sex and Exposure Category
Estimated AIDS Incidence in the United States among Adults and Adolescents, by Sex and Exposure Category graph
Source: Centers for Disease Control and Prevention, 2002 7

The portion of AIDS cases related to drug abuse has steadily increased over the course of the past two decades and intravenous drug use continues to be a major contributing cause to the increase in new cases.

Drug Addiction Treatment IS HIV Prevention

 

HIV Seroconversion at 18-Month Follow-Up is Decreased by Drug Addiction Treatment
HIV Seroconversion at 18-Month Follow-Up is Decreased by Drug Addiction Treatment graphSource: Metzger et al., 19938

 

Studies have shown that drug treatment can dramatically reduce the rate at which people acquire HIV.

Partial Recovery of Brain Function with Prolonged Abstinence from Drug Use

PET figureSource: Volkow et al., 2001 9

Preventing Drug Abuse is Our Most Effective Approach to Combating the Nation’s Drug Problem

Preventing Drug Abuse book cover

 

Research has taught us much about what does and does not work in drug abuse prevention at the individual, family, and community levels.

A set of science-based general principles of effective drug abuse prevention has emerged from NIDA-supported research. Preventing Drug Use Among Children and Adolescents has come to be known by community leaders throughout the Nation as the “Red Book.” Preventing Drug Abuse is Our Most Effective Approach to Combating the Nation’s Drug Problem

Steroids? Not in my game plan.

 

Results of the Adolescents Training and Learning to Avoid Steroids (ATLAS) Program

Compared to Controls, Participants Reported:

  • Lower intent to use at 1- year follow-up
  • Lower use of over-the- counter sports supplements at 1-year follow-up
  • Higher levels of self-esteem
  • Greater knowledge of steroid effects

Source: Goldberg et al., 19961

Elementary School Programs that Emphasize Social Development Reduce Risky Sexual Behaviors

Promoting Academic Success, Social Competence, and Bonding to School Can Reduce Risky Behaviors

Image of pregnant female

One intervention that focused on social development led to:

  • Fewer sexual partners
  • More condom use
  • For females, being less likely to have a baby by age 21

Source: Lonczak et al., 2002 2

 

Youth development programs targeted at elementary school students may have the potential to help youth acquire healthy behaviors that can be sustained across their life spans.

School-Based Prevention Programs Can Reduce Drug Use

 

Project ALERT Decreases Marijuana Use in Middle School Children
Project ALERT Decreases Marijuana Use in Middle School Children graphSource: Ellickson et al., 20033
  • Project ALERT reduced the proportion of new users of cigarettes and marijuana by 19% and 24%, respectively
  • Marijuana initiation rates were 38% lower for ALERT students who had not tried cigarettes or marijuana at the start of the study

Tailoring prevention programs to specific populations is critical.

Programs for elementary and middle school children should focus on factors such as self-control, emotional awareness, communication, social problem solving, and academic support (especially in reading).

As the Level of Perceived Risk Increases, the Rate of Drug Abuse Drops

 

12th Graders’ Past Year Marijuana Use vs. Perceived Risk of Occasional Marijuana Use
12th Graders’ Past Year Marijuana Use vs. Perceived Risk of Occasional Marijuana Use graphSource: Johnston et al., 20045

Prevention messages can make a difference. They can convey information to change attitudes about drug use.

Targeted Media Campaigns Can Significantly Impact Public Health Behavior

 

Picture of teen with basketball
  • One campaign targeted to sensation seeking adolescents resulted in:
    • An estimated 26.7% drop in the use of marijuana
    • Persistent effects after the campaign concluded
Source: Palmgreen et al., 20014

 

Stigma of Drug Abuse

“There is no easy solution to the problem of stigma associated with drug addiction and its treatment…”
—Institute of Medicine

 

Image of man

 

It is because of stigma that:

  • Some people don’t get treatment.
  • Some doctors won’t treat addicts.
  • Some pharmaceutical companies won’t work toward developing new treatments for addicts.

“…The sense of stigma is most likely to diminish as a result of public education and broader acceptance of addiction as a treatable disease.”
—Institute of Medicine

 

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Faces of Addiction
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Trends in Drug Abuse
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Addiction is a Chronic Disease
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Treatment Can Work
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Prevention Can Work
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Stigma of Drug Abuse
  1. Institute of Medicine. “The Development of Medications for the Treatment of Opiate and Cocaine Addictions: Issues for the Government and Private Sector” National Academy Press, Washington D.C., 1995.

 

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