Addiction as a Medical Issue
There has long been debate as to whether alcoholism is chiefly a mental or physical ailment, today the conversation is broadening to include all sorts of addictions.
If trends in medical education are any indication, the idea that willpower and determination alone can beat back the demon of alcoholism or drug addiction is becoming archaic. Medicine had relegated treatment of addicts to the realm of psychiatry almost exclusively, but that appears to no longer be the default position.
Evidence that not only the conversation, but the mindset, of health professionals is changing is seen in the introduction of 10 new residency programs emphasizing the relationship between addiction and brain chemistry. Upon completion of medical school and a primary residency, doctors can now spend a year of residency in an addiction medicine program at one of the 10 medical institutions offering the program. These are the first accredited residency programs with 10 or more institutions planning to become accredited over the coming year.
Accreditation to date is being granted through the American Board of Addiction Medicine (ABAM). The board is committed to furthering medical treatment for addiction and is therefore working to get the programs likewise recognized and accredited by the Accreditation Council for Graduate Medical Education. In order for that to happen, 20 medical institutions would need to offer similar programs. Gaining such accreditation would mean that addiction medicine would become a recognized specialty and would qualify as a primary residency program.
Inclusion of addiction medicine as a standard specialty demonstrates this acceptance of addiction as physiological and not merely a psychological disease. Thinking started to turn when researchers were able to detect physical changes in the brains of addicts through high-resonance imaging. The fact that the brain undergoes actual physical change as a result of drug addiction helps to explain why relapses occur. Rather than being a sign that treatment won’t work, relapses could indicate that treatment needs to be sustained. Brain changes cannot be cured through rehabilitation and detox any more than any other chronic medical condition (such as diabetes). Instead of acute treatment, substance abuse should receive a blended approach which includes medication, counseling and required lifestyle adjustments that the management of other chronic diseases currently demands.
New interest in addiction as a medical specialty is mirrored by the introduction of new pharmaceuticals for the treatment of addicted patients. New drugs such as buprenorphine, which relaxes withdrawal symptoms and blocks cravings for heroin addicts, along with drugs to treat opioid addiction represent hopeful efforts in the new treatment approach.
The new mindset in medicine is to look for ways to address the health and treatment needs of 23 million Americans who need but do not currently receive help from a physician for their substance abuse. Residency programs which train doctors to discern, diagnose and properly address addiction through medication and intervention are signs that the long debate seems to be turning toward management of physical disease rather than cure of mental illness. Addiction is becoming recognized as a medical issue that deserves specialized care.