Shifting from Sick Care to True Healthcare
Abuse and addiction to alcohol, nicotine and illegal substances cost the United States more than $700 billion annually in combined medical, economic, criminal and social effects. Each year, 90,000 Americans die from the use of drugs and alcohol and almost 20 percent of all inpatient hospital costs are associated with substance use.
Yet drug and alcohol disorders often go untreated. In 2013, there were 22.7 million individuals over the age of 11 who needed treatment for an illicit drug problem. Unfortunately, according to the Substance Abuse and Mental Health Services Administration, only 2.5 million received care at a specialty treatment facility.
Individuals who need treatment often slip under the radar in medical screenings and never receive referrals or follow ups to assess and treat their addiction. Those at risk of developing an addiction may never have conversations with their primary care providers about their drinking or substance use habits. Consequently, most addicts enter treatment following a significant life-changing event, such as an accident, divorce or a crime.
If the healthcare community focused earlier on awareness and prevention, professionals could significantly reduce the tremendous costs associated with treating advanced drug and alcohol abuse. Clinicians could effectively move from “sick care” for individuals whose lives are already devastated by their addictions to true healthcare. Preventive care and regular screenings could keep those at risk from engaging in destructive practices or it could place them in treatment very early so that they do not develop serious complications. It would also allow providers to identify and proactively address common comorbidities such as cardiovascular disease, pulmonary disease, cancer, HIV/AIDS, hepatitis, diabetes and psychiatric disorders.
Early interventions have proven to be highly effective for improving health outcomes. The Screening, Brief Intervention and Referral to Treatment (SBIRT) tool has become a vital and effective way to quickly identify patients who are at risk of addiction or need more extensive treatment. SBIRT, when used appropriately, reduces drug- and alcohol-related comorbidity and mortality while improving overall health. Successful drug abuse prevention, awareness and treatment reduces the spread of HIV/AIDS, hepatitis, and other infectious diseases.
Prevention and early intervention efforts also substantially reduce social costs. Treatment cuts drug use in half, reduces criminal activity up to 80 percent and reduces arrests by as much as 64 percent. Treatment improves prospects for employment by 40 percent. By getting individuals the help they need more quickly, screening and prevention programs also reduce the criminal and social consequences associated with addiction.
Addiction, like many chronic diseases, requires aggressive, focused, long-term treatment to put it into remission. The “once and done” model of addiction treatment centering on managing acute withdrawal symptoms fails to establish a solid foundation for continued management of this chronic illness.
Recent research has increased the understanding of addiction and substance use disorder as a chronic, relapsing brain disease that affects both the brain structure and an individual’s behavior, with genetic and environmental factors contributing to its development. Imaging studies show that addicts’ brains undergo physical changes in regions associated with judgment, decision making, learning, memory and behavioral control.
View early screening and assessment for substance use in the same way the medical community views early detection and prevention as important for medical conditions. Relapse rates for addiction parallel those for other chronic disease, which also contain both physiological and behavioral components such as diabetes, hypertension and asthma. However, patients with addictions typically receive much less follow up, ongoing support and tools for maintenance. As relapse does not indicate treatment (or moral) failure in hypertension, but rather indicates the need for an alternative approach or additional medication, a drug use relapse indicates a similar need for alternate or additional treatment. Effective treatment for addiction enables patients to reduce the effects of addiction on the brain and behavior and regain control of their lives, but it can take time — and multiple approaches.
According to the National Institute on Drug Abuse, combining treatment and medications, where available, with behavioral therapy is the best way to ensure success for many patients. Effective treatment programs address the whole person, not just the addiction. Depression and other comorbidities derail recovery, if not treated, as do medical issues. Different types of medications, for both the addiction and other co-occurring conditions, may be useful at different stages of treatment to help a patient stop using drugs, stay in treatment and avoid relapse.
Drugs, Brains, and Behavior-The Science of Addiction (2013).
Primary Care Intervention to Reduce Alcohol Misuse Ranking Its Health Impact and Cost Effectiveness (2015). Leif I. Solberg, MD, Michael V. Maciosek, PhD, Nichol M. Edwards, MS.