Progress in Addiction
The American Society of Addiction Medicine’s enhanced definition of “addiction” couldn’t have come at a better time for those of us practicing medicine.
Once again, we are at a crossroads in society. Factors like the economy, social media, life’s everyday stressors and a patient population looking for a “quick fix” are combining to trigger addictive behaviors at an increasingly alarming rate. The ASAM definition helps us really understand the pathology behind addictive behaviors. It allows those of us in practice to look at the actual behavior as the disorder, as opposed to the substance of alcohol and/or chemicals as the root of the illness.
None of this is new.
Look back to 18th century Africa and Europe, and later here in North America with Native and Colonial Americans, and we see that populations have been dealing with the illness of addiction throughout history. Viewing addiction medicine as a practice really came of age in the U.S. in the 1970s, when our society finally began to decriminalize addiction. Thanks to new laws and a focus on addiction at the Federal level, we stopped punishing addicts for their illness and began to develop systems where they could receive care.
I saw this in my own practice in Maine, where I helped to create that state’s first comprehensive detoxification and treatment facility. I’ve watched the creation of ASAM and the development of addiction medicine as a specialty. I’ve seen addiction medicine develop a text book and develop addiction residencies and fellowships in an ever-increasing number of teaching institutions across the country.
However, as far as I have personally witnessed that this specialty has come over the course of my own career, this enhanced definition of “addiction” by ASAM represents a tipping point and a call to action. I’m hopeful my colleagues will review this document and integrate it into their clinical practice with a few tips.
1. Start expecting that patients suffering from the illness of addiction will get well. Like other diseases, there are levels of severity with addiction, and the illness can progress over time. With early recognition and treatment of this illness, patients can realize healthy and productive lives.
2. Seek collaboration from an addiction medicine specialist. Make them a part of the team – especially when it relates to chronic pain issues. Just as an internist would refer a cancer patient to an oncologist, the illness of addiction presents a variety of complex medical issues. As chronic pain issues continue to increase, I am hopeful hospitals will begin to recruit expertise in addiction medicine to offer patients comprehensive treatment, while minimizing exposure to risk management issues as well.
3. Start to incorporate questions about addiction into your patient’s family history. Is there a history of addictive behaviors – inclusive of not only drug and alcohol addictions, but also food, gambling, sex and other addictive triggers? Documenting these clues can dictate the actions we take to minimize exposure to addictive substances or even stressful stimuli like surgery.
Where these tips and this enhanced definition really help our patients is at the bedside. I challenge my colleagues to review the ASAM document, digest it, and incorporate it into their daily practice. I am convinced we will look back at this definition as a change agent for understanding the illness of addiction, and as a way for making greater access to care a reality.
Dr. Stanley J. Evans, Addiction Medicine Physician at Caron Renaissance in Boca Raton, FL, can be reached at SEvans@caron.org.