Substance Problems is it a Disease?
Naltrexone, Suboxone (buprenorphine), and acamprosate. Studies are conducted at all stages of development, with research looking at the effects of early substance exposure to adolescents and the damage caused to cognitive (thought/memory) areas of a the brain.
What does all this mean to you? First, not all models are addressing one “type,” being the substance dependent person. The moral model was created for what is called the “real” alcoholic, meaning an alcohol dependent person, the Medical model, is only addressing three stages of dependence, the behavioral model actually address a broader range of problems, which expanded on substance misuse and substance abuse. The biggest gap in understanding “treatment” is a lack of understanding in the differences, or the “disease/non disease models” which is, not all people develop dependency while most have co-occurring problems or disorders.
The smallest groups create the labels, it is an established fact that ten percent of substance problems reach “dependence” where the active user, would be properly called “alcoholic” since they became “alcohol dependent or drug dependent.” Drug addict, is subjective, since nothing delineates the difference between misuses, abuse, or dependence, the street slang for a substance dependent person typically is incorrect. However these terms only address “active” status. Alcoholism, is the “active state of using alcohol” having formed an alcohol dependence, there not a term to describe the same “status” for a person with a illicit drug “ism” people do not use the term drugism, it is subject to a different term called “addiction”. Neither term describes the status of a person in remission, partial remission or any state of abuse, or misuse of a substance.
So, what this means, 90% of the people seeking help with substance problems, are not dependent, but clearly abusing a substance and in some, not all, that can lead to true dependence, and the amounts taken at early ages produces loss of cognitive skills as they reach adulthood, here we see terms such as permanent brain damage appearing proven in cognition testing and seen in medical PET/MRI scans. Meanwhile the medical disease or concepts are all addressing a 10% audience, of the substance problem population, those that actually reach “the criterion of dependence.” Most that seek help are not in active “alcoholism or dependence”. That status is reached 10% of the time. So we have a 90% “using” population, best described as “Substance Use” or Alcohol Use Disorder, Cocaine Use Disorder, Opioid use disorders et cetera. That makes “treatment” equal, in nature and allows for an end to “how bad are you” conversations to “qualify” as needing help.
If we revisit each model and apply it is a disease, now how to treat it would depend on the stage of misuse, abuse, or dependence a person has reached or showing signs of reaching. Up to 75% of dependence problems quit on their own, without the help of a professional therapy or mutual self help groups, however that statistic can be misleading since public perception of “dependence” is so often misunderstood, the person misusing or abusing a substance is often mislabeled “alcoholic/ addict.” Most that have substance problems, up to 90% have co-occurring disorders. With integrated treatment, the co-occurring disorders are treated, perhaps more aggressively than the substance problem, which is harms reduction. Reducing the harms a person experiences becomes the focus of treatment rather than, labeling or mislabeling. This would immediately increase “recovery rates” since all problems would be treated. Proper diagnosis, instead of opinion, treats the issues, where substance problems are seen as a self medication practice, a person’s attempt to treat a symptom of a disorder that is often confused with the symptoms associated with substance withdrawals. This false positive, would and often does mislead diagnosis, since deeper set disorders, or preexisting conditions, typically are designated with the same symptoms seen in substance dependence such as depression, anxiety, or manias.
Notice what happens to the “disease” the symptoms occur as behavioral problems, not physical problems once the substance is removed via medically safe detoxification processes. The “symptoms” of craving, sadness, depression, loneliness, anger, fears, boredom, complacency, et cetera often are ignored, since the focus is myopic, “don’t use, No matter what” is often “repeated” but the issues of depression, anxiety, anger, fear, boredom, complacency, stress, are not seen as mental disorders, but merely something that will “pass” in the “this too shall pass” mentality. This places people in harm’s way, if they have mental conditions, but are told “It will pass on its own”. This type of “treatment” actually is in denial of the underlying