Opioid Addiction Calls for a Chronic Disease Model of Care

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Read Beacon Health Options’ white paper, “Confronting the Crisis of Opioid Addiction

You’re unlikely to read or hear the news these days without learning more about the devastation of opioid addiction in our communities – large and small, rich and poor, urban and suburban – it’s everywhere, much the way the flu snakes its way through schools and workplaces. Indeed, there are a staggering 2 million Americans addicted to opioids; this fact should have the public standing at attention in a way it never has before. We have to do something – and quickly.

While we’re hearing of it more than ever, addiction is not new. Where and when has the system failed? Deep-rooted challenges include addressing stigma and the “character flaw” often associated with drug addiction. A seismic shift is required to make these adjustments in attitude.

Redefining and Right-Treating Addiction

However, action is not only dependent upon the vagaries of social change. First and foremost, the health care delivery system must recognize addiction for what it is – a chronic brain disease – and needs to treat it accordingly, much as we do asthma and diabetes. Extensive research has shown that opioid exposure creates permanent brain changes in genetically susceptible individuals. These changes occur in the very parts of the brain that affect responsible decision-making, impulsivity and the ability to feel pleasure or satisfaction. In other words, traditional detox programs fall short; bodies become drug-free, but brains are permanently rewired in a way that makes affected individuals continue to seek drugs to avoid the tremendous dysphoria and pain they feel without them. In brief, without follow-up care in community settings, people living with opioid addiction will resort to old behavior. Therefore, like other chronic diseases, addiction requires ongoing management measured in years rather than days.

Currently, substance misuse is not routinely treated as a chronic condition. In the chronic disease model of care, six fundamental elements enable high-quality, chronic disease care:

  • Community resources and policies
  • Health care organization
  • Self-management support
  • Delivery system design
  • Decision support
  • Clinical information systems

This framework is more than a clinical program, per se; the model incorporates the necessary societal, systemic and legislative overhaul to promote real and continuous improvements in care. By following through on these six tenets, the health care delivery system can start to construct an evidence-based, rational, hands-on solution to a problem that cannot wait for society to embrace addiction for what it is: a chronic disease and not a moral failing or lack of self-control.

Change is never easy; real transformation requires innovation from all fronts. However, the logical framework of the chronic disease model of care is an excellent place to start.

Beacon is currently working with consumers, health plans, Medicaid agencies, policy makers, providers and our medical leadership to implement the key elements of the chronic disease model in each of our markets. To understand the evidence supporting Beacon’s recommendations, and be a part of putting a stop to this pervasive issue and bring about lasting, positive change, we invite you to read our white paper, “Confronting the Crisis of Opioid Addiction.” Download, read, share, respond – let’s help fix this!

Click here to view an overview of our white paper: Confronting the Crisis of Opioid Addiction – An Overview of Beacon’s White Paper.

Listen to Beacon leaders discuss the white paper and learn how we can right-treat addiction through the chronic disease model of care.

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8 Comments. Leave new

Dave West, LCSW
June 4, 2015 8:49 pm

The white paper is very constructive in approaching addiction though a systematic approach on various levels. Thank you for posting this approach to opioid addiction.

However, I’m stuck by the connotation of it being labeled as a ‘chronic brain disease’. I concur that is has long term/chronic effects on the brain. But it seems that calling it a ‘disease’ leads to a misleading understanding. Historically, a ‘chronic brain disease’ model has been compared to diabetes. This comparison may be applicable to Diabetes II. But Diabetes I is a genetic disposition that has nothing to do with the person’s behavior causing onset.

The overall framing of addiction as a ‘disease’ seems to minimize a fuller approach to treatment. However, I am aware that since the introduction of the ‘disease model’, there has been a better embrace of addiction recovery. Be that as it may, I think it points to a junction for more debate in order to propel more dialogue about treatment models.

Let’s compare addiction with true diseases. “In addiction there is no infectious agent (as in tuberculosis), no pathological biological process (as in diabetes), and no biologically degenerative condition (as in Alzheimer’s disease). The only “disease-like” aspect of addiction is that if people do not deal with it, their lives tend to get worse. That’s true of lots of things in life that are not diseases; it doesn’t tell us anything about the nature of the problem. (It’s worthwhile to remember here that the current version of the disease concept, the “chronic brain disease” neurobiological idea, applies to rats but has been repeatedly shown to be inapplicable to humans.” (Lance Dodes M.D. on Dec 17, 2011 in The Heart of Addiction)
Dave West, LCSW

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[…] The proposed solution is to implement a chronic care model across all related treatment organizations, policies and systems of care. Help address the opioid addictions crisis and learn more about the suggested recommendations in their full white paper. […]

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I concur with Dennis and Scott that addioticn is a chronic condition. Assuming I worked at a public treatment center there are several things I would do to further the work of aligning this belief to what is actually practiced in our profession. Direct work with clients and families would include the education piece about how addioticn is like having cancer, not like having a really bad case of the measles. Framing the issue of chronic vs. acute this way is crucial to helping all involved take the long view of success. Group work with a mixed-stage set of clients over an extended number of sessions as in Weegmann and English, skyped or cell phone based assertive continuing care, in-person quarterly RMC’s, would all be woven into my practice (assuming my agency was supportive). Much systemic work is needed to spread this vital reframing of addioticn as a chronic condition. From an education standpoint, this concept and practice is not a hard shift to sell, but many of these shifts will cost money. When it comes down to dollars that is a different story. From all levels within the agency, to community, state and federal funding sources both education and advocacy is necessary. I am ready to sign up for the sustained push that is required for progress to be made. Taking these sytemic changes even further into the very critical need for overall change in our nation’s addioticn treatment and aftercare structure. Toward that end I agree with McClellan and Meyers and say increases in funding support are needed to implement best practices in treating adults, adolescents, those who are dually diagnosed and incarcerated.

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I am in complete agreement with the article that states opioid addiction as a chronic brain disease. “We need to recognize that once addicted, many people experience permanent brain changes, which makes opioid addiction a relapsing and unremitting, chronic illness. Unfortunately, our health care system is currently organized to treat this addiction with acute care services and the hope of abstinence upon discharge. Evidence tells us that this approach typically leads to treatment failure and readmission to acute detoxification services.”
We, at Hope House Treatment Centers are fortunate to have one of the leading addictionologist in Maryland, Dr. Michael Hayes. We clearly see that for opioid addiction we just cannot say “You need to stay clean and sober’ without the help of suboxone and counselling. We are seeing that people need to be on Suboxone for a lengthy period of time and longer if need be (which could be years). If many people experience permanent brain changes, then they may need to be on Suboxone for life.
So, it is imperative that Insurance companies specially Medicaid buy into the chronic disease model. Medicaid has issued a Parity Law enforcement to Insurance Companies while they themselves are flouting it by reimbursing at an outpatient level. I spoke about this to Shannon McMahon and she states that they are looking into it!!!!
Physician Assistants or Nurse Practitioners should be able to prescribe Suboxone and the 100 patient limit should be done away with for physicians. These are barriers to effective treatment.
I have also sent in my testimony to help get the waiver from the IMD Exclusion Law.
I am also getting ready to fight the Anne Arundel County Law that states that no medical clinic can be opened (including mental health and addiction) that is within 1000 feet away from a school or residence. It contravenes The American With Disabilities Act. I have approached ACLU and The Maryland Disabilities Law Center to represent us .
Peter D’Souza

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[…] this chronic care model in our white paper, “Confronting the Crisis of Opioid Addiction” and an earlier blog post). Key elements of this evidence-based model include medication-assisted treatment (MAT) and […]

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[…] a 2015 White Paper, “Confronting the Crisis of Opioid Addiction”, Beacon Health Options takes the view that addiction is a chronic brain disease that is best […]

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[…] addiction is a chronic brain disease that is best treated by a chronic disease model of care. Read Beacon’s blog post on the subject and download our white paper, “Confronting the Crisis of Opioid […]

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[…] addiction is a chronic brain disease that is best treated by a chronic disease model of care. Read Beacon’s blog post on the subject and download our white paper, “Confronting the Crisis of Opioid […]

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