Addiction Medicine: Closing the Gap between Science and Practice

likely than those who did not exercise to have
relapsed.^313

Chronic Disease Management .........................................................................................

Although the reasons are not yet clear, some
individuals may experience one episode in
which their symptoms meet clinical diagnostic
criteria for addiction and be non-symptomatic
thereafter.^314 In many cases, however, addiction
manifests as a chronic disease--a persistent or
long-lasting illness--which requires ongoing
professional treatment and management.^315 This
may be due to a preexisting brain dysfunction or
to changes that occur in the brain in response to
repeated exposure to addictive substances which
increase the vulnerability of the individual to
relapse, even after cessation of substance use.^316

All chronic diseases--regardless of whether they
are genetically based, driven by biological or
environmental influences or originate from some
combination of these factors--require long term,
evidence-based medical management of the
disease by qualified health professionals and
may include pharmaceutical and/or psychosocial
therapies as indicated, to assure that patients
remain symptom free and that co-occurring
health conditions and the patient’s nutrition and
exercise requirements are addressed.^317

Chronic disease management can improve
patient functioning, suppress symptoms, prevent
the development of additional diseases or co-
occurring conditions and reduce relapse.^318

Relapse can result from a wide range of factors
including cravings and withdrawal symptoms;
interpersonal conflict, peer pressure and other
stressors; and the patient’s emotional state,
motivation level, self-efficacy and ability to
cope with high-risk situations.^319 Recent
research also points to individual differences in
brain structure as a risk factor for relapse:
patients in treatment for addiction involving
alcohol who had reduced volumes of gray
matter* in the regions of the brain associated

• Gray matter volumes were measured via magnetic

resonance imaging (MRI). Gray matter is considered
a reliable indicator of neural count and functionality.

with impulse control and cognitive function

were more likely to relapse after a shorter period

of time than those with higher volumes of gray

matter in these brain regions.^320 Yet another

obvious but rarely considered factor that may

contribute to relapse risk is that the treatment the

patient received simply was inadequate, either in

terms of the type of intervention provided or the

length or intensity of the treatment.^321

Chronic disease management, as it applies to

addiction treatment and relapse prevention,

seeks to address and prevent those factors that

increase the likelihood of relapse by ensuring

that treatment delivery is effective and that

personal, psychological and environmental risk

factors for relapse are addressed and

mitigated.^322 Specifically, physicians

supervising addiction treatment should assess

the need for chronic disease management and

ensure continuing care.^323

Medically Supervised Disease Management .............................................................

Health care providers are optimally situated to

provide clinical disease management.^324

Following acute treatment, the disease

management process is critical to help maintain

health and prevent relapse.^325

Patients who have received acute treatment for

addiction may require maintenance medications

such as methadone, buprenorphine, naltrexone,

disulfiram or NRT to prevent relapse.^326 Since

many patients with addiction have co-occurring

health conditions that may complicate their

treatment or exacerbate the risk of relapse,

medical professionals should carefully supervise

and coordinate treatment for all conditions.^327

Medical professionals supervising patient care

also may perform toxicology screens to monitor

patients’ substance use following acute

treatment and modify clinical interventions

accordingly.^328

Medical professionals also should supervise the

psychosocial interventions that patients receive

following acute addiction treatment.

Psychosocial therapy often is a critical

component of relapse prevention.^329

Collaborating with other health professionals, as