ischemic heart disease and chronic obstructive
pulmonary disease.^89 Alcohol consumption
contributes to diseases that are among the top
causes of death, including heart disease, cancer
and stroke.^90 Addiction involving alcohol is
linked to cirrhosis, alcoholic hepatitis, chronic
pancreatitis, cardiomyopathy, heart arrhythmias,
stroke and neoplasms of the liver, pancreas and
esophagus.^91 Heavy alcohol use and addiction
involving alcohol are associated with the
incidence and re-infection of tuberculosis.^92
Injection drug use is a risk factor for infectious
diseases, including HIV, hepatitis C and
hepatitis B.^93 The incidence of various forms of
cancer,^94 heart disease^95 and sexually-transmitted
diseases^96 are higher among those with addiction
than among those without addiction.
Risky use and addiction also have high rates of
co-occurrence with many mental health
problems including depression, anxiety, post-
traumatic stress disorder, bipolar disorder,
schizophrenia and other neuropsychiatric
disorders such as attention deficit/hyperactivity
disorder, conduct disorder and eating
disorders.^98 The association between addiction
and co-occurring health conditions can result
from several factors. Substance use may
precipitate the onset of other conditions such as
depression or anxiety disorders.^99 Other times,
the health conditions may precede the onset of
addiction, as often occurs with mood disorders
and attention deficit/hyperactivity disorder,^100 as
individuals attempt to self-medicate the pain or
distress associated with their illness.^101 The two
types of conditions also may co-occur as a
function of an underlying psychological or
biological propensity, or substance use can
exacerbate or complicate symptoms of existing
health conditions.^102
Addiction Can Be a Chronic Disease.................................................................................
Once an individual develops addiction, changes
in the brain’s reward circuitry may remain even
after cessation of substance use.^103 These
changes leave addicted individuals vulnerable to
physiological and environmental cues that they
have associated with substance use, increasing
the risk of relapse. In these cases, addiction is a
chronic disease--like heart disease, hypertension,
diabetes and asthma--defined as having a clear
biological basis, a behavioral component,
environmental influences, unique and
identifiable signs and symptoms, a predictable
course and outcome and the need for continued
management following treatment.^104Like any other chronic condition, addiction
rarely abates after a single course of medication
or other treatment or after a single attempt to
alter one’s lifestyle or behavior. As is true of
other chronic conditions, individuals with
addiction can have symptom-free periods and
periods of relapse.^105 Many patients relapse
multiple times and still others never achieve
effective disease management.^106 In fact,
addiction frequently is characterized as a disease
where relapse is virtually inevitable. Yet, this
conception of addiction might be due to the
focus of research studies on those with the most
severe manifestations of addiction, who
experience multiple episodes of symptom
relapse and co-existing health and social
problems over the course of many years or even
a lifetime.^107 Furthermore, very few people with
addiction actually receive adequate, effective,
evidence-based treatment.^108 The seemingly
high rates of relapse* may be due, at least in
part, to inadequate or ineffective interventions
and treatments.^109* Relapse rates for those with addiction are
comparable to relapse rates for those with other
chronic diseases.It’s not surprising to us now that when you stop
the treatment, people relapse. It doesn’t mean
that the treatment doesn’t work, it just means
that you need to continue treatment.^97--Daniel Alford, MD, MPH
Associate Professor of Medicine
Boston University School of Medicine