Addiction is a chronic disease. Epidemiological evidence clearly shows that while science-based treatments are effective, many patients achieve long-lasting recovery only after years of therapy, often including multiple treatment episodes. Neurobiological research on drugs' effects reinforces the message of chronicity: It shows that repeated drug use causes long-term changes in the way the brain processes information and emotions.
As a chronic disease, addiction responds best to treatment approaches already applied to other chronic conditions, such as hypertension and diabetes. These incorporate patient education and self-care, long-term monitoring with attention to complications, and prompt escalation to higher levels of care when symptoms intensify. Continuity of care is key. Without it, patients are less likely to accumulate the sequential gains that ultimately result in long-term, stable control over their condition.
Accordingly, NIDA is sponsoring a wide range of research to understand and respond to substance abusers' needs at each point of care, from the initial presentation for treatment through all stages of recovery. Our ultimate aim is to develop and promote a full-spectrum system of care with powerful initial treatments, long-term followup and support, interventions to stave off relapses, and rapid return to treatment when relapse occurs. Further, we are designing these programs for use by community treatment providers so that they can be implemented there as soon as they become available.
Some established interventions, such as methadone and buprenorphine maintenance, are inherently suited to the chronic nature of addiction. NIDA investigators have recently demonstrated positive results from several new approaches that build on patients' achievements in initial treatment, including monthly cognitive behavioral therapy booster sessions and telephone-based continuing care. NIDA researchers are also seeking to facilitate the efficient implementation of new treatment protocols and practices and invite feedback from staff implementing these protocols in therapeutic settings.
Many questions must still be answered before we can fully understand and respond to all the implications of addiction over its long, perhaps lifelong, course. Recognizing that addiction is a chronic illness enables us to ask the most important questions and translate the answers into new and improved treatment approaches and interventions.