Disease Models of Opiate Addiction

Addiction treatment Centers West Palm Beach are doing as much as they can in treating drug and alcohol addiction. They are face with difficult barriers from the insurance companies shortening the length of time payable for addiction treatment.

Addiction Treatment Centers West Palm Beach Fighting the Heroin Epidemic

As most of us are aware, the opioid and heroin problem in our country is at epidemic proportions, and I would go so far as to state unequivocally that we are dealing with a magnitude and severity of a situation in addiction medicine that is unprecedented in nature.  Suddenly, relapse isn’t an “oops let me try again”, it is DEATH.


A recent CNN article detailed some alarming statistics:  “heroin-related deaths increased 439% from 1999 to 2014. As of 2014, heroin-related deaths had more than tripled in five years and quintupled in 10 years.  In 2014, opioids were involved in 28,647 deaths — 61% of all US drug overdose deaths — and 10,574 were related to heroin, in particular. Data from 2014 reflects “two distinct but interrelated trends,” the CDC notes, a long-term increase in overdose deaths due to prescription opioids and a surge in illicit opioid overdose deaths, mostly related to heroin.”

In my personal addiction treatment medicine practice, I would estimate that approximately 70% or greater of my addiction treatment patients in the West Palm Beach, Florida area are addicted to heroin.  Very clearly, the near-universal mechanism by which we as a country have dealt with substance use disorders to date, namely traditional 12 step rehab, is inadequate in this new and exploding population of opiate use disorder patients.

Two Addiction Treatment Thought Models Adopted by Addiction Treatment Centers West Palm Beach

There are two prevailing “thought models” which attempt to explain the pathophysiology behind addiction.  The first is termed “the moral model”, which asserts that addiction is entirely a choice and secondary to an individual’s moral decision-making (or lack thereof).  This model presupposes that, if not for one’s dysfunctional values and choices, he or she would not have an addiction problem.  The second model is known as the “disease model”, which categorizes addiction as a chronic disease.  ASAM (the American Society of Addiction Medicine) defines addiction as ”a primary, chronic disease of brain reward, motivation, memory and related circuitry”.

us-sergeon-general-Vivek-H-Murthy-pleading-for-medication-assisted-treatment-by-addiction-treatment-centers-west-palm-beach-floridaAs part of a recent landmark statement, the US Surgeon General, Vivek Murthy, distinctly stated that addiction is “a chronic illness that we must approach with the same skill and compassion with which we approach heart disease, diabetes, and cancer.”  Furthermore, President Obama’s 2017 fiscal year budget includes $920 million to support cooperative agreements with States to expand access to medication-assisted treatment for opioid use disorders.  All of this did not happen on a whim- these statements and decisions are directly based on clinical evidence that including MAT in the treatment of the chronic disease of addiction increases the likelihood of abstinence from the illicit substance and decreases the probability of overdose and death.

Adopting Medication Assisted Treatment to Save Lives

Accepting addiction as a chronic disease mandates that we, as addiction professionals, view and treat it in the same multi-disciplinary manner in which we treat other chronic diseases. Namely a COMBINATION of medical interventions and behavioral adjustments and modifications.  In other words, we as physicians don’t look at an obese diabetic patient and simply say “lose a hundred pounds and your diabetes will go away” and omit insulin therapy.  Nor do we look at a smoker with emphysema and simply say “stop smoking and you will breathe better” and omit inhalers that improve lung function.  Are the insulin and inhalers, respectively, “crutches” for these patients?

I suppose one could look at it that way, but mainstream medicine, and our society would submit that these medications are imperative to preserve life and improve the quality of one’s life.  So, if the addition of medication is perfectly acceptable, appropriate and the actual standard of care for all these other chronic disease states, why the stigma when discussing medication as it applies to the chronic disease of addiction?   As an addiction medicine physician, I feel that it is imperative to at least consider utilizing all available tools at our disposal, and this includes Medication-Assisted Treatment.

Ensuring Addiction Treatment Clients Get the Correct Care

responsible-medical-care-by-addiction-treatment-centers-west-palm-beach-FloridaHaving said that, medication assisted treatment should also not be used in a cookie-cutter fashion and is not appropriate in all forms for all patients.  The specifics regarding medication assisted treatment medications are beyond the scope of this introductory article, but will be detailed in a future editorial.  However, suffice to say that, when used responsibly and appropriately, MEDICATION ASSISTED TREATMENT saves lives.  Our national academy and addiction authority, ASAM, our surgeon general, our Country’s President and addiction medicine physicians in the trenches with these patients concur that that is, indeed, the case. This goes far beyond addiction treatment centers West Palm Beach and is a serious national problem.

The addiction treatment centers West Palm Beach recovery community cannot continue to treat our current climate of heroin addiction in a rigid, dogmatic fashion, or thousands of more deaths will be left in the wake- guaranteed.  I would submit this question to the recovery community as a whole: given the REALITY that abstinence is only attainable by approximately 10% of our patients addicted to heroin, what should our answer be to the other 90%?  Attain the recovery community’s traditional idea of abstinence or go die?  During the treatment, no other disease would that be the sentiment.

harm-reduction-plan-b-for-addiction-treatment-centers-west-palm-beach-florida-fighting-the-heroin-epidemicThe logical answer is harm reduction.  If a portion of our patients are utilizing some form of medication assisted treatment, yet going to work, having meaningful relationships, and living a fulfilling life devoid of crime and an elevated risk of death and communicable disease, what is wrong with that?  If I could actually attach a title to the current arena of mainstream heroin addiction treatment it might be “Abstinence- worth dying for.”  The unyielding ideals in the context of the current patient population are at the very least antiquated and simplistic, and at the very most, downright dangerous.

In summary, we have an absolute epidemic of opioid/heroin abuse in this country of a never-before-seen magnitude, and our current and historic methods of dealing with alcoholism and other addictions are NOT WORKING.  Traditional 12-step, “abstinence-based”, one-size fits all programs are simply NOT acceptable as a uniform approach to this new and evolving segment of addicts, and these patients are DYING IN RECORD NUMBERS.

not one more addiction treatment centers west palm beach must adopt medication assisted treatmentThe primary difference between heroin and alcohol or other drugs of abuse is that with ANY relapse, just ONE use or momentary lapse in judgment, the heroin addict has a significant rate of sudden death.  Perhaps being dogmatic about traditional, Big Book, 12 step programs is more acceptable when the risk of relapse does not include the very high likelihood of immediate death.  But, because of the totally unknown mixture of drugs in each purchased “bag” or “cap”, including the most potent opioids known to man, namely fentanyl and carfentanyl, a relapse is not necessarily an invitation to “try again”, but is a game of Russian roulette often ending in death.

In my time treating addiction patients with substance use disorders I have often heard the statement “the definition of insanity is doing the same thing over and over again and expecting a different result.”  I think the way we are currently treating our heroin-addicted patients accurately, albeit ironically, fits that definition.   It is time that addiction treatment centers West Palm Beach and nationally stop preaching and demanding that our idea of “abstinence” in the course of addiction treatment is the ONLY acceptable goal.

We can continue jumping up and down screaming abstinence-based rhetoric while our patients continue to die, or we can think more pragmatically about the issue and consider the non-judgmental addition and acceptance of appropriate medically-based therapies to the paradigm of addiction treatment.  Our patients’ lives truly depend on our willingness in the recovery community to adapt to this uncharted territory by implementing the same treatment paradigm that we use as a society in any other chronic disease.

Let us walk you through the treatment process. We're here to help.
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Let us walk you through the treatment process. We're here to help.
100% Free and Confidential.
1 (561) 265-1990