The statistician George box would say, “All models are wrong but some are useful.” Its a helpful phrase to remember when thinking about substance use disorders and addiction. There is not one right way to think about this problem, as every approach— medical, law enforcement, spiritual— contains both useful insights and significant flaws. However, I am a doctor, so my training teaches me to think about substance use disorders through the medical model.
As doctors, we treat many conditions that are characterized as chronic, relapsing-remitting diseases. There are many diseases fit this mold, from Crohn’s disease to multiple sclerosis. Thinking about opiate use disorder, or any substance abuse disorder through this lens provides some useful insights:
Chronic simply means it does not go away. It will always be there. It does not necessarily mean it will be a problem. I However, just because something is not bothersome at this moment does not mean it doesn’t exist. Other chronic illnesses include things like high blood pressure, diabetes, and heart disease. People with chronic illnesses do not necessarily feel bad all the time; often, the illness barely gets in the way of life.
Relapsing-remitting means the disease goes through periods where it is bad and flared-up, is a problem, then goes through periods where it is not acting up, is not an issue, is in remission. The goal of treatment then becomes to induce remission, and keep the disease in remission for as long as possible.
Viewed through this lens, the goals of treatment become much easier to understand: to induce remission, to maintain remission, and to ensure that any relapses are as short as possible, as infrequent as possible, and as little destructive as possible. This framework is true regardless of whether the disease is a substance use disorder, a neurological disorder, or a gastrointestinal disorder. However, given how loaded and stigmatized substance abuse disorders are, this framework also helps both patients and doctors approach the problem as a solvable issue, rather than an inherent failing in the patient.
The question then becomes, how do we achieve this? That will be the topic of a future post.