When I started this blog, I had no idea how much time I would spend writing about definitions. I didn’t realize how murky our language becomes when we talk about addiction, even among professionals, and how great the need is for clarity and honesty in our terms.
A few weeks ago, I wrote about ASAM’s recent statement defining the disease of addiction. Just a few days ago, I found a 2005 report from the Substance Abuse and Mental Health Services Administration (SAMHSA), outlining “Guiding Principles of Recovery” and “Systems of Care Elements” for treatment systems helping those with substance abuse problems. You can read that report here. I won’t talk about each guideline individually, because it is my opinion that the document overall is vague, noncommittal, and ultimately unhelpful to patients and physicians.
Addiction is a medical disease, with an underlying biochemical cause. Like any other disease, we treat addiction with medication, and we use scientific evidence to measure the success or failure of our treatments. Addiction patients, like all patients, deserve precision and clarity from their physicians to help them through addiction’s complex and frightening threats to their health. The SAMHSA definition of “recovery” is none of those things. It isn’t clear, precise, or scientific. It presents principles of “recovery” that are certainly desirable, but aren’t medically relevant. While I would agree that getting better from an illness should come along with “hope and gratitude”, and should be “a process of healing and self-redefinition”, those are not the things that should form the foundation of treatment. The foundation of treatment should be sound medical science, and its goal should be to achieve the best possible state of physical and mental health through the safest and surest means possible.
That’s the other major problem with “recovery”; it has no goal. I’ve seen this firsthand in non-medical, 12-step treatment programs, where “recovery” is described to patients as a state in which they must constantly strive to live, which they might fall from at any moment. It’s a vague, endless struggle that gives no promise of results. True medicine, practiced by knowledgeable physicians, should always have an end-goal, even when that end-goal is achieved by a long-term maintenance plan instead of a short-term total cure.
We already have a word that describes the goal of medication maintenance. That word is “remission”.
Addiction is a chronic disease. The goal of medication maintenance is not to instantly and completely cure it, because with our current level of technology, that isn’t possible. Until it is, we strive to get the patient to a point where their disease is well-controlled, and does not disrupt or interfere with the quality of their life.
12-step programs make a point of telling their clients that while people can be “in recovery” for decades, no one is ever truly recovered. With legitimate medical treatment, it is entirely possible for a patient to be recovered, with the requirement that they take the proper medication. This is exactly how we treat asthma, diabetes, and high blood pressure. Only in the field of addiction is vague spiritual “recovery” touted as a real alternative to simply treating disease.