PART ONE: Medical evidence has convinced addiction professionals that addiction a disease. Yet, older attitudes, beliefs and practices persist, hindering proper treatment. This website seeks to educate other medical professionals as well as members of the general public on why addiction is truly a disease and explores the full implications of this truth.
PART TWO: A separate second mission for this website is to advocate for chronic pain patients who represent “collateral damage” in the war on the opioid crisis. Overzealous efforts to curb opioid prescriptions have left many patients suffering with untreated pain without reducing addiction rates.
Explanation of the Addiction Medicine Mission:
The primary message and organizing principle for this website is that addiction must be viewed as a disease. It was a moment of epiphany for me when I first understood addiction truly is a disease. Addiction is no less a disease than diabetes, arthritis, Alzheimer’s or cancer; addiction deserves to be treated along the same medical principles that guide the treatments of other diseases. This revelation enlightened my attitudes and belief systems, transforming how I approached addiction and how I saw those afflicted by the disease. The objective of this website is to bring this epiphany to others.
Unfortunately, I find the message “addiction is a disease” has gotten stale. Even worse, it has been (mis)appropriated by the addiction treatment industry and turned into a meaningless marketing slogan. Yet, within this kernel of truth that “addiction is a disease” lies the seed of profound change. Most people do not adequately appreciate the full ramifications of the disease model. Currently, addiction is only treated as a “quasi-disease”, by which I mean that most people recognize the medical profession has a role, but addiction is not quite seen as a bona fide disease on par with diabetes, cancer or arthritis. Medical practices related to addiction are still informed and dictated by older attitudes, belief systems, prejudices, practices that do not exist for other diseases. To illustrate this point, many if not most pain doctors prescribing opioids will dismiss a patient found to have cocaine on urine drug testing. Yet, there is no other disease we would ever diagnose based upon a single piece of data. Urine samples can be mislabeled, the cocaine might have come from a legal source (cocaine is still used in ENT procedures), or it might have been laboratory error. Furthermore, even if the physician had accurately diagnosed the patient with a cocaine addiction, there is no other area of medicine where it would be appropriate to dismiss a patient for having an inconvenient diagnosis.
This website seeks to first establish why addiction is a disease and what that statement means. Subsequently, we explore where current treatments for addiction have failed to fully embrace the disease model and what the full implications are.
Explanation of the Chronic Pain Advocacy Mission
It might seem incongruous for an addiction physician to be advocating for improved access to opioids for pain patients but I do not see any inconsistency. I have managed opioid prescriptions for longer than I have been an addiction physician. Since 2011 or 2012, efforts targeting the opioid crisis has dramatically cut opioid prescriptions, to the point that many if not most physicians no longer prescribe any opioids. Yet, despite phenomenal successes at cutting access to legal opioids, the opioid epidemic has only grown. I make the argument that making opioids less available has only fed the opioid epidemic. As one pain patient put it, pain patients derived of pain medications have only three choices: suffer, suicide, or turn to illicit opioids.
Cutting access to legal opioids has only fed the addiction epidemic. Thus, it is entirely consistent for an addiction physician to advocate ending this ineffective and counter-productive strategy, which is only punishing innocent pain patients. It is unethical for society to regard the suffering of pain patients as an acceptable price of “collateral damage” in the war against opioids. Collateral damage is unacceptable even in actual physical wars. Access to legal opioids needs to improve.