With the passing of May as Mental Health Awareness Month, it is the perfect time to appreciate the tremendous gains we’ve made in understanding, accepting, and managing mental health issues. As a society we have largely abandoned notions of conditions such as depression, anxiety, or ADHD as being abnormal. No longer viewed as character flaws or weaknesses, mental illness has steadily moved from the shadows of shame and doubt into a routine practice of chronic illness management. As with diabetes, high blood pressure, and heart disease, mental health is readily promoted as part of general medical practice, with appropriate medications and healthy lifestyle choices as the mainstays of management.
In keeping with this theme, we must recognize a lingering hurdle in the quest for effective mental health services. Substance use disorder (SUD), often referred to as “addiction,” remains poorly understood, harshly judged, and seriously undertreated. Inconsiderate labeling of affected individuals (“wino,” “junkie,” “addict,”) is commonplace. Possession, use, and distribution can carry serious legal and social consequences. Those who struggle with addiction are often marginalized and punished. Sadly, society’s contempt and ignorance perpetuate these problems by failing to appropriately identify and manage persons with SUD.
Chronic Illness Vs. Lifestyle Choice
When viewed through a chronic illness lens, the gross mismanagement of SUD becomes painfully obvious. Rather than viewing SUD as a lifestyle choice, it is best reframed as a chronic, relapsing brain disease, characterized by compulsive use despite harmful consequences. By reframing, SUD is viewed as a chronic illness. Just like any other chronic illness, SUD cannot be cured. It can, however, be effectively managed. This distinction becomes clear when we compare SUD to another chronic illness, such as diabetes. We cannot hope or expect to “cure” diabetes with a short stay in the hospital. Rather, medication and lifestyle management must continue for a lifetime.
With SUD, relapse is often viewed as an offense. Providers may “contract” with their clients, that they must remain sober, or be dropped from the practice. Compare this scenario to someone with heart disease. It would be unfathomable to think that, if a patient had a second heart attack (a “relapse”), they would not be permitted to return to their current provider. Providers may refuse to care for individuals with SUD out of the concern that their practice may become known as caring for “those people.” From a standpoint of chronic illness, this thought process would be as ridiculous as refusing to see patients with high blood pressure because it would be distasteful to associate with someone struggling with such an issue.
Managing SUD As A Chronic Illness
Throughout the month, we should consider the advantages of viewing SUD as a chronic illness. Management of “typical” chronic health conditions has progressed to amazing advances in care. As an example, in the 1940s, the treatment of diabetes began with development of one type of insulin. Today, we have an amazing array of highly effective medications and technology at our disposal. Similarly, the damage hypertension causes to kidney function has been greatly mitigated by improvements in medications for high blood pressure. It should become intuitive to follow a similar path in managing SUD.
We must be dedicated and supportive of this cause. Unlike other chronic illnesses, medical management of SUD remains in its infancy. FDA-approved medications for SUD only exist for alcohol, tobacco, and opiates. To date, nothing has been developed to assist with cocaine, methamphetamine, or cannabis. Through awareness comes innovation. We must acknowledge that SUD exists, that it is a chronic illness, and that it is no respecter of age, gender, or social class.
This blog post was written by Katrina Gabelko, Nurse RN at Southeast Regional Crisis Center (SERCC).
Nexus Family Healing is a national nonprofit mental health organization that restores hope for thousands of children and families who come to us for outpatient/community mental health services, foster care and adoption, and residential treatment. For over 50 years, our network of agencies has used innovative, personalized approaches to heal trauma, break cycles of harm, and reshape futures. We believe every child is worth it — and every family matters. Learn more at nexusfamilyhealing.org.
