Drug Dependence, a Chronic Medical Illness: Implications for Treatment, Insurance, and Outcomes Evaluation

The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2000-10, Vol.284 (13), p.1689-1695
Main Authors: McLellan, A. Thomas, Lewis, David C, O'Brien, Charles P, Kleber, Herbert D
Format: Article
Language:English
Subjects:
Addictions
Alcohol use
Asthma - diagnosis
Asthma - etiology
Asthma - physiopathology
Asthma - prevention & control
Biological and medical sciences
Chronic Disease
Chronic illnesses
Diabetes Mellitus, Type 2 - diagnosis
Diabetes Mellitus, Type 2 - etiology
Diabetes Mellitus, Type 2 - physiopathology
Diabetes Mellitus, Type 2 - prevention & control
Drug use
Health care
Health Policy
Humans
Hypertension - diagnosis
Hypertension - etiology
Hypertension - physiopathology
Hypertension - prevention & control
Insurance coverage
Insurance, Health
Medical sciences
Miscellaneous
Outcome Assessment (Health Care)
Pharmacology. Drug treatments
Substance-Related Disorders - diagnosis
Substance-Related Disorders - etiology
Substance-Related Disorders - physiopathology
Substance-Related Disorders - prevention & control
Substance-Related Disorders - therapy
United States
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Summary:The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking. We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma. Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence. Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness. Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.284.13.1689