Addiction has historically carried stigma, as it was viewed as a behavioral problem. An individual’s struggle with addiction was rarely discussed and inpatient treatment was the default. Science has proved addiction a disease, but inpatient detoxification and rehab dominate the treatment landscape, disallowing stigma associated with addiction to fade.
Treatment for addiction needs to be pulled forward into modernity. Like for other chronic diseases, outpatient treatment delivers better outcomes and should become the norm.
Inpatient treatment perpetuates the idea that addiction is a shameful behavioral problem, as patients are separated from the general population until they learn to modify their “behavior.” It was believed that once the individual addicted to drugs or alcohol learned to change his/her behavior, things would fall in place.
In inpatient detoxification and rehab, patients receive treatment in a bubble, isolated from their living environment. When patients return home from treatment and face life stressors, the results are not predictable. Such treatment plans are rare for other chronic diseases, even those that are contagious.
Repeated abuse of alcohol/drugs changes the circuitry in the brain, where the brain becomes dependent on the substance abused to stimulate the release of dopamine to feel pleasure. The brain’s own triggers to release dopamine become suppressed and the individual suffering from addiction may feel depressed when not actively using. These changes take years to correct, leaving the individual susceptible to relapse in the interim.
Outpatient detoxification (most acute phase of addiction treatment) for alcohol, benzodiazepines and opiates is nascent but should become ubiquitous, as it delivers better outcomes at lower costs. Outpatient detoxification/rehab and other treatment for addiction is often more successful because it integrates the home environment into treatment. In an inpatient setting, coping/relapse prevention skills learnt are never tested at home, decreasing probability of success.
Chronic diseases, such as diabetes and HIV, are treated effectively on an outpatient basis, but drug and alcohol detoxification/rehab has been provided mostly in inpatient settings. Accessing treatment while staying in real-life environment helps patients learn coping skills and work through triggers in real-time with their treatment team. As per a CNT study, 65% of Ambulatory Detox patients were sober 90+ days, relative to ~40% after inpatient detoxification. 72,000 overdose deaths in 2017 attest to the fact that the current dominant addiction treatment model, inpatient detoxification and rehab, has proved ineffectual.
Making outpatient detoxification and allied treatment the default will help the perception that addiction is a chronic disease needing treatment interventions.