Historically, addiction has been regarded as a moral failure, a sin or a display of weakness on the part of the user. It is widely believed that if people want to stop abusing drugs or alcohol “enough,” they can “just stop” - stop destroying their bodies, stop hurting their families and stop draining society. Modern medicine, sound research techniques and sophisticated brain imaging technology have directly disproved this belief and reinforce the reality that addiction to drugs or alcohol is a brain disease that has many similarities to other chronic medical diseases such as diabetes, hypertension and asthma.
Cravings, loss of control, physical dependence and tolerance: these established patterns of behavioral and physiological symptoms are associated with substance use disorders. Researchers and addiction professionals have also pinpointed a definitive and unique pattern of neurobiological adaptations that take place in the brain. We now know that chronic abuse of a psychoactive substance attacks the brain, resulting in long-lasting adaptations, damage to the cerebral cortex and limbic system, and disruptions in neurotransmission.
This new understanding does not mean that a person addicted to drugs or alcohol is helpless to change his or her behavior, but it does mean that people seeking help need more comprehensive and long-term treatment than originally thought. Effective addiction treatment requires biologically based interventions that are used in conjunction with traditional psychotherapeutic techniques, such as talk therapy and support groups. It can take years to get the body back to its “normal” state given that many of these neurobiological adaptations can persist for years after the last use of drugs and alcohol. Accordingly, addiction treatment services must also be accessible long-term.
Prior to the Affordable Care Act (ACA), signed into law by President Obama in March 2010, comprehensive addiction treatment services were limited to those who had medical insurance with optional substance use disorder treatment benefits, leaving most people to pay for treatment out of pocket. Under the new law, services such as screening, early intervention, treatment and recovery support for clients with substance use disorders will be provided in the same manner and in the same primary care settings as services for diabetes, asthma or any other illness. The change will bring needed help to many as it also increases awareness that drug dependence is a chronic, treatable disease. The health care legislation, as it currently stands, also accommodates for broader coverage for Americans with substance use disorders by providing coverage for those previously uninsured, requiring insurance plans to cover substance use disorders, prohibiting denial of coverage due to a pre-existing condition - including substance use disorders - and providing greater access to treatment through Medicaid.
In 2008, 23.1 million Americans aged 12 and older needed treatment for a substance use problem, and yet only 2.3 million - one in ten - received care at a specialty treatment center. Many of those who do not receive, but could benefit from, treatment do not have health insurance or other means to pay for it. As we move toward implementation of new health care regulations, more people will be able to get the care they need.
Cynthia Moreno Tuohy is the Executive Director of NAADAC, the Association for Addiction Professionals, the nation's largest addiction counselors organization. She has worked on addiction and recovery issues for over 30 years. More information is available at
www.naadac.org. Addiction Professional 2011 May-June;9(3):N3