Friday, January 27, 2012


I am attending a major 'think tank' session today in Texas. The discussion revoles around whether to subscribe to the new definiton of addiction, set out by the American Society of Addiction Medicine. For Physicians and Pharmacists this is an easy sell. They call it a 'brain disease'. It is chronic and can be treated by medication. But the question still lingers as to why it occurs in the first place. If it is a disease than it just appears - we have no participation in it. If it is a disorder then maybe there is the implication that we have a part in the process. No one sits on our chests, puts a funnel in our mouths and pours alcohol down our throats. Likewise no one forces us to ingest or IV opiates. This 'disease' only shows up after we have participated in an action to make it happen. I would like to suggest that we have a disorder or even an illness, and we need help and support to get well. Wellness is our goal. Whether we use pharmacotherapy, or AA, or Mental Health/Substance Abuse Counseling, the goal is the same and we must be involved in the process somehow. Although ASAM decided to redefine addiction in a way that benefits physician practices and pharmaceutical companies, we must consider that stepping up on our own is a critical part of personal wellness.


Gerry said...

Disease v. Disorder is an issue that I believe is based on the ICD 9(soon to be the ICD-10)code, and the billing for treatment. Physicians are trained to look, a.k.a make a diagnosis based on signs and symptoms of illness. Treatment is guided by the progression of the illness. Semantics will only affect the billing practices.

Dr. Alicen said...

You raise a good point. Training physicians to diagnose based on symptoms and to treat based upon the progression of an illness is the way we do things in America.

But physicians receive a mere few hours of addiction training in medical school and little or none after they graduate. We medicate diseases.

What is missing is holistic treatment with multiple providers, for folks who have disorders. This can/cannot include medication.

Old time Psychiatrists used to be the one-stop shopping for disorders and they did well. Now, they too, medicate and provide little or no therapy. That is left to Mental Health and Psycho therapists who need to work in concert with physicians and psychiatrists toward patient wellness.