Chronic Medical Care for Chronic Medical Illnesses: Addiction Should Not Be an Exception

Over the years it has become the standard of care to follow patients regularly who are treated for chronic medical problems like diabetes mellitus and heart disease. Any physician who would only follow these patients for 30 days or even 6 months without follow-up could be determined to be derelict in his or her responsibility to provide usual standard of care. Yet, today it is not unusual for patients with substance use disorders to be seen only in detoxification or during residential counseling. There is little concern about the appropriateness of this practice.

Addiction is a chronic medical illness and requires chronic medical care. There are some patients that achieve abstinence and sobriety who recover nicely without further difficulties. However there are others who require frequent monitoring and adjustments to their treatment plans.

Many patients with addiction also have other co-occurring illnesses that may impact their ability to remain in recovery from their substance problems. Some patients have psychiatric issues that may need psychiatric attention and medication management some of which could potentially put their recovery at risk. Other patients over their lifetimes may develop new medical problems such as fractures, pre and post-operative surgical care, or other pain syndromes that may require opiate pain medications. These patients may be at risk to reactivate their addiction and substance misuse. Having ongoing care and addiction monitoring by an addiction medicine specialist can be of great value in terms of monitoring these patients' care and their ongoing recovery from addiction and their co-occurring  medical conditions.

This concept, in part, is already practiced by many treatment professionals and their respective programs. Many of these programs follow their patients for a set period of time, often spanning decades. This can work by having face to face visits, initially every three to six months and eventually on an annual basis with random urine testing. Personal experience employing this method in my practice has resulted in a “success” rate of more than 96 percent over a 5-year period. 

The Chronic Medical Care Model is advocated minimally for consideration and hopefully for adoption by addiction treatment professionals. Clearly, as seen in the treatment of other chronic medical conditions, sustained treatment engagements and interventions lead to better treatment outcomes than any short term intervention to any chronic illness.