Chronic disease paradigm, again

 

In the Journal of Addiction Medicine citation reviewed first today, is found a well-supported example of the basis for regarding addiction as a co-morbid, exacerbating, chronic disease.  Chronic diseases bear the following characteristics:

• Late onset of clinical symptoms
• Unpredictable if often inexorable course
• Complex etiology
• Progressive: No cures; remissions are the therapeutic benchmark
• Treatment is behavioral (adherence & monitoring) as well as medicinal

Late onset is exemplified by cerebrovascular and cardiovascular disease in the presence of hyperlipidemia; of renal disease consequent upon hypertension; and hepatic cirrhosis and gastroesophageal cancers with alcohol use.  But in defining chronic illness, alcoholism and other addictions are not commonly included in the panoply of examples.   They are seen as etiologic, but less so as chronic illnesses unto themselves, with lengthy, progressive, possibly remitting courses. 

In the JAM article by Moreno, Wakeman and colleagues, strong support is given to management of OUD with buprenorphine in reducing hospital length of stay for comorbid disorders.

- W. Haning, MD