Both problematic substance use and substance use disorders vary overall, and they vary widely – in terms of whether they present or not, and in their severity. But something that is clearly understood is addiction illness. Even though the current DSM (DSM-5) describes addiction illness in the narrative text fairly succinctly and sufficiently, and even though the DSM-5 does not permit us to diagnose addiction, most working clinicians – when we see severe, complex and chronic addiction illness in our patients – we can identify it; we do know what it is.
Addiction illness is well understood, well defined, and is known to be relatively long. The problem is that the length of addiction treatment is comparatively short. Bob DuPont1 and others have pointed out that even medication maintenance strategies like methadone maintenance are usually a few years long, but these are still very short compared to the length of the illness and of recovery.
What this leaves us with, then, is that the course and indicators of improvement are less well known.
One simple reason for that being true is we just do not see people over many years. That is, we do not see people for decades following their initial care for addiction, and we tend to not have professional and clinical structures of care and support that stretch out over the much longer term.
As a result, we just do not know what the indicators and course of healing from substance use disorders are.
Background factors contributing to this, and the resulting implications, are profound2.
- For example, we do not systematically collect clinical data from people continuously during their long recovery, or during the long periods following their exit from care.
- We do not have clinical structures that provide routine wellness checks with feedback, simple and routine preventative recovery maintenance, or more complicated therapeutic or recovery-maintenance procedures if and as more difficult challenges or problems arise.
- And our training programs for clinicians working in our field tend to be problem-oriented and responsive to severe problem presentations (rather than embracing all of: wellness, prevention, all therapeutic approaches, all therapeutic tools, and clinical methods related to both disease management and recovery management over decades).
I would like to offer Stages of Healing as a framework within which improvements from addiction illness can be conceptualized, both during and following initial care (which is tantamount to disease management), and continuing care (which is tantamount to recovery management). Adopting this approach will also contribute to improving, defining and expanding research endeavors, and I will discuss that as well.
1DuPont, R.L. (2016). Interview with Brian Coon for the North Carolina Recovery Advocacy Alliance Summit
.2Coon, B. (2019). Planes, Car Repair Shops, and Dentists. October 31, 2019. Recoveryreview.blog
In case you missed it, Part 1: OVERVIEW is here.
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