Chronicity

The word chronicity can imply many things when related to substance use and addiction. Most typically, it references the chronic nature of addiction and the reoccurrence, or the more stigmatizing term relapse, of the illness. Recent studies confirm that the majority of people with severe and persistent substance use [Page 177]disorders (e.g., substance dependence as defined in the revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Edition, Text Revision (DSM-IV-TR) who achieve a year of stable recovery do so only after three or four treatment episodes over the span of many years. To society, this appears as relapse, is often equated with patient failure in treatment, and is not viewed as a medical reoccurrence of a chronic illness. However, studies of publicly funded addiction treatment document the medical intractability of the illness. For example, William White notes that of all individuals inducted into treatment at a publicly funded agency, 60% have already had one or more prior treatment admissions, and 24% have had three or more prior admissions. Between 25% and 35% of clients who complete addiction treatment will be readmitted within 1 year, and 50% will be readmitted within 2 to 5 years. Viewed from another perspective, in the past 25 years, many researchers have documented the rate of full recovery (abstinence) ranging from 30% to 72% over an individual's lifetime. A 60-year comprehensive study completed by George Valliant reports that 59% of individuals who receive treatment attain full recovery at some point in their life. In this context, Clinton DeSoto and colleagues define recovery as durable after 4 to 5 years of sustained remission (when risk of future lifetime use drops below 15%).

Interestingly, some studies do document a post-treatment return to social drinking in clients; that is, they return to drinking at levels that do not meet DSM-IV-TR clinical criteria for dependence or abuse. Deborah A. Dawson reports that in the year following treatment, as many as 49% of individuals return to nondiagnosable use. Treatment of substance use disorders, usually by measures based on a medically acute care understanding of addiction, underscores the need for clarity in defining both chronicity and recovery. Specifically, the chronicity of addiction is often not taken into account when providing treatment and this failure, in turn, can lead to inadequate care. In addition, when the definition of recovery is based solely on abstinence from alcohol and other drugs, there is no flexibility to incorporate instances of reoccurrence into the accepted course of the illness.