Dr Kelly Clark: Addiction Is a Chronic Brain Disease

Prescription drug abuse is an epidemic in the US and a chronic brain disease, but it is not treated the way other chronic conditions are, said Kelly J. Clark, MD, MBA, president elect of the American Society of Addiction Medicine.

Transcript (slightly modified)

What is the scope of the addiction problem in the US today?

The scope of the addiction problem is epidemic. The CDC has called prescription drug abuse an epidemic and they don’t use that term lightly. More Americans die from unintentional overdose than die from motor vehicle accidents.

We’ve found now that the abuse of opioids, unintentional overdose deaths, have actually decreased the anticipated lifespan of a segment of Americans—particularly, middle-aged white women. The scope of this problem is enormous. We have about 2 people in this country die every hour from opioid overdose.

Why isn’t addiction viewed similarly to other chronic conditions and how do we change that narrative?

Addiction was treated the way many central nervous system (CNS) diseases have been treated in the past, which is as a moral failing or even a curse. Something is wrong with the person, culturally from our background, who has an addictive disease. We used to stigmatize people who had Parkinson’s disease—tremors—who had other CNS illnesses, like dementia. And we don’t really do that anymore with diseases other than the disease of addiction.

We’ve also had this construct of addiction as being a moral failing that people can just get over or pull themselves up by their boostraps. And we really have a construct now, as doctors, as medical professionals, that addiction is a chronic brain disease.

It’s very hard, though, to get people throughout the entire population to understand that, particularly people who are well aware of our traditional 12-step modalities, which is a spiritual approach and has worked for millions of people in treating their alcoholism. We’ve found that the approach that worked for treating alcoholism has not worked as well for treating opioid addiction.

And we as a society have been hesitant to follow what evidence-based medicine shows us about treating opioid addiction, which is particularly the use of medications in an ongoing way—the way you would any other chronic disease state.