WORKING TOWARD TRUE PARITY

The World Health Organization (WHO) defines chronic diseases as being “of long duration and generally slow progression. Chronic diseases, such as heart disease, stroke, cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in the world, representing 60% of all deaths.” The Centers for Disease Control and Prevention (CDC) also recognizes the impact of chronic diseases, and it supports a variety of programs to improve the nation's health by preventing chronic diseases and addressing their risk factors. The CDC provides national leadership on chronic diseases by offering treatment guidelines and recommendations, as well as by helping state health and education agencies promote healthy behaviors.

Yet in the CDC's and WHO's online information, a prominent mention of or reference to addiction as a chronic disease is missing. If you carefully scrutinize the WHO's and CDC's Web sites you can find references to addiction that suggest it is a chronic disease, but other chronic diseases receive much more attention.

If parity is to have true meaning, then the disease of addiction must be understood, recognized, and treated in the same ways that we address other chronic diseases. Researchers and treatment providers of all chronic diseases, including addiction, must be funded at the highest levels to make a positive impact on the overall health of our nation—and the world.

For decades recognition of addiction as a chronic disease has been hampered by questions about addiction treatment's “success,” implying that addiction can be cured or fixed. This viewpoint reflects a nonscientific understanding of this disease. For what other chronic diseases are we obsessed with success rates? Chronic diseases are just that—diseases for which there is no curing, no fixing, and no simple solution.

For most chronic diseases, such as diabetes, arthritis, heart disease, and epilepsy, there is a great deal more emphasis on managing the disease one day at a time. Once the diagnosis has been made and the individual stabilized, the majority of the medical attention shifts to managing the disease so that the person can live as normally and productively as possible. Disease management has become an important part of the response to most chronic diseases.

So what is dissimilar with the disease of addiction? Once the diagnosis has been made and the individual stabilized, shouldn't we be putting the majority of our energy into ensuring that the disease is managed, one day at a time, for the rest of the person's life?

When people with diabetes, arthritis, or heart disease have setbacks, relapses, or flare-ups, they are not labeled as bad persons. A celebrity's setback with diabetes is not likely to make front-page headlines. Instead, flare-ups, relapses, or setbacks are dealt with, and the management plan is examined and adjusted if necessary. Why is it that setbacks, relapses, or flare-ups in those with the disease of addiction are responded to in such different ways? The answer could lie in the fact that beneath the rhetoric or politically correct language identifying addiction as a disease is a much more deeply held belief that addiction is not a disease.

In this time of great anticipation and energizing around federal parity legislation, we also need to make sure that addiction is understood not only as a 100% bona fide disease, but as a chronic disease for which lifelong management is the norm. With these beginning steps, we need to be committed to exerting our influence so that the WHO and CDC include addiction in any lists of chronic diseases and, even more importantly, in programs that address chronic diseases.

Parity is about more than votes in the House and Senate. It is about addiction being recognized and accepted as a chronic disease having an enormous impact on society, and for which disease management should be the primary emphasis, just as it is for other chronic diseases.

To contact Dr. Hunsicker, e-mail rhunsicker@naatp.org.