dreamglowI recently received the following question from a reader:

Dr. Junig, I made a horrible mistake after almost a year of doing well on Suboxone.  A friend gave me a Vicodin tablet, and on impulse, I took it.  I’m afraid to tell my doctor because he has a zero tolerance policy, and he will probably kick me out of his treatment program.  What should I do?

I have received a number of similar messages over the years, including messages written after a person told his/her doctor about a relapse, resulting in discharge from treatment.

Without allowing for suspense to build up, I’ll admit that I find such ‘treatment’ to be barbaric.  A person who has relapsed is in a very precarious position, usually feeling ashamed, afraid, and embarrassed– the very feelings that are likely the most powerful triggers for drug use.  What, exactly, is the benefit in discharging a person in such a condition?

Opioid dependence has a significant mortality rate, especially during relapse. When a person is discharged for relapse and later dies from overdose, who was served?

I understand the need to hold patients accountable, in part to provide  incentive for patients to adopt behaviors that are most likely to  result in successful treatment.  But discharging patients without a treatment plan or follow-up care does not lead to a positive outcome. Patients discharged from buprenorphine treatment — or from traditional treatment, for that matter — do not stay clean and find another treatment center, recommitted to doing well.  Instead, they return to using — often more discouraged and disheartened than before.

By now, every treatment professional pays at least lip service to the idea that addiction is an illness, or a disease.  I certainly believe that to be the case.  And if we are serious about recognizing and treating addiction as a disease, we should treat relapse as we treat the recurrence of any chronic, relapsing illness.  When patients ‘fail’ preventative treatment for asthma, should we discharge them from treatment?  What if the person fails because of missing doses of an inhaler?  Certainly THAT person should be kicked out?

Whether one substitutes diabetes, hypertension, heart disease, depression, OCD, or any other chronic illness, the answer is the same.  It appears inhumane to kick a person out of treatment because of a flare-up of a disease.

What is it about addiction that causes patients to be treated differently?

Photo by Dream Glow Pumpkin Cat 210, available under a Creative Commons attribution license.