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Addiction: A Chronic Disease
with Powerful Impact

“One thing needs to be very clear,” asserts Dr. Mona Gupta, a Raleigh-based psychiatrist, “addiction is a disease—not a character flaw or a failure of self-discipline. It is a disease of the brain that not only deeply affects the patient, but impacts all the systems of which the patient is a part.”

Dr. Gupta

It’s a disease, she points out, with a profound impact on our society. “Nearly 20 million adults battled addiction in 2017, for example. And the surgeon general estimates that one in seven Americans will face substance addiction,” she says. “Those are staggering numbers, especially when you appreciate that an individual’s addiction problem is not isolated—it’s a disease that affects family members, co-workers, friends. And the cost is immense. The estimated cost of drug abuse in the U.S.—including illegal drugs, alcohol, and tobacco—is more than $820 billion a year and growing.

“As those numbers attest, addiction is a serious economic problem. But it is important that we remember that it is, first and foremost, a health problem. Addiction,” she explains, “is a chronic disease similar to other chronic illnesses such as type 2 diabetes, cancer, and cardiovascular disease. As with these other conditions, there is often a genetic predisposition to the disease. But, while genetics play a major role in determining who succumbs to the disease, environmental factors—including both experiences and lifestyle—are extremely important.”

Effective treatment, says Dr. Gupta, “is one that uses a multi-faceted approach to meet the patient where they are and support them in facilitating positive change in all areas of their life.”

Mental Challenges of Chronic Illness

“Chronic diseases,” points out Dr. Gupta, “are the leading cause of death and disability in the U.S.—responsible for seven out of ten deaths each year. And, impor-tantly, there are strong relation-ships between mental illness and cardiovascular disease, diabetes, obesity, asthma, arthritis, and other chronic health problems. For example, depression is found to co-occur in over 15 percent of cardio cases, nearly 30 percent of diabetes cases, and more than 40 percent of cancer cases. The risk of tobacco use is twice as high for those with mental illness, compared to the general population—and the rate of injuries, intentional and uninten-tional, is two to six times greater for those with a history of mental illness.

“The connection between chronic physical health problems and depression is particularly significant,” she says. “Not only do long-term physical problems contribute to depression, but depression, in turn, affects the patient’s ability to heal physically. By addressing the issue of depres-sion, we can also affect physical recovery. This has been illustrated in a number of studies where patients who had been given anti-depressants after bypass surgery had better surgical outcomes.”

The Role of Stress

“I can’t overstate the impact of stress in virtually all of these dis-orders,” says Dr. Gupta. “Diabetes, hypertension, cardiovascular disease, thyroid disease, and men-tal health generally—all of these conditions are exacerbated by stress.”

“Stress,” Dr. Gupta notes, “is another word for pressure, fear, worry. It’s a part of all of our lives, and when balanced can be a positive, motivating force. But in excess, when we can’t manage it, stress is toxic. And a chronic illness is, itself, a major stressor. So, when our bodies are dealing with illness, it is especially important to learn to manage the external stresses so we are able to heal. As you learn to manage your stress—to understand there is just so much you can do in a day and don’t take it personally if something doesn’t work out exactly as planned—you really are taking care of all of your health problems, physical, mental, and emotional.”

Substance Abuse
Intensive Outpatient (IOP)

That multifaceted approach is exemplified in a new program— Substance Abuse IOP—offered by Gupta Psychiatry for patients dealing with substance abuse and addiction. “IOP,” explains Dr. Gupta, “stands for ‘Intensive Outpatient Program.’ This program fills a very real need,” she says, “because it provides a level of support not typically available outside a residential program.

“We’ve designed a support system for treating primary sub-stance use disorders that falls between a more restrictive inpatient/residential level of care and the less restrictive outpatient level of care,” she explains. “It recognizes that many people dealing with substance abuse issues need a lot of support, but may not need or be able to participate in a residential program.”

The program consists of 10 hours of clinical services each week, in-cluding group therapy, and indivi-dual and family counseling. It also includes a medication evaluation and access to psychiatric medication management services if needed, including outpatient medical detox when appropriate for the patient. The program spans a minimum of eight weeks, and can be extended to meet the individual needs of the patient.

“The Substance Abuse IOP schedule is very carefully designed,” says Dr. Gupta, “to ensure that patients are getting extensive support, but doing so in a way that allows them to go on with their work and home lives. Therapy sessions are scheduled for evenings and Satur-days. This way, we’re not affecting the average employee’s hours, and making it possible, perhaps, for their spouse to take care of their children. While patients still get the focused care they need, it won’t fully disrupt their day-to-day activities.”

Candidates for Intensive Outpatient Services

“As with any chronic disease,” notes Dr. Gupta, “the experience is an individual one. Many patients dealing with addiction are also struggling with other health problems, such as depression or chronic pain. Our goal for every patient is positive change within the whole person—mind, body, and spirit—not simple to control their substance use. But while the goal is the same, the treatment path must address the very individual needs of each patient.

“For many patients, the Substance Abuse IOP is ideal; for others residential treatment or less intensive outpatient programs may work best. Good candidates for the Substance Abuse IOP are patients who are struggling with a primary substance use disorder and possible co-occurring mental health diagnosis, and who are unable to maintain sobriety from substances for long periods of time without clinical intervention. They are free of withdrawal symptoms, but may require some level of outpatient medical detox from substances.”

Dr. Gupta says they welcome referrals to the program from many sources: from residential, inpatient treatment facilities, or local hospitals, local therapists, local physicians, primary care, or even internally. “We may identify patients in our psychiatry or outpatient counseling practice who are good candidates for the program,” she notes. “And we invite patients to self-refer. If you believe this is a program that would work for you, let us know.