The basis of this revolution is the gradual accretion of knowledge about the pathophysiology, treatment and social consequences of drug addiction. All of this information is coming together into a coherent view that points toward needed changes in public policy. Since most drug addicts are adults with other medical disorders, internists need to be part of this revolution. Internists need to adapt their practice to new realities of treating drug addiction and must be leaders in seeking changes in public policy. This article will lay out the basic facts and their implications for physicians, patients and society.
Addiction is a chronic disorder.
The decision to start taking drugs is voluntary, although it is conditioned by heredity and environment. Most first-time users do not become addicted, but many eventually lose the ability to control their use of drugs and become addicted. In this sense, drug addiction is similar to diabetes or hypertension. The analogy between drug addiction and diseases like hypertension or diabetes is appropriate because both conditions produce permanent anatomic and functional changes that put the patient at risk for health problems. Addictive drugs can produce changes in brain pathways that persist long after a person stops taking drugs and place the individual at high risk of relapse.