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“Drug Dependence, a Chronic Medical Illness” Article by Kleber et al.

Conclusions reached by authors

The following are the main points discussed by authors on drug dependence as a chronic illness. The authors concluded from their research that drug dependence has similar features to chronic illnesses although many of the medical facilities do not regard that (Kleber et al. 2000). Among the features that the authors found on drug dependence being similar to chronic illness is that drug dependence is not curable and requires continuous treatment.

While individuals are on treatment, they experience improved health and less impulsive desire for the drug. When discharged and out of treatment, they are likely to relapse to drug use. The authors indicated that over sixty percent of alcoholics treated returned to the use of the drug. Likewise, patients with diabetes, hypertension, and asthma may improve their health when on treatment. However, if they return to the previous lifestyle that exposed them to the condition their health is likely to deteriorate.

The evidence they marshalled to reach their conclusions

The authors did a variety of studies to support the similarity of chronic illnesses and drug dependence. The first evidence that they provided is a genetic predisposition of the diseases (Smart 2007). They indicated that the heredity of an individual contributes to the likelihood of whether he or she is likely to be affected by the chronic illness or not (Kleber et al. 2007).

The genotype of individuals affects their drug abuse especially if their parents used a particular drug. The researchers used the study of alcoholics and tolerance where children whose fathers were alcoholics would have more tolerance to alcohol than children of non-alcoholics did. The tolerance on substance is especially on the effects brought about by using the substance.

In the case of alcohol, effects such as hangovers are likely to be more prevalent in the children of people who do not use alcohol than in children born to an alcoholic father. Similarly, a child born to a diabetic parent is likely to experience the same problem if the same predisposing factors prevail.

The authors also provided a detailed explanation on how substance abuse develops into a chronic illness. They define drug dependence as an overwhelming and irresistible urge to use the substance at the expense of doing something urgent or important (Kleber et al. 2000). It is an uncontrollable impulse for a pleasure experienced when or after using the substance. The authors do not provide details of how occasional and regular drug use becomes drug dependency.

They however explain how brain neurons pick the pleasure and store it in the memory such that when the individual is exposed to the stimuli that invokes memories of pleasure experienced when using the substance, the desire for the substance becomes irresistible. Likewise illnesses such as diabetes, hypertension and asthma have their own predisposing factors that expose an individual to the risk of getting the disease especially through use of certain food in the case of diabetes and hypertension. Factors such as eating junk foods and lack of enough exercise lead to uncontrollable sugar levels that result to diabetes (Smart 2007).

The other evidence the authors present to support their claim that drug dependence is similar to chronic illness is that there is no specific cure for drug dependence and the only established treatments are medical regimens on that particular drug. When the patient fails to follow the instructions, then there is likelihood that the patient will continue being dependent on the drug.

In relation to diabetes and hypertension as well as asthma there is no complete cure for the illness and all the physician does is to prescribe diet and behavioural changes that the patient must ascribe (Plant 2006). In most cases, some patients are unable to adapt to this changes due to social economic factors such as lack of resources to support their medication as well as lack of family support in their behaviour changes.

Reasons for agreeing with the evidence

Yes, I agree with this evidence as most of the drug and substance abuse start as a leisure practice but soon become an inherent lifestyle that one cannot do without. On the issues of heredity of the predisposing factors, the evidence from the researchers is not new but there are factors other than the genetic that make it easy for children of alcoholics to use alcohol. Such factors are more dependent on socialisation of the young person in the family where the family is more tolerant to drug abuse than in a family that is intolerant.

The evidence on the mental effect of substance abuse is verified by Ivan Pavlov’s behavioural conditioning experiments when he would ring a bell to the pets when giving them food for a while. When he stopped administering food but rings the bell, the pets would still salivate due to the associations they had with the bell.

This condition applies to the drug abuse, as there are associations that trigger memories of pleasure derived from using the drug that make the victim vulnerable to a relapse of the substance. Similarly, in chronic illness such as type 1 diabetes caused by lifestyle memories of pleasure derived from the prohibited food tempt the individual to break the medical regimens in regard to their condition (Hedblom 2007).

Reasons for agreeing with authors that the drug dependence is a chronic illness

I also agree with the authors on the need to treat drug dependence as a chronic illness. This is because it has negative effects on the affected individuals incapacitating them and making them economically dependent. Classifying drug dependence or drug addiction as a chronic illness will make the condition to warrant a special attention from the medical field than the one it currently has. Most of the medics never examine their patients on substance abuse and they consider it as waste of time.

However, with classification of substance abuse as a chronic illness, individuals currently seeking treatment may receive more attention. Currently there are no long-term treatments. The treatments received are only detoxification procedures after which the patient is discharged to community care (Kleber et al. 2000).

Why doctors fail to diagnose alcohol problems

The first reason why doctors fail to diagnose alcohol problems is lack of emphasis on drug dependence as a major disease. Many view the disease as controllable and as a matter of personal choice to use the drug or not (Babor, Kranzler & Lauerman1989). Most of the doctors also view alcohol screening on their patients as a waste of time mainly because the disease is not insured and most of the patients do not manage footing alcohol related bills.

Most of the medical facilities do not have appropriate medical interventions on alcoholism. This demoralises the healthcare medics not to take the illness with much seriousness. In the medical training also, drug dependence is not regarded as a chronic illness and there is little study on drug and substance dependence treatments.

The most demoralising factor that makes the doctors to abandon quest for treating alcoholism is that forty to sixty per cent of alcoholism patients return to alcohol one year after their discharge making the treatments an exercise in futility (Kleber et al. 2000).

Why doctors who diagnose alcohol related problems respond inadequately

Doctors who diagnose alcohol related problems usually are unable to respond to the patients adequately mainly because there is no major cure for drug dependence. Other than the routine counselling and drug prohibitions, there are limited treatment methods for drug dependence. Unlike illnesses such as diabetes and hypertension which have a well-defined mode of treatment alcohol related problems do not have a specific mode of treatment (Plant 2006).

The other issue which make the doctors respond inadequately to the alcohol and drug dependence illnesses is that the insurance covers restrict drug dependence treatment to only detoxification and stabilisation treatment. They do not cover any continuing care as in the case of other chronic illnesses such as diabetes and hypertension. This obstructs the doctor in following up the patient to the full treatment and recovery.

Evidence that problematic drinking is genetic mediated

Although drinking alcohol is sometimes a personal choice, there are genetic factors, which determine whether alcohol reaction on an individual will be of negative or positive effect. This evidence was on a follow up study on four hundred and fifty sons of alcoholics. The research found that seventy per cent of them consumed alcohol compared to the sons of non-alcoholic where only twenty percent did (Schuckit & Smith1996).

This is highly attributed to the tolerance factors in the inherited genes and that make the person with the inherited allele to have tolerance factors such as lack of hangovers compared to those with no alcoholic allele. Individuals whose fathers were not drunkards had hangovers and skin dehydration after taking alcohol. This made the drinking experience unpleasant and most of them did not end up taking alcohol (Hedblom 2007).

Evidence that problematic drinking is mediated by psychological factors

The evidence that psychological factors mediate problematic drinking is demonstrated by Ivan Pavlov’s study on human behavioural tendencies. Circumstances that expose the individual to the pleasure experienced when taking alcohol will have an effect on the individual. Those who have positive experiences are likely to take more alcohol than those who had negative experiences.

Psychological factors involve the desire to experience certain trepidation and excitement that come about when taking alcohol (Hedblom 2007). This excitement does not last for long but it stimulates the mind. Psychological and emotional factors such as depression also encourages alcoholism where an individual abuses alcohol to forget a problem or a stressful situation (Schuckit 1994)

Problematic drinking and social factors

Other than the hereditary and psychological factors that influence drinking habit of an individual social factors also necessitate problematic drinking. Social factors especially largely depend on culture in the society. If the society is like the Aborigines in Australia who are prevalent alcoholics, it is likely that people will consume alcohol because they are Aborigines rather than because they need it or because they are chronic dependant to have a sense of identity.

Many of the alcoholics take alcohol because their friends take and they want to belong to that group of individuals (Smart, 2007). The social factors affect the treatment of this disease as the associations of taking alcohol which are social end up affecting the mind. Children who grow up in a family setting where family members take alcohol are also likely to develop alcoholism. The association usually affects them, and they may start taking alcohol at a very young age.

Treatment effectiveness

The authors give a good description on how to administer alcohol related treatments such that they are effective on the patients suffering from the substance abuse. The first one is to regard the disease as a chronic disease. This will warrant alcoholism as serious illness that has long-term effect on patients.

When treated as a chronic illness, the treatment is usually continuous (Plant 2006). To make these treatment effective insurance policies must adapt to the fact that prevalence of drug dependence in the society is more evident than before and must make efforts to insure the condition as a chronic disease providing cover for extended treatments and consultations (Smart 2007). In the meantime, the paper proposes other treatment procedures such as clinical advice that has proved effective.

Counselling of the alcoholics by the medics has a far-reaching effect compared to any other treatment method. When patients understand the magnitude of drug dependence they will stop to relapse into alcohol taking, once they have agreed to take treatment. The other procedure to ensure that the treatments administered are effective is having a follow up on the patient (Schuckit 1994).

Lessons from the assignment

The first lesson from this research is that the chronic illnesses need treatment. This will make it possible for doctors and patients to accord the diseases the necessary attention. It is interesting to know that there are similarities between chronic illnesses such as diabetes, hypertension, and asthma and alcoholism.

Other than the medical procedures to contain the disease, policy measures to incorporate the drug dependence as a chronic illness that is not restricted in terms of the number of visits that the patient may consult the doctor and extended treatments will assist in curbing the disease. With knowledge that drug and substance use is likely to develop into chronic illness the government needs to institute mechanisms to control consumption of alcohol and other drugs in the country which have a far reaching effect on the individuals.

Failure to contain the illnesses have a negative effect on the country due to the lost hours of labour and billions of money spent in treating the conditions. The government must also create awareness on the effects of drug abuse on users.

The medics may apply the recommended counselling therapy to drug dependence patients apart from the detoxification procedures to assist the patients to recover.

This article further creates awareness that the medical students need to study more on drug dependence and find out whether there are curable procedures that can contain the disease. Knowledge that the genetic predisposition of a person has influence in alcoholism is a profound lesson.


Babor, T, Kranzler, H, & Lauerman, R (1989), ‘Early detection of harmful alcohol consumption’, Addict Behaviour, vol.14, pp. 139-157.

Hedblom, J (2007), Last call: Alcoholism and recovery, Johns Hopkins University Press, Baltimore.

Kleber, H, Lewis, D, McLellan, T, O’Brien, C (2000), ‘Drug dependence, a chronic medical illnessimplications for treatment, insurance, and outcomes evaluation’, JAMA, vol. 284 no. 13, pp. 1689-1695.

Plant, M (2006), Binge Britain: Alcohol and the national response, Oxford University Press, New York.

Schuckit, M (1994), ‘Low level of response to alcohol as a predictor of future alcoholism’, American of Psychiatry, vol.151, pp.184-189.

Schuckit, M, & Smith, T (1996), ‘An 8-year follow-up of 450 sons of alcoholics and controls’, Arch Gen Psychiatry, vol. 53, pp. 202-210.

Smart, L (2007), Alcohol and human health, Oxford University Press, Oxford.