SAFE GC Coalition: NIDA Opens Pre Addiction Conversation

Researchers at the National Institute of Drug Abuse (NIDA) are raising the possibility of moving toward a plan for better detection and support of those in the early stages of substance use disorder that, if untreated, may lead them to develop a severe health condition – addiction.

According to NIDA, by the time someone reaches out for addiction care, they may have already have suffered numerous painful losses in their lives. Addiction can steal a person’s happiness, job, friends and family, and can erode their freedom. Researchers maintain hitting “rock bottom” is a myth (the expectation is that someone must hit “rock bottom” before treatment can work) that can have dire consequences. By then the damage is consequential and a much harder road to recovery. NIDA researchers say the best time to get help is as soon as possible. Yet frequently when a person asks for help early on, society – friends and family, coworkers, health care systems – do not recognize it as a serious issue. They may ignore or deny it.

To define this early stage that researchers refer to as “pre-addiction,” they proposed considering the criteria of mild or moderate substance use disorder (SUD). Identification of “pre-addiction” as an early condition of addiction could motivate greater attention to the risks associated with early-stage substance use disorder and help marshal the policies and healthcare resources that will support preventive and early intervention measures. Researchers are proposing the term “pre-addiction” because it gives a readily understandable name to a vulnerable period of time in which preventive care could help avert serious consequences of drug use and severe substance use disorders. This is similar to how doctors counsel and provide for care to prevent chronic diseases like heart disease or diabetes for patients who demonstrate higher risk of developing those conditions.

NIDA researchers maintain US healthcare needs to improve their delivery preventive medicine. Despite the well-known conventional wisdom that an ounce of prevention is worth a pound of cure, they feel the system has always been set up to treat diseases and disorders once they manifest, not avert them. This has started to change for some conditions, however. For instance, it is now standard to monitor risk factors like cholesterol, blood pressure, and BMI during routine checkups, so that steps can be taken to avert heart attacks or stroke through some combination of lifestyle changes and medications.

The same mentality could be applied to substance use disorders. It is no longer necessary or reasonable to make people with drug or alcohol problems “hit rock bottom” before a substance use disorder is recognized and addressed. Nor is it true that people will only contemplate treatment when their disorder reaches that point. It is possible, through screening and early intervention—including brief intervention during routine checkups—to alert people to problematic patterns of drug or alcohol use that do not (yet) meet the threshold of addiction, sometimes defined as severe substance use disorder (SUD).

One of the definitions of addiction is inability to control drug use despite adverse health consequences and even despite a desire to change. For those meeting the criteria of severe SUD, treatment and external recovery supports are often needed. Unfortunately, just 10 percent of people who could benefit from treatment get it. Prior to reaching this point, however, it is easier for people to exert control, including by setting limits and being more mindful of their substance use.

Increased awareness of the harms of heavy drinking and binge drinking even outside of a diagnosed alcohol use disorder has alerted people to unhealthy patterns that in an earlier era escaped attention because the crucial addiction criterion—inability to control use—was not met. A diagnosis of pre-addiction could similarly serve as an alert to the individual about a behavioral pattern with potentially major—but also very preventable—health and life consequences in the future. It could create a different inflection point, one that recruits the patient more actively as an agent in their own health and wellness.

For a renaming of mild to moderate substance use disorders as pre-addiction to be meaningful, it would require measures to define and detect substance use that is clinically significant and amenable for early intervention. The current Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for mild to moderate substance use disorder are a starting point, as are existing screening tools used in primary care that ask about frequency of substance use. But research is needed to better characterize the kinds of substance use and the kinds of individual risk factors that would raise concern for future addiction and other health problems.

There is a need for a wider range of evidence-supported and reimbursable interventions for individuals meeting pre-addiction criteria, and clinicians would need to know how to deliver them or refer patients to the appropriate specialists. NIDA is already directing substantial funding, including via the Helping to End Addiction Long-term® Initiative to increase the range of addiction treatments, but a diagnostic framing of mild to moderate substance use disorder as pre-addiction could create a market and thus incentive for greater development of interventions to prevent addiction from developing in the first place.

SAFE is the only alcohol and substance use prevention agency in Glen Cove. Its Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” in order to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.