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Drug use in lower class areas can be seen as "trashy" or "disgusting", while in the lives of upper class, it can be seen as part of the social scene or part of parties. People often also insult the poorer people who are addicts but praise the rich who have gotten help and continued on their careers. For example, many have shown respect to Actress and Singer Demi Lovato after her near to death overdose. If money can "solve" the issue, then for most, there is no issue.

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Addiction is an enormous problem that many people suffer and die from everyday. In 2019, over 70,000 people died from a drug overdose. Some of these deaths may have been preventable if more affordale and accessable care was made avalible. The sad reality is that due to the perception of addiction based on social class, a majority of the deaths caused by overdose and addiction mainly are people from a lower socieoeconomic class.

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In America, the treatment and perception of addiction is better for those who are wealthy compared to those who are poor.

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Addiction is the dependance on something. It typically does not refer to a positive dependance. This dependance can be on substances, things, or even people. There are many different types of addictions.

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Drug addiction is the addiction substances such as cocaine, methamphetamine, prescription painkillers, and many more

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Alcohol addiction is one of the most common types of addiction. It is when a person cannot get through their routine without alcohol.

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Behavioral addiction is the need to act compulsive or repeated negative behaviors.

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What is the average cost of rehab or treatment for those suffering from addiction?

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What is the average cost of rehab or treatment for those suffering from addiction?

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Rehab treatments can be extremly expensive, especially without insurance. Some detoxes can cost between 200-800 per day. Other, more inensive care can cost even more. This can add up quickly.

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What kinds of treatment are available to combat addiction?

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What kinds of treatment are available to combat addiction?

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Addiction is a serious issue and often requires serious intervention. Treatments often entail councling to observe the roots and reasons for the addiction. Medical care/detoxing to the substance out of the system. Group sessions to talk about issues. Many people also check themselves in for a set period of time to keep themselves clean or to work through the addiction.

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Most of the time it does not. Addiction is a long battle that can take a long period of time to overcome.

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Does addiction lead to any other issues?

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Does addiction lead to any other issues?

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Addiction can lead to many other issues. For example, addiction can lead to homelessness if a person gets kicked out of their home due to family not willing or being able to help the addict. It can lead to diseases Fromm synthetic substances or unsanitary injection materials. Addiction can also lead to death if not treated.

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How have treatment options grown and expanded over the years?

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How have treatment options grown and expanded over the years?

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Up until the 1960s, most drug users were viewed as criminals. They often did not receive the treatment nessicary for help. In 1971, President Richard Nixon first established federal funding for treatment programs. It didn't focus intensively on care, rather, it worked to prevent drugs from entering the United States. Now, many treatment options are available. There are countless online aids, therapy groups/counciling, and a more open discussion amongst people. Although there are way more options avalible to fight addiction, the perception of addicts have remained the same, at least for the poor.

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Although there are many free resources available, such as AA or online counseling, most treatment comes with a price tag. Rehab faclities can sometimes be partically or fully covered by insurance. Often times, the best and most exclusive rehabs come with a heavy price tag. For example, Paracelsus in Switzerland, costs around $370,000 per month. Treatment for the rich and famous is more accessible and when money is not a concern, any thing is up for grabs.

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The Most Expensive Rehab in the World | High Society

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~ I have attached videos to the presentation, some may be blocked by the school because of the content and language. I had to add them off of my non-school account. Sorry if they don't play ~

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In some cases, there is corruption. Rehab is a buisness. Companies make money off of peoples addictions and if they keep coming back, then it is even more money for the company.

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Working at a $1000/Day Corrupt Rehab | Informer

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In many cases, rehab and treatment has become unacessable and unaffordable for people. Other times, families cannot handle seeing or caring for their loved ones who face addictions. It can become too much to handle. As addicts are pushed onto the streets, their addictions most often become worse. The addictions often become worse due to the easy access to drugs, normalcy of drug use, and drugs/substances being a source of comfort for a person.

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As a whole, people can become more sensitive and understanding of those battling addictions. We as a society need to stop with the constant ridiculing and become more compassionate.

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I will speak at major events such as town hall meetings or school board meetings to better provide an audience with addiction helping resources. I will include free resources as money is one of the main issues for people not receiving help. I will also be open to questions at these events to further assist.

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Drug addiction treatment has changed in the last fifty years, partly due to the categorization of some drugs, better understanding of chemical mechanisms, and advances in medicine. Treatment can now occur in outpatient and inpatient rehabilitation facilities, which was not always available previously. Though some aspects of treatment have changed, the ways people can medically detox from drugs are still the same in many cases. Some options, like tapering programs and substitution drugs, are still used, but doctors now better understand how these processes affect the body.

Around 1962, Harry J. Anslinger, the head of the Federal Bureau of Narcotics, criminalized many drugs, which forced many drug users into prison for carrying, distributing, or taking drugs. Because of this, many people who should have received medications and attention for serious drug problems went to jail instead, where drug use and violence were part of everyday life.

Until the late 1960s, drug users were seen as criminals, not as people who needed treatment for addictions. In 1971, President Nixon initiated the first federal funding of treatment programs. This program was unprecedented, and it led the United States down the road to treating drug abuse and patients the way they are today.

At that time, the government funded the first methadone maintenance program. It was experimental and very controversial, but according to Nixon, "...as long as there is a demand, there will be those willing to take the risks of meeting the demand." He believed that interdiction and eradication were not the answer, but treatment was.

Unfortunately, his presidency didn't do as much for drug users as it should have, and instead it focused on attacking the trafficking of marijuana from Mexico. Years later, during President Carter's presidency, cocaine use elevated. The use of the drug rose significantly during the late 1970s and early 1980s, which caused the government to spend even more funds on eradication and interdiction. Because of this, drug addiction programs lost approximately $24 million in funding.

Now, drug treatment is beginning to change. Looking online at sites dedicated to drug, withdrawal, and addiction help indicates just how far we've come. Long-time therapies, like 12-step programs or medicine-free therapies, are no longer viewed as the only answer to addiction. Instead, society is beginning to realize that drug addiction is a disease that needs medical treatment by a trained medical professional. Until recently, many addicts received help from those who were not even medically trained. A medication-free attempt was the method many doctors and providers used to treat addicts as well. Previously, many people believed that stopping drug use in this way was the only answer, since adding more drugs was considered a negative option. Currently, the National Institute on Drug Abuse is pushing for a broad recognition of addiction as an actual disease, and it hopes to find medical approaches to therapy that will help patients find the addiction-free lives they want without the struggles of cravings, withdrawal, or other symptoms.

In the years leading up to 2012, an addiction society officially declared that addictions are a brain disorder. Specialty training programs that focus on substance abuse have been added to many medical schools' curricula, and the federal government has started to fund more resources to help families and patients understand and deal with drug-related issues. Science-based addiction treatment is becoming a way of life, and there are more drugs being released to aid those who want to stop illicit drug use, prescription drug use, or other addictions.

According to National Institute on Drug Abuse chief Dr. Nora Volkow, addiction leads to a chronic disorder that needs attention. It requires multiple rounds of therapy to reduce the risk of relapse.

One of the latest medication types introduced is a group of long-acting drugs. These drugs reduce a person's cravings, which can help addicts prevent relapse due to out-of-control cravings and symptoms. In 2006, a drug formally used to treat alcohol dependence, naltrexone, was made into a monthly injection. This drug alone has increased patients' chances to stay in treatment programs for opioid abuse without relapse for a full six months by an extra 13 percent. According to doctors and experts, this is a significant improvement for those struggling with addiction.
Another other major change in alcohol and drug addiction treatment in the last fifty years isn't so much the treatment itself, but society's attitudes toward treatment. Inpatient rehabs no longer carry the stigma they did as recently as the 1980's for those attending rehab. Indeed, many private residential treatment facilities feature luxury amenities for their clients, so that they are kept as comfortable and pampered as possible during treatment. For help finding a rehab for yourself or a family member, call us toll-free at .

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How Drug Addiction Treatment Has Changed in the Last 50 Years - Drug Rehab Options

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Drug addiction treatment has changed in the last fifty years, partly due to the categorization of some drugs, better understanding of chemical mechanisms, and advances in medicine. Treatment can now occur in outpatient and inpatient rehabilitation facilities, which was not always available previously.

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 Understanding Addiction by Elizabeth Connell Henderson M.D

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 Understanding Addiction by Elizabeth Connell Henderson M.D

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Addiction in America: Society, Psychology, and Heredity by Jack E. Henningfield  Ph.D

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Addiction in America: Society, Psychology, and Heredity by Jack E. Henningfield  Ph.D

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In the midst of the recent “opioids crisis”, President Trump has vowed to carry on the war on drugs. Yet the problem of narcotic addiction is not new in the United States. This stimulating essay takes a closer look at how perceptions of addiction have evolved over time. In August 2017, President Do…

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How do drugs and alcohol affect mental health?

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This section explains how using drugs and alcohol can affect your mental health. It also explains how you can get help to stop using drugs and alcohol. In this section, 'drugs' means recreational drugs, alcohol, or prescription drugs. When someone with a mental illness also uses drugs, doctors call this 'dual diagnosis' or 'co-occurring diagnosis'.

If you would like more advice or information you can contact our Advice and Information Service by clicking .

Overview

There are many reasons why you might use drugs and alcohol.

Some people use them to try and deal with their symptoms of their mental illness. This is called 'self-medication'.

Drugs and alcohol can make the symptoms of your mental illness worse.

Some drugs may make it more likely for you to get a mental illness, and they may make it harder to treat.

Mental health, and drug and alcohol services should work together to give you the support you need.

If you have any problems getting help, you could make a complaint.

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.

About

How can drugs and alcohol affect my mental health?

People use drugs and drink alcohol for lots of different reasons. Whatever your reason, using drugs or alcohol may have a long-term negative effect on you. The possible long-term effects include the following.

Needing to take more to get the same effect.

High blood pressure and strokes.

Problems with your liver and pancreas.

Development of certain cancers e.g. liver cancer, bowel cancer and mouth cancer.

Difficulty obtaining or maintaining an erection.

Problems with orgasms.

Difficulties becoming pregnant.

Feeling like you must use the drug or alcohol. This is known as being dependent.

Withdrawal symptoms including feeling sick, cold, sweaty or shaky when you don't take them.

Having sudden mood changes.

Having a negative outlook on life.

Loss of motivation.

Depression.

Anxiety.

Problems with relationships.

Being secretive.

Having episodes of drug-induced psychosis.

If you use alcohol or drugs for a long time it can cause serious issues for your mental well-being. Drugs can make you more unwell and more likely to try and harm yourself or take your own life.

There is also some evidence that using some drugs may cause mental illness for the first time. For example, research has shown that cannabis can increase your chances of developing psychosis or a psychotic disorder.

You can find more information about 'Cannabis and mental health' by clicking here.

What is psychosis?

Psychosis is a medical term. If you have psychosis you will process the world around you differently to other people. This can include how you experience, believe or view things.

You might see or hear things that others do not. Or believe things other people do not. Some people describe it as a "break from reality". There are different terms use to describe psychosis. Such as "psychotic symptoms", "psychotic episode" or "psychotic experience."

It can be a symptom of mental illness and can also be a short-term effect of some drugs.

You can find more information about 'Psychosis' by clicking here.

Drugs and effects

Which substances can affect my mental health?

In this section we have listed some of the different types of substances that could have an impact on your mental health. Please be aware that this list is not a list of all substances.

Taking any substances can be dangerous. They can also have bad interactions with any medications or other substances you might use.

For more information on different substances you can visit the website of 'Talk to Frank'. They are a specialist charity that provides information on drugs. You can find their website here: www.talktofrank.com/

Cannabis

(Also known as: bud, bhang, dope, draw, ganja, grass, hash, herb, marijuana, pot, skunk, weed)

Cannabis is one of the most commonly used drugs in England. According to one study, 1 in 13 people aged 16-59 had used it in the last year. Young people aged 16-24 are more likely to use cannabis. The same study shows that just under 1 in 5 young people had used cannabis between 2018 and 2019.

Some people take cannabis because it makes them feel relaxed or happy, but It can also make you feel anxious or feel paranoid. Some people may experience things that aren't real. This is a sign of drug-induced psychosis. Some studies have shown that the risk of psychosis may be higher if you:

use cannabis for a long time,

use it frequently, and

use 'high-strength' cannabis, like skunk.

If you have been using cannabis and you feel that it is affecting your health, make an appointment to see your GP as soon as you can. Your doctor should not judge you and should not tell other people you use drugs.

Alcohol

(Also known as: bevvies, booze)

Some people with a mental illness have problems using alcohol. Alcohol is legal, which means it is easier to get. It can make the feelings of some mental health issues feel worse.

The long-term effects of alcohol also depend on how much you drink, and how regularly you drink it. If you drink too much on a regular basis then you could cause yourself serious physical and mental harm.

Drinking can make you do something you would not normally do. This can include self-harm and suicide. Very high levels of alcohol can cause psychosis.

New Psychoactive Substances (NPS)

(Also known as: PlantFood, NPS, Mdat, Eric 3, Dimethocaine and Bath salts).

These are drugs that contain one or more chemical substance. They produce effects that are similar to cocaine, cannabis and ecstasy.

Some of the drugs classed as NPS used to be known as 'legal highs'. This is a common term that people use. It is used because some NPS were legal before 2016. However, the name is now wrong, because since 2016 they have been made illegal.

The short-term effects of an NPS depend on what you take.

Some new psychoactive drugs can cause confusion and a feeling of panic. You can also have hallucinations. This is when you see, smell, hear or feel things that other people don't. Hallucinations can affect the way you behave. Your behaviour can become erratic and can put your own safety at serious risk.

These drugs can also affect your judgement, which could put you at risk.

Some NPS can be very dangerous. They can kill you or hurt you very badly. There is a higher risk of this if taken with alcohol or other psychoactive drugs.

Amphetamine and methamphetamine

(Also known as: Crystal Meth, Ice, Meth, Glass, Whizz, Speed, Billy, Base, Yaba, Tina and Christine)

In the short-term, these drugs can make you feel wide awake and alert. This can make it difficult for you to relax or get to sleep. They might cause you to have a drug-induced psychosis. In the long-term, amphetamines might make you anxious and depressed. They can also be addictive.

When you stop taking the drug, you may feel depressed and you might find it hard to sleep.

Benzodiazepines

(Also known as: Benzos, Blues, Downers, Roofies, Vallies, Diazepam, Rohypnol, Valium, Xanax)

Benzodiazepines are a type of tranquilisers. They are used to treat anxiety. They are also used as a muscle relaxant. Sometimes a doctor will tell you to take benzodiazepines to help you with anxiety. But people also buy them illegally because of their relaxing effects. They can be addictive, and so doctors only give them for a short time.

In the short-term, these drugs can make you feel calmer. Depending on the type you take, they could make you feel confused or overly sleepy.

Taking benzodiazepines with other drugs or alcohol can be dangerous. It can affect your breathing. It can also increase the risk of overdose and death.

In the long-term, some people become addicted. This can have a big effect on their day-to-day life.

You can find more information on 'Benzodiazepines' by clicking here.

Cocaine

(Also known as: Blow, Crack, Coke, Charlie, Chang, Freebase, Sniff, Snow)

In the short-term, cocaine can make you feel awake, talkative and confident. After this wears off, you can feel tired and depressed after taking it.

In the long-term, cocaine use can affect how you feel. It can affect your relationships with friends and family. Cocaine is also addictive and over time you are more likely to have ongoing problems with depression, paranoia or anxiety.

Cocaine can cause fits, heart attacks and strokes. If you mix it with some other drugs you are more likely to overdose or die.

Ecstasy

(Also known as: E, MDMA, MD, Molly, Pills, XTC)

In the short-term, ecstasy may make you feel energetic, very happy, chatty and confident. It can also sometimes make you feel anxious, confused or trigger drug-induced psychosis.

In the long-term, ecstasy use can lead to memory problems. You may also develop depression and anxiety.

Heroin

(Also known as: Brown, Gear, H, Smack, Skag)

In the short-term, heroin can make you feel relaxed and happy. It takes away pain and can make you feel sleepy. But there is a higher risk that you could take too much or overdose with heroin than some other drugs.

Heroin can be taken in lots of different ways, including by injection. However, there is a high risk of getting an infection if you inject heroin, particularly if you share needles with someone else.

Heroin is very addictive. It can have serious long-term effects. You may feel that heroin becomes more important than other things in your life. This might make it harder to keep a job and affect your relationships.

LSD

(Also known as: Acid, Blotter, Trips, Micro-dot)

In the short-term, LSD may make you experience things that aren't real. Sometimes the experience will be enjoyable, and sometimes it will be frightening. This is known as a bad trip.

If you have a history of mental health problems taking LSD can make it worse. If you panic during a trip on LSD it can be scary. LSD may also trigger mental health problems which you haven't experienced before.

Getting help

How can I get help?

If you have a mental illness and use drugs, the NHS may call this 'dual diagnosis' or 'co-occurring diagnosis'. Your local NHS trust may have a policy that says how they will help people with dual diagnosis. Check on their website to see if you can find out more about what to expect locally.

If you are not already getting help with your mental health from your local mental health team, a good first step is to make an appointment to see your GP. Your GP may offer you medication and therapy to treat your mental illness. They may refer you to a drug and alcohol service to help you with your drug use.

If your needs are too complicated for your GP to deal with alone, you might need more specialist support. A GP can refer you to your local mental health service or community mental health team (CMHT).

They should offer this support and work with drug and alcohol services to give you all the help you need. The Department of Health and Social Care says that people with dual diagnosis are a key group of people who should get help from mental health services. You should not be stopped from getting help if you have drug or alcohol problems and severe mental illness.

Care Programme Approach (CPA)

The National Institute for Health and Care Excellence (NICE) produces guidance for the NHS and other organisations responsible for people's health and care. They say that people who have a severe mental illness and drug or alcohol problem should get help under the Care Programme Approach (CPA). The CPA is a framework that the NHS uses to plan someone's long-term care.

Under the CPA you will have a care co-ordinator to plan your care. They will help to write a care plan. This should account for all the different needs you might have such as:

NICE also say that you should be able to give your views on the care plan to make sure that it meets your needs. And the care plan should be shared with your carers or family if you agree.

You can read the NICE guidance online here:
www.nice.org.uk/guidance/ng58

There may be a team in your area which helps people with dual diagnosis. It is sometimes called the dual diagnosis team. However, not all areas of the country have them, and it may have a different name. If there isn't one in your area, you could try contacting your local community mental health team (CMHT) for help. However, you will need to be referred to the CMHT by your GP.

As well as NHS services, you could try contacting local charities. Many charities have support services or support groups for people struggling with substance misuse. You can find some national charities listed in the Useful Contacts section below.

You can find more information about:

NHS Mental Health Teams (MHTs) by clicking here.

Worried about your mental health? by clicking here.

Care Programme Approach by clicking here.

Problems

What can I do if I have problems trying to get help?

Some people with dual diagnosis have told us that it has been difficult to get the help they need. For example, you may have been told that mental health services cannot help you because of your drink or drugs problem.

But the Department of Health and Social Care is very clear that mental health services should try to help you if you have dual diagnosis.

The National Institute for Health and Care Excellence (NICE) also say that you should not be turned away from mental health services because you have a drug or alcohol problem.

If your mental health team have said they can't help you then you can ask them what their reasons are. You can ask for a copy of their policy for eligibility criteria. You may then be able to use this to show you are eligible for their support.

If you are not happy with the services you get, talk to the person in charge of your care. This might be your GP or your 'care coordinator'. They might be able to change things for you. An 'advocate' may be able to help you to get your point of view across. You might need to make a complaint to the NHS if you do not get the help you need.

You can find more information about:

Carer's, friends and relatives

What if I am a carer, friend or relative?

Supporting someone struggling with dual diagnosis can be difficult. It might help to speak to the person you are helping, to see what support they want. For example, some people might just want someone to talk with. Other people might want more practical help, such as with booking appointments or helping them speak to professionals.

We Are With You and Adfam are two charities that offer support and advice to relatives, friends and carers of those struggling with substance misuse. You can find their contact details in the Useful Contacts section below.

You might also feel that you need support for yourself. The National Institute for Health and Care Excellence (NICE) says that carers who support someone with a dual diagnosis should be offered a carer's assessment under the Care Act 2014. You may be able to get practical support to help you with your caring responsibilities.

NICE also says that if you are caring for someone with a dual diagnosis you can:

be involved in their care planning, and

work with services to help those services improve.

But this can only happen if the person who you care for wants you to be involved. Speak to the mental health team if you have ideas about what services should be available or how things could work better.

You can find more information about:

Useful contacts

Drinkline
This is the national alcohol helpline. They provide information and selfhelp materials for callers worried about their own drinking, and to support the family and friends of people who are drinking. They are confidential, you do not have to give your name and they can provide advice on where to get help.

Adfam
This is a national charity for families and friends of drug users. It offers confidential support and information.

Frank
Frank provides information and advice on drugs to anyone concerned about drugs and solvent misuse, including people misusing drugs, their families, friends and carers.

Telephone: 0300 123 6600. Open 24 hours a day, every day
Text: 82111
Email: Online form here: www.talktofrank.com/contact
Webchat: www.talktofrank.com/contact-frank Open 2pm-6pm every day.
Website: www.talktofrank.com

Alcohol Change UK
Alcohol concern is the national organisation for alcohol misuse. It does not provide services, but they do produce information on alcohol.

We Are With You
This is a drug and alcohol treatment agency. Their services deal primarily with drug and alcohol problems including support for families.

Al-Anon Family Groups
This is a service for families and friends of alcoholics. Al-Anon family groups provide understanding, strength and hope to anyone whose life is, or has been, affected by someone else's drinking.

Narcotics Anonymous UK (NAUK)
NA is a non-profit fellowship or society of men and women for whom drugs had become a major problem. They are recovering addicts who meet regularly to help each other stay clean. They have groups around the country.

Helpline: 0300 999 1212 10am - midnight
Website: www.ukna.org/

Alcoholics Anonymous (AA)
AA provides an opportunity for people to get together to solve their problem with alcohol and help others to recover.

Cocaine Anonymous (CA)
CA is a fellowship of men and women who use the 12 step, self-help programme to stop cocaine and all other mind-altering substances.

DrugWise
DrugWise provides information and publications on a wide range of drug related topics.

Website: www.drugwise.org.uk/

PostScript 360
A charity committed to supporting individuals to reduce the harms caused by prescribed drugs that are associated with dependence and withdrawal. They do this through a wrap-around service of one to one therapy, group therapy and a telephone support service.

Release
They offer advice and information on drug problems. They have expertise in legal matters surrounding drugs.

Turning Point
This is an organisation that works with people affected by drug and alcohol misuse, mental health problems and learning disabilities.

Address: Standon House, 21 Mansell Street, London, E1 8AA
Email:
Website: www.turning-point.co.uk

Need more advice?

If you need more advice or information you can contact our Advice and Information Service.

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How do drugs and alcohol affect mental health?

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People use drugs and drink alcohol for lots of different reasons. Whatever your reason, using drugs or alcohol may have a long-term negative effect on you. It may take longer for your mental health to get better if you use drugs or alcohol.

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Abstract

Infectious diseases (ID) physicians are increasingly responsible for the management of infectious consequences of substance use disorders (SUD). While we are often consulted for diagnosis and treatment of the infectious disease, it is clear that successful management of these infections requires a holistic approach, including acknowledgement and treatment of the underlying SUD. As we have learned through years of treating human immunodeficiency virus and hepatitis C virus infections, ID physicians have unique expertise in addressing both the infection and the complex biopsychosocial factors that underpin the infection. Many ID physicians have incorporated the management of addiction as part of their scope of practice, and here we seek to give a name and define the role of these ID/addiction dual specialists. We define the potential role of ID/addiction physicians in clinical care, health administration, and research, as well as provide recommendations to bolster the supply and reach of this burgeoning subspecialty.

In 2018, over 68 000 drug overdose deaths occurred in the United States, continuing a trend of increasing drug-related mortality that spans more than a decade [ 1]. While initial increases in opioid overdose deaths in the late 1990s were attributable to prescription opioids, changes in the drug supply have led to the involvement of heroin or illicitly manufactured fentanyl in the majority of these deaths [ 2]. Although opioids remain implicated in the largest number of deaths, there are increases in overdoses involving all drug classes and polysubstance use, with especially large increases from stimulants [ 3, 4]. Substance use disorders (SUD), including opioid use disorders (OUDs), are chronic, relapsing diseases of the brain and can be effectively treated using a chronic-care model and medications [ 5]. There are 3 Food and Drug Administration-approved medications for OUD (MOUDs)-buprenorphine, methadone, and extended-release naltrexone-that reduce opioid cravings, reduce overdoses, and lead to decreased mortality, yet these lifesaving medications remain underutilized and inaccessible to many [ 6]. According to the Surgeon General's report, only 1 in 10 Americans with addiction receive treatment, and many of them get care that isn't evidence-based [ 7].

Increasing rates of OUD have resulted in an emergent epidemic of infectious complications of infection drug use (IDU) that include outbreaks of human immunodeficiency virus (HIV) [ 8, 9] and hepatitis C virus (HCV) [ 10], as well as increasing hospitalizations and deaths from skin and soft tissue infections, osteomyelitis, septic arthritis, bacteremia, central nervous system infections, and infective endocarditis [ 11-15]. While the incidence of IDU-associated infectious syndromes has increased, the medical system has not risen to meet these challenges. Among patients presenting to the health-care system with OUD-associated infections, addiction as the underlying cause of the disease is often under-recognized and undertreated, with relatively few people receiving life-saving MOUDs [ 16-18]. Furthermore, when addiction care is available, it is often fragmented and not well integrated with ID care. Addiction medicine care among patients with IDU-associated infections can be cost-effective and is associated with improved infection and addiction outcomes [ 19, 20]. Referral to addiction treatment is associated with decreased mortality in patients with IDU and infective endocarditis [ 21]. Additionally, patients with HIV who receive medications for their SUDs have improved viral suppression and increased retention in HIV care [ 22-24]. Among patients with HCV, the provision of MOUDs facilitates successful cures and is feasible in primary care and in methadone maintenance programs [ 25]. There is a need for physicians and health-care systems able to provide integrated care to patients with IDU-associated infectious diseases.

THE CASE FOR INFECTIOUS DISEASE/ADDICTION SPECIALISTS

ID physicians are uniquely equipped to integrate treatment for SUDs into clinical infectious disease care. Doing so has the potential to make major impacts on the lives of individual patients and on the health-care system as a whole. ID physicians routinely confront the social determinants of health, whether through HIV treatment or other diseases enabled by poverty. Our patients are often the most stigmatized and neglected by society. Thus, we are especially attuned to the delicate interplay between an individual's environment, social circumstances, mental health, and medical conditions, and how each of these issues must be addressed to achieve successful health outcomes. Our expertise and impartiality are well suited to the treatment of addiction and its infectious complications. Furthermore, many ID physicians report interest in managing addiction, and some already make this a part of their routine practice [ 26].

Patients with infectious complications of addiction will benefit from the comprehensive, coordinated care made possible by ID/addiction physicians. Just as Ryan White-funded HIV clinics lead to improved outcomes, compared to privately insured patients, through providing integrated medical, behavioral, and social services [ 27], ID/addiction physicians take a similar, all-inclusive approach. The compassion and dedication required to manage infectious complications of the opioid epidemic are traits that characterize ID physicians. These traits were most prominent during the early HIV/acquired immunodeficiency symdrome epidemic in the United States, but have remained consistent over time, as evidenced by work with tuberculosis and Ebola. The ID community has consistently ventured into uncharted territories that others resist.

Addiction treatment should not be limited to those specialties that have traditionally treated it. Currently, clinicians in internal medicine, psychiatry, and family medicine provide most addiction care. There is, however, room to expand as this disease cuts across disciplines. This is especially pertinent for specialists who encounter the infectious sequelae of SUD, such as infectious disease physicians. There is a need for physicians with dual expertise in the management of both infectious diseases and SUD. Just as some ID physicians have chosen to specialize in the treatment of HIV or transplant ID, we propose the recognition, promotion, and development of ID/addiction specialists.

Clinical Needs

ID/addiction physicians are needed in clinical care to both improve individual patient outcomes and to impact the larger care-delivery system. First, expertise in addiction medicine is crucial for the inpatient management of our patients with serious bacterial or fungal infections caused by ongoing illicit drug use [ 19]. The recognition and diagnosis of addiction in these patients is the first step to increasing awareness and transitioning toward addiction treatment. IDU-associated infections lead to high rates of readmission and have high mortality, and there is reason to believe that inpatient initiation of MOUDs improves both infection- and addiction-related outcomes for those with underlying OUD [ 16, 19, 28, 29]. ID/addiction physicians provide holistic integrated care, aid in transition to the outpatient setting, and co-manage patients' infections and addiction after discharge. They are an important voice in determining surgical candidacy, based on an evaluation of infection severity and addiction disease activity. ID/addiction physicians also aid in a more seamless hand-off or transition of care to primary care or addiction medicine providers for long-term OUD management once the infectious complication has been treated. For acute bacterial and fungal infections, which require several weeks of curative treatment, the MOUDs provided by ID/addiction physicians serve as secondary prevention of future infections and are especially important when prosthetic material has been introduced.

There is a similar need for integrated infectious disease and addiction medicine services in the settings of HIV and HCV treatment. Integrated programs that include HIV, HCV, and OUD treatment exist, but are not widespread. For HIV, infectious disease physicians can provide MOUDs in addition to antiretroviral therapy, which enhances adherence and retention in care, facilitates viral suppression, and prevents transmission of HIV [ 22-24, 30]. People living with HIV have a high burden of chronic pain and frequent use of long-term opioid therapy; many of these patients also have or may develop concomitant OUD. Infectious disease physicians are able to implement safe opioid prescribing, in addition to identifying addiction and implementing addiction treatment. HCV is now easily curable and only requires 8-12 weeks of directly acting antiviral (DAA) treatment to develop a sustained viral response. Mathematical modeling has demonstrated that MOUD treatment linked with DAA can reduce new HCV infections [ 31]; thus, ID specialists can provide both DAAs and MOUDs to promote retention in care and increased rates of cure, as well as reduce reinfections.

Administrative and Policy Needs

On a health-system level, ID/addiction physicians use their expertise to help design and improve systems of care for patients with IDU-associated infections. They help develop policies to ensure evidence-based care for patients with infections from SUDs. This includes system-level procedures, such as order sets to promote health-care maintenance for patients with addiction (eg, HIV, HCV, and sexually transmitted infection screening; hepatitis A and B vaccination; education/referral for HIV pre-exposure prophylaxis services; and opioid overdose prevention and naloxone distribution). There is a need for leadership of multidisciplinary teams for the management of complicated infections requiring surgical intervention [ 32]. Perhaps most importantly, ID/addiction physicians help reduce stigma for health-system stakeholders and normalize addiction as a medical problem in need of medical treatments. In a health policy capacity, ID/addiction physicians should bring attention to the problems of IDU-associated infections and advocate for legislation to support solutions. Examples include lobbying to deregulate the prescription of buprenorphine [ 33], expanding access to syringe exchange programs, and supporting funding for pre-exposure prophylaxis.

Research Needs

Although there are many evidence-based actionable interventions for patients with SUDs, many questions remained unanswered, especially in the field of infectious sequelae of substance use. Very broadly speaking, there is no established best practice to manage infectious complications of addiction; thus, expanding research in this area is important to informing clinical practice, especially in large, busy, tertiary hospital programs. A number of issues in need of investigation come up in daily clinical practice, such as: in what setting should patients with IDU-associated infections be treated? Are MOUDs effective at preventing initial or recurrent infections? Which MOUD provides the most protective benefit to infected patients? Is inpatient initiation of MOUD superior to a referral for treatment? Are peripherally inserted central catheters safe in patients with ongoing SUDs? What is the role of oral antibiotics for serious IDU-associated infections? What is the role of antibiotics with very long half-lives? These are critical knowledge gaps with wide-ranging implications that ID/addiction physicians are poised to help answer.

APPROACHES TO THE PROBLEM

Enhancing Training in Addiction Medicine

Medical trainees are frequently confronted with the sequelae of opioid misuse and use disorder, including fatal and nonfatal overdoses and infectious diseases. They also routinely help manage the complex social issues associated with addiction, such as a lack of housing, domestic violence, and food insecurity. Yet despite frequent exposure to substance use disorders, few internal medicine residents feel very confident in diagnosing addiction and fewer feel comfortable providing treatment [ 34]. To enhance training in addiction medicine, infectious disease fellowship programs should offer rotations on addiction medicine consult services, which have been shown to have beneficial effects on residents' addiction expertise ( Table 1) [ 35]. All graduating ID fellows should complete the Drug Abuse Treatment Act of 2000 waiver training to prescribe buprenorphine. ID/addiction fellowship tracks, akin to transplant ID concentrations, should be developed to provide focused clinical, research, and mentorship opportunities. Interested fellows should be referred to apply for training programs, such as the National Institute on Drug Abuse (NIDA) and Boston Medical Center's Fellow Immersion Training in Addiction Medicine program [ 36], as well as the American Society of Addiction Medicine's Ruth Fox Scholarship [ 37]. For fellows dedicated to a career at the crossroads of ID and addiction medicine, opportunities for combined ID/addiction medicine fellowship programs should be expanded, with a goal of sitting for both ID and addiction boards [ 38].

Outside of ID fellowship training, there are opportunities and needs to increase all ID physicians' comfort with addiction. Cross-pollination between ID and addiction medicine divisions will be mutually beneficial. It will allow for better understandings of the nuances of assessment and management of patients with infectious complications of SUD. The development of multi-disciplinary care conferences for complex ID/addiction cases is a first step toward integrated care. Having ID physicians stationed in addiction medicine clinics, and vice versa, where they are available for real-time consultation, will improve care and build mutual expertise. Although addiction treatment is not within the scope of training for many ID physicians, all of us confront patients with SUDs. Thus, all ID physicians should be educated on the tenets of harm reduction, and gain experience counseling patients on safe injection practices (eg, not reusing injection equipment, regular skin cleaning), syringe service programs, overdose education and naloxone use, and MOUDs.

Society-level Interventions

ID/addiction physicians in leadership roles of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America, HIV medical association, and Pediatric IDSA will help guide the implementation of programs to nurture this emerging field. The development of an interest group, the creation of dedicated message boards, and providing mentorship will help build a community of ID/addiction physicians in the IDSA. Ensuring the representation of addiction specialists on guideline and ID Week planning committees will help spread best practices and education to other IDSA members. IDSA-sponsored journals have already done an excellent job of publishing innovative research at the intersection of ID and addiction, and will continue to be an important asset. The ID societies should continue their support of ID Week Drug Abuse Treatment Act 2000 waiver trainings, as well as efforts to expand the general ID workforce.

Research Interventions

To improve the volume and quality of clinical research, funding organizations should be lobbied to increase the availability of grants dedicated to infectious complications of addiction. Investigators should be encouraged to apply for National Institutes of Health funding through the NIDA, in addition to the National Institute of Allergy and Infectious Disease. The National Institute of Allergy and Infectious Disease and NIDA should consider a fast-track grant review mechanism, similar to that for HIV research, for high-priority ID/addiction research, especially for projects that expand access to SUD treatment. A focus on pragmatic clinical trials, and implementation and demonstration projects, is of particular importance; we have treatments with proven efficacy for both infections and addiction, but a significant implementation and dissemination gap remains. Finally, researchers should publish their work in a variety of journal disciplines, such as general medicine and substance use disorder journals, in order to better disseminate knowledge outside of the ID community.

CONCLUSION

Infectious diseases account for a large proportion of nonoverdose deaths among people with opioid use disorder and other substance use disorders [ 39, 40]. Infectious disease physicians are uniquely prepared to help treat both infectious diseases and comorbid SUDs. Some ID physicians have already made addiction medicine a regular part of their clinical practice and research agenda. We propose the establishment of ID/addiction as a discrete subspecialty within ID, to help grow the cadre of physicians with dual expertise in this important field. Additionally, all ID physicians should gain expertise recognizing SUDs and implementing harm reduction interventions. Through educational initiatives, society activities, and the promotion of research, we believe ID physicians will be able to fill an important need in addressing the current drug overdose crisis and the future infectious disease/substance use disorder syndemic.

Notes

Financial support. This work was supported by the NIDA (grant number K02DA032322 to S. A. S.).

Potential conflicts of interest. S. A. S. received grant funding from the National Institute on Drug Abuse in support of this work for mentorship activities regarding the interaction of opioid use disorder and infectious diseases. Both other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

References

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Infectious Complications of Addiction: A Call for a New Subspecialty Within Infectious Diseases

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Infectious diseases (ID) physicians are increasingly responsible for the management of infectious consequences of substance use disorders (SUD). While we are often consulted for diagnosis and treatment of the infectious disease, it is clear that successful management of these infections requires a holistic approach, including acknowledgement and treatment of the underlying SUD.

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