Drug dependence, a chronic medical illness - Implications for treatment, insurance, and outcomes evaluation
Drug dependence, a chronic medical illness - Implications for treatment, insurance, and outcomes evaluation
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DOI：
10.1001/jama.284.13.1689
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发表时间：
2000-10-04
影响因子：
120.7
通讯作者：
Kleber, HD
中科院分区：
文献类型：
--
作者：
McLellan, AT;Lewis, DC;Kleber, HD
毒品依赖对社会制度的影响帮助形成了一种普遍持有的观点，即毒品依赖主要是一个社会问题，而不是一个健康问题。反过来，缺乏预防和治疗的医学方法，我们检查了药物(包括酒精)依赖是一种慢性医学疾病的证据。文献综述比较了药物依赖的诊断、遗传性、病因学(遗传和环境因素)、病理生理学和治疗反应(坚持和复发)与2型糖尿病、高血压和哮喘的相关性，遗传遗传性、个人选择和环境因素与所有这些疾病的病因和病程具有可比性。药物依赖会导致大脑化学和功能发生重大而持久的变化。有有效的药物可用于治疗尼古丁、酒精和阿片类药物依赖，但不包括兴奋剂或大麻依赖，这些疾病的用药依从性和复发率相似。药物依赖通常被视为一种急性疾病，审查结果表明，药物管理和持续监测的长期护理战略产生了持久的好处。药物依赖应该像其他慢性病一样得到保险、治疗和评估。
The effects of drug dependence on social systems has helped shape the generally held view that drug dependence is primarily a social problem, not a health problem. In turn, medical approaches to prevention and treatment are lacking, We examined evidence that drug (including alcohol) dependence is a chronic medical illness. A literature review compared the diagnoses, heritability, etiology (genetic and environmental factors), pathophysiology, and response to treatments (adherence and relapse) of drug dependence vs type 2 diabetes mellitus, hypertension, and asthma, Genetic heritability, personal choice, and environmental factors are comparably involved in the etiology and course of all of these disorders. Drug dependence produces significant and lasting changes in brain chemistry and function. Effective medications are available for treating nicotine, alcohol, and opiate dependence but not stimulant or marijuana dependence, Medication adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness, Review results suggest that long-term care strategies of medication management and continued monitoring produce lasting benefits. Drug dependence should be insured, treated, and evaluated like other chronic illnesses.