Do you have an acute or a chronic illness?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

medical

Acute or Chronic Illness?
Photo courtesy of Pixabay.com

Getting the right kind of treatment for your illness is important.

Whether it’s a physical, emotional or mental disorder, getting the right treatment makes all the difference.

One of the problems we have in the behavioral health field is a tendency to treat chronic illnesses as if they were acute illnesses.

What is an acute illness?

Acute illness is something like breaking your leg. It happened suddenly, you go to the hospital and the Doctor sets it in a cast.  Eventually, the broken leg heals and you walk normally. Another example of an acute illness would be a case of pneumonia.  This can be quite serious and may result in a hospital stay.  You may need emergency treatment.  When that pneumonia goes away and you can return home.  You may have some after effects, But at some point, you will be pronounced cured of your pneumonia.

How is a chronic illness different?

Chronic illnesses have to be managed not cured.  Things like diabetes and heart disease are managed.  With a chronic illness, the Doctor continues to provide care and monitoring to keep the disease from getting worse.  In the past, acute illnesses were the main things doctors treated, today more than 75% of what doctors’ treat are chronic illnesses.

Mental health and substance use disorders are chronic illnesses.

For years we’ve made a mistake by thinking that we can treat mental and emotional illnesses as if they were acute. Someone is under the influence of a substance and are sent to detox for 72 hours.  As if substance use disorders were the same sort of things as a broken leg or an overdose of poison.

The belief used to be that once the drugs were out of their system that person was cured.  If the substance use disorder was an acute disorder, like poisoning, that would have work.  It is common for people straight out of detox to pick up drugs again within a few days. Detoxification does not work to cure substance use disorders because they are chronic illnesses.

The person sent to the psychiatric hospital for a suicide attempt might be released after two or three days when they no longer were feeling suicidal.  Sometimes that person gets additional care after the hospitalization.  But not always.

This is often another case of treating a chronic illness as if it were an acute illness. Without further treatment, after the brief hospitalization, there is a good chance that the depression and thoughts of suicide will return.

Mental health problems and substance use disorders require long-term treatment.

Repeatedly we have found that people with mental health problems who get treatment over a longer period of time are less likely to have a return of symptoms. Those people who continue to stay in treatment for up to two years after an episode of depression are less likely to have a recurrence of that depression.

With substance use disorders we find that those people who continue to stay in some form of continuing care are less likely to have a relapse.  Staying connected to whatever program or treatment helped you to recover from your substance use disorder improves the chances that you will stay recovered. In drug and alcohol treatment this continuing care is often referred to as aftercare.

One thing that has been sorely missing in mental health treatment is some form of continuing care after the initial episode. Far too often mental health issues are treated as if they were acute illnesses rather than the chronic conditions they are. Providing some kind of continuing support, groups, or individual counseling, reduces the risk of relapse into an active state of mental illness.

One highly effective continuing care system is the development of a written wellness and recovery plan.

For more about aftercare see the post in the “What is.” series.

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

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Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.

What is Aftercare?

By David Joel Miller, MS, Licensed Therapist & Licensed Counselor.

What is

What is Aftercare?
Photo courtesy of Pixabay.

How does aftercare relate to treatment?

Aftercare is continuing or follow-up care that is received after the initial intense round of treatment. This is common in counseling those with a substance use disorder. It should be more common for those with most types of mental illness also. Aftercare is intended to prevent a return to active symptoms of the disorder. In the case of substance use disorders, this means aftercare should reduce the risk of relapse.

This term probably originated back in the days when the 28-day rehab was common practice. You got your initial drug or alcohol treatment in a residential treatment center and then after that initial period, you went home. Remember that while medical treatment for physical health problems has been around for centuries, treatment for substance use disorders and mental illness are relatively new procedures.

It is easier staying clean and especially sober when you are in a residential program. It is possible to get drugs and alcohol into a rehab facility but many of the people who are there are really trying to quit and they will report that kind of thing. Programs try their hardest to keep drugs out, kind of like jails do.

What often happened when people left the program was that they ended up back in the same environment as before. Everywhere you go there are people using drugs, drinking and so on. The temptation to revert to the old ways of behavior is tremendous. Think of the alcoholic in early recovery. Everywhere they go there is alcohol. Why even the grocery store is out to get them. You have to walk past the wine to get produce and the beer is in front of the meat case.

To help people who had done a residential drug treatment program stay sober aftercare of some kind is a big help. This may be as little as one time a week or it could be more. Some aftercare’s are even a meeting every night.

Having this ongoing connection to other clean and sober people helps keep the person focused on their recovery and reduced the temptation to do what others were doing and get high or drunk. If you hang out with sober people you are less likely to drink.

Recently we have seen this same aftercare advantage with those with a mental illness. You can go see a therapist, get and take meds but if at the end of a few weeks you go back to your old way of living and nothing changes then you can end up feeling the way you used to feel. The depression has returned.

Staying connected to meds and therapy longer reduces the risk of relapse. One study I read reported that those who stayed on antidepressants meds for two years had fewer relapses even after discontinuing the medications.

Whatever you do to change your life. Keep doing it after that initial change effort starts working. That is aftercare in practice. Maintaining your changes are the primary purpose of attending an aftercare program.

FYI These “What is” sometimes “What are” posts are my efforts to explain terms commonly used in Mental Health, Clinical Counseling, Substance Use Disorder Counseling, Psychology, Life Coaching and related disciplines in a plain language way. Many are based on the new DSM-5, some of the older posts were based on the DSM-IV-TR, both published by the APA. For the more technical versions please consult the DSM or other appropriate references.

You might also want to check out these other posts Drug Use, Abuse, and Addiction 

Staying connected with David Joel Miller

Two David Joel Miller Books are available now!

Bumps on the Road of Life. Whether you struggle with anxiety, depression, low motivation, or addiction, you can recover. Bumps on the Road of Life is the story of how people get off track and how to get your life out of the ditch.

Casino Robbery is a novel about a man with PTSD who must cope with his symptoms to solve a mystery and create a new life.

For these and my upcoming books; please visit my Amazon Author Page – David Joel Miller

Want the latest blog posts as they publish? Subscribe to this blog.

Want the latest on news from recoveryland, the field of counseling, my writing projects, speaking and teaching? Please sign up for my newsletter at – Newsletter. I promise not to share your email or to send you spam, and you can unsubscribe at any time.

For more about David Joel Miller and my work in the areas of mental health, substance abuse, and Co-occurring disorders see my Facebook author’s page, davidjoelmillerwriter. A list of books I have read and can recommend is over at Recommended Books. If you are in the Fresno California area, information about my private practice is at counselorfresno.com.