Comment on the case for considering quality of life in addiction research and clinical practice

Paradoxically, providers of substance abuse treatment demonstrate both too much and too little focus on quality-of-life parameters. Thus, with regard to medication-assisted treatment, most programs set criteria for "termination" based on attendance, adherence to counseling schedules, and urine toxicology results, and they apply these criteria rigidly, with no regard whatsoever as to how favorably the patient judges her or his improved overall condition. Other programs, however, make demands on patients that far transcend the primary problem they treat--drug dependence--and in some cases even discharge patients who fail to find employment within a specified period of time, even when illicit drug use has ceased altogether [2].The best approach would seem to be to apply to addiction treatment precisely the same perspectives and practices, good and bad, as are commonplace in the care of all other chronic ailments.Dr. Newman raises interesting points that are frequently mentioned when quality of life is discussed in the context of substance use disorders (SUDs). Thank you for the opportunity to offer some clarifications.Pointing out that the nearly exclusive focus of treatment for other chronic conditions-- e.g., asthma--is on reducing and managing symptoms, Dr. Newman writes, "The best approach would seem to be to apply to addiction treatment precisely the same perspectives and practices, good and bad, as are commonplace in the care of all other chronic ailments." From the perspective of specialty care (i.e., addiction treatment), especially medication-assisted treatment, it may seem difficult to disagree: Clients are diagnosed with a physical condition and prescribed the most effective pharmacotherapy for their diagnosis.aHowever, this loses sight of the fact that SUDs are somewhat unique among chronic conditions in that, for many, they typically present with numerous co-occurring functional impairments (physical- and mental-health problems, of course, but also housing