Addiction Medicine
Closing the Gap Between Science and Practice
Forty million Americans ages twelve and older have an addiction involving nicotine, alcohol, or other drugs, making addiction a disease affecting more Americans than heart conditions, diabetes, or cancer, according to a five-year national study released June 2012 by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are at-risk substance users—using tobacco, alcohol, and other drugs in ways that threaten health and safety.
The report, Addiction Medicine: Closing the Gap Between Science and Practice, reveals that while seven in ten people with diseases such as hypertension, major depression, and diabetes receive treatment, only about one in ten people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.
The CASA Columbia report found that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment, and disease-management tools and practices exist, they are rarely employed. The report exposed the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and that most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills, or credentials necessary to provide the full range of evidence-based services.
“This report shows that misperceptions about the disease of addiction are undermining medical care,” said Drew Altman, PhD, president of The Henry J. Kaiser Family Foundation, who chaired the report’s National Advisory Commission. While doctors routinely screen for a broad range of health problems such as high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction, and instead treat a long list of health problems that frequently result from it, including accidents, unintended pregnancies, heart disease, and many other costly conditions, without examining the root cause.
This landmark report examines the science of addiction—a complex disease that involves changes in the structure and function of the brain—and the profound gap between what we know about the disease and how to prevent and treat it, versus current health and medical practice.
Few Patients with Addiction Receive Quality Care
The CASA Columbia report found that while almost half of Americans say they would go to their healthcare providers if someone close to them needed help for addiction, less than 6 percent of all referrals to addiction treatment come from health professionals. The report also found no clearly delineated, consistent, and regulated national standards that stipulate who may provide addiction treatment in the US; standards vary significantly by state and the source of payment for treatment.
Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices. Most providers of addiction treatment are addiction counselors who are not required to have any medical training. CASA Columbia’s analysis of minimum state requirements found that
Physicians and other medical professionals, who make up the smallest share of addiction treatment providers, receive little education in addiction science, prevention, and treatment. In fact, the CASA Columbia report cites other research, which found that, of patients who had visited a general medical provider in the past year, only 29 percent were even asked about alcohol or other drug use. “Right now there are no accepted national standards for providers of addiction treatment,” said Susan Foster, CASA Columbia’s vice president and director of Policy Research and Analysis, who was the principal investigator for the report.
“There simply is no other disease where appropriate medical treatment is not provided by the healthcare system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards. Neglect by the medical profession has resulted in a separate and unrelated system of care that struggles to treat the disease without the resources or knowledge base to keep pace with science and medicine.”
A Costly Disease
The CASA Columbia report reveals that addiction and risky use of tobacco, alcohol, and other drugs constitute the largest preventable and most costly health problems facing the US today, responsible for more than 20 percent of deaths in the US, causing or contributing to more than seventy other conditions requiring medical care and a wide range of costly social consequences, and accounting for one-third of all hospital in-patient costs. Research suggests that effective healthcare interventions to prevent and treat addiction would significantly reduce these costs.
“As our nation struggles to reduce skyrocketing healthcare costs, this report makes clear that there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction,” said
