Addiction Medicine: Closing the Gap Between Science & Practice | CASAColumbia

Addiction Medicine: Closing the Gap between Science and Practice

Addiction Medicine: Closing the Gap between Science and Practice

Published: June 2012

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Background

40 million Americans age 12 and over meet the clinical criteria for addiction involving nicotine, alcohol or other drugs. That is more than the number of people with heart conditions, diabetes or cancer. Meanwhile, another 80 million Americans fall into the category of risky substance users, defined as those who are not addicted, but use tobacco, alcohol and other drugs in ways that threaten public health and safety.

Methods

CASAColumbia’s work for this report involved:

  • A review of more than 7,000 publications
  • Analyses of 5 national data sets
  • Interviews with and suggestions from 176 leading experts in a broad range of fields relevant to the report
  • Focus groups and a national general population survey of 1,303 adults about their attitudes and beliefs related to addiction and its treatment
  • Two New York State surveys of addiction treatment providers
  • An online survey of 1,142 members of professional associations involved in addiction care
  • An online survey of 360 individuals with a history of addiction
  • Analyses of state and federal governments’ and professional associations’ licensing and certification requirements for treatment providers
  • A case study of addiction treatment in New York State and New York City 

Results

This 5-year study found that, despite the prevalence of addiction, the enormity of its consequences, the availability of effective solutions and the evidence that addiction is a disease, both screening and early intervention for risky substance use are rare, and only about 1 in 10 people with addiction involving alcohol or drugs other than nicotine receive any form of treatment. 

Of those who do receive treatment, few receive anything that approximates evidence-based care. This compares with 70% to 80% of people with such diseases as high blood pressure and diabetes who do receive treatment. This report exposes the fact that most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat the disease, and most of those providing addiction care are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of effective treatments. Misunderstandings about the nature of addiction and the best ways to address it, as well as the disconnection of addiction medicine from mainstream medical practice, have undermined effective addiction treatment.

Recommendations

The time has come for addiction medicine to be fully integrated into health care systems and medical practice. Health care providers, especially physicians, are our front line in disease prevention and treatment. They must understand the risk factors for addiction, screen for risky substance use and intervene when needed, and diagnose, treat and manage addiction just as they do all other diseases.

Other health care providers, including nurse practitioners, physician assistants, psychologists and social workers, are critical parts of the solution as well. We need national, evidence-based standards that stipulate who may provide addiction treatment, and core competencies for all health care providers integrated into their education and licensing requirements. We must regulate addiction treatment facilities and programs as health care providers and hold them accountable for treatment consistent with medical standards and proven practices.

A Note on the Language
In 2012, CASAColumbia stopped using words like “drug abuse”/“drug abuser” because the terms are imprecise and have negative connotations. Instead, we now distinguish between “addiction” (clinical criteria for the disease) and “risky use” (use of addictive substances in ways that increase the risk of harm but do not meet criteria for addiction). Some reports and other publications published prior to 2012 still contain this language.

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Further information

Read the press release.