Addiction is not a moral issue. Approximately 16 percent of Americans over the age of 12 deal with addiction.
That’s twice the amount of people fighting cancer, 40 million compared to 19 million, and almost twice the number of people with heart disease or diabetes.
Those numbers don’t include the 80 million people who smoke, drink and use drugs in “risky ways that threaten health and safety.”
A major report, released by the University of Columbia’s National Center on Addiction and Substance Abuse (CASA), is 586 pages of addressing one of America’s most ignored health problems with several solutions.
Here is a very brief summary of the CASA report and the addiction medicine community’s reaction to it.
Need For Change
In the CASA report’s introduction, Drew Altman, PhD, chair of the CASA Columbia National Advisory Commission on Addiction Treatment, said, “America’s failure to prevent risky use and effectively treat addiction results in an enormous array of health and social problems such as accidents, homicides and suicides, child neglect and abuse, family dysfunction and unplanned pregnancies.”
Resulting in, “[T]his nation’s largest preventable and most costly health problems, accounting for one third of hospital inpatient costs, driving crime and lost productivity and resulting in a total cost to government alone of at least $468 billion each year.”
Dr. Altman continues to identify the main problem as lack of proper addiction training for medical professionals. There are 9,034 Accreditation Council for Graduate Medical Education (ACGME) accredited residency programs in American hospitals today.
Psychiatry is the only area that has a sub-specialty with training and certification in addiction.
That means that there is no formal training beyond apprentice-like experience for dealing with addiction rather than a science-based certification program. Dr. Altman said, “There are no national standards of care.” Imagine if the same were true for other medical fields like neurosurgery or cardiothoracic specialties.
Jeffrey H. Samet, MD, MPH, president of American Board of Addiction Medicine Foundation, said, “Addiction Medicine[the CASA report] is the most up-to-date report on the availability of effective, life-saving and cost-saving treatments for unhealthy substance use and addiction to alcohol, nicotine and other drugs, including some prescription medications.”
“It is thorough and well-documented. This country suffers from an inexcusable lack of access to treatment for patients in our healthcare system who suffer from addictive diseases. The report pointedly highlights the inadequacy of education for physicians and other healthcare professionals about addiction.”
“Clinical training, coupled with passage of ABAM’s rigorous certification examination, will provide physicians with knowledge of evidence-based addiction treatments. And patients will have access to specialized medical care for substance use disorders related to alcohol, tobacco and other addicting drugs at any point of entry to the healthcare system.”
“Trained addiction medicine physicians will join their addiction psychiatry colleagues and other addiction professionals in the interdisciplinary care of patients with addictive disorders.”
Slipping Through The Cracks
More than 70 medical conditions that require medical attention can be traced back to substance use and abuse. Including, but not limited to, cancer, respiratory disease, cardiovascular disease, cirrhosis, ulcers and pregnancy complications. More than 20 percent of deaths in the U.S. are a result of tobacco, alcohol or drug use.
The amount of people who meet the criteria for addiction to tobacco, alcohol or drugs, yet never receive any treatment whatsoever, is reported at 89 percent. Nearly 80 percent of Americans visit a doctor at least once a year. Over two-thirds of people with addiction see a doctor at least twice a year.
One of the main reasons for this disparity is insurance. Most people can’t afford a trip to the Betty Ford Clinic. The public health sector bares the brunt of addiction fallout costs at around 54 percent, while private insurance companies cover around 21 percent.
According to the report, addiction is the result of many factors, which include a genetic predisposition, both structural and functional brain vulnerabilities, psychological factors and environment. That is to say, yes, peer influence can create a haven for risky use, but a genetic predisposition can tip the scale towards addiction.
The age of onset is one of the greatest predictors of future addiction. Most addiction cases, 97 percent, are in people who started using before the age of 21. Mental illness and trauma are also frequent co-pilots with addiction.
Effective screening tools, standardized use of language associated with addiction medicine and science-based training and certification are where the medical community should start. National campaigns for awareness are another important tool to prevent the onset of use, continued risky use and the avoidance of treatment for addiction.
Effective therapies in the medical field include: a solid comprehensive assessment of the situation, stabilization of the current state, either acute care or chronic disease management paths, engaging support services.
There is no way to absorb the cost of addiction efficiently at the current rate. Prevention methods have to be put in place, and while they may cost money up front, the long-term costs will drop significantly.
All doctors should be trained in some level of standardized addiction assessment and treatment methods, even if they specialize in an area where they would likely never encounter the need for addiction assessment or treatment.
If medical schools, residency programs, licensing exams and board certification exams incorporated a standardized addiction assessment and treatment awareness component, it is unlikely that 40 million people with addiction and 80 million people engaging in risky use will slip through the cracks.
This report is a call to action for the medical community and national involvement to deal with a problem that can no longer be ignored. The financial and social costs are already unbearable and will continue to rise if a solution plan is not enacted.
The report, “Addiction Medicine: Closing the Gap between Science and Practice”, was published by The National Center on Addiction and Substance Abuse at Columbia University, June 2012. Funding for the report was provided by the Annenberg Foundation, The Diana, Princess of Wales Memorial Fund, The Franklin Mint, The New York Community Trust, and the Adrian and Jessie Archbold Charitable Trust.