Addictions and risky use of addictive substances constitute one of the largest and most costly public health issues facing the nation, but addiction care has been vastly under-resourced and remains largely separate from mainstream medical and behavioral health care practice. Unrecognized and untreated, addictions cause or contribute to more than 70 other medical conditions with costs to the government alone totaling at least $468 billion a year (The National Survey on Drug Use and Health, SAMHSA, 2010). The personal cost to families and the larger society is incalculable.
Despite, or perhaps because of, these discouraging statistics, there are reasons to be hopeful about the future of addictions prevention and treatment in the U.S. Chief among them is the focus within health care reform on cost containment, improved health outcomes and the integration of health and behavioral health care.
The convergence of the imperatives of health care reform with the rapidly growing knowledge base about addictions as a complex brain disease and the efficacy of treatments offers an unprecedented window of opportunity to bring addictions screening and treatment into the mainstream of medical and behavioral health practice. By doing so, we have the potential to substantially improve health and mental health outcomes for the 8.7 percent of the population aged 12 or older who were classified with dependence or abuse of alcohol and illicit drugs. Kim Williams, Director of MHA-NYC’s Center for Policy, Advocacy and Education notes, “As a result of planned healthcare integration efforts, providers will have the potential to promote earlier identification of risky use of substances and addictions and ensure that consumers are getting the right addiction services, in the right amount at the right time.”
The June, 2012 report, Addiction Medicine: Closing the Gap between Science and Practice issued by the National Center on Addictions and Substance Abuse at Columbia University (CASA-Columbia) represents the culmination of a five year research project that details current research in neuroscience and addictions and reviews the evidence base for effective screening, intervention, and disease management. Perhaps most importantly, the CASA-Columbia report provides a call to action and a roadmap for reducing the chasm that currently exists between those who need treatment and those who receive it and between the services they receive and the receipt of quality care. Key findings and recommendations include:
- Physicians and other health and graduate level mental health professionals should be on the front lines of addressing addictions within the medical system.
- Barriers to addictions treatment including: limited availability of services, inadequate insurance coverage, and lack of information on how to get help.
- Best practices require: comprehensive assessment, stabilization of the patient’s condition, evidence based pharmacological treatments and/or psychosocial addictions treatment, chronic disease management and support services.
- The education and training gap between the available knowledge about the prevention and treatment of addictions and the education and training of individuals who provide or should provide addiction care must be rectified.
Our ability to translate knowledge into practice will depend not only the dissemination of relevant neuro-scientific and behavioral research and evidence based treatment models but on our ability to bring public attitudes and beliefs about the causes of addictions and the people who suffer from them in line with what we now know about addictions .
Despite overwhelming scientific evidence to the contrary, too many Americans still attribute addictions to a failure of will or lack of self-control. If we are to succeed in expanding access to scientifically based addictions treatment, it will be necessary to confront the legacy of stigmatizing attitudes through widespread public and professional education campaigns.
Although health care reform and scientific knowledge create fertile ground for systemic change in the prevention and treatment of addictions, only our collective compassion and robust advocacy efforts on behalf of and with those who suffer from addictions can guarantee a standard of care for addictions that is comparable to that of other illnesses. Let the advocacy and collaboration across disciplines continue and flourish.