Addiction Medicine: Closing the Gap between Science and Practice

40 million Americans ages 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.

Key Takeaways

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. 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. Additional key findings include the following:

• 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.
• Most medical professionals who should be providing addiction treatment are not sufficiently trained to diagnose or treat the disease.
• 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.

Recommendations

• Incorporate screening and intervention for risky substance use into routine medical practice.
• Incorporate diagnosis of, and treatment for, addiction into routine medical practice.
• Educate and train all physicians to address risky substance use and addiction.
• Require non-physician health professionals to be educated and trained to address risky substance use and addiction.
• Require that all insurers provide coverage for comprehensive addiction care.
• Establish national accreditation standards for all addiction treatment facilities.

Research Methods

This report relied on various research methodologies, including a review of more than 7,000 publications, analyses of 5 national data sets, and interviews with 176 leading experts in a broad range of fields. Several surveys were conducted, including a national survey of 1,303 adults about their attitudes and beliefs related to addiction and its treatment, an online survey of 1,142 members of professional associations involved in addiction care, and an online survey of 360 individuals with a history of addiction. Analyses of licensing and certification requirements for treatment as well as a case study of addiction treatment in New York State and New York City provided further data.