Читать книгу The Therapist's Guide to Addiction Medicine - Barry Solof - Страница 8

PREFACE

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

Fourteen states do not require all addiction counselors to be licensed or certified;

Six states do not mandate any educational degree to become credentialed;

Fourteen states require only a high school diploma or GED;

Ten states require an associate’s degree;

Six states require a bachelor’s degree; and

One state requires a master’s degree.

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.

In 2010 only $28 billion was spent to treat the 40 million people with addiction. In comparison,

$44 billion was spent to treat diabetes, which affects 26 million people;

$87 billion was spent to treat cancer, which affects 19 million people; and

$107 billion was spent to treat heart conditions, which affect 27 million people.

“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 commission chairman Altman.

Other Notable Report Findings

Although addiction is often a chronic disease, treatment typically addresses it as an acute condition and does not include the necessary long-term disease management.

Public perceptions do not distinguish between risky substance use and the disease of addiction.

Costs to federal, state, and local governments amount to 11 percent of total spending; ninety-five cents of every dollar pays for the consequences while only two cents go to prevention and treatment.

Recommendations

The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches, and to bring practice into line with the scientific evidence and with the standard of care for other public health and medical conditions. “It is time for healthcare practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars,” noted Foster.

For this study, CASA Columbia conducted a thorough review of more than 7,000 publications; in-depth analysis of five national data sets; focus groups and a nationally representative survey of 1,303 adults; statewide surveys of addiction treatment directors and staff providers in New York State; an online survey of 1,142 members of professional treatment associations involved in addiction care; an online survey of 360 individuals with a history of addiction who are managing the disease; and an in-depth analysis of state and federal governments’ and professional associations’ licensing, certification, and accreditation requirements. CASA Columbia also obtained comments and suggestions from 176 leading experts in a broad range of fields relevant to the report.

Founded in 1992 by former US Secretary of Health, Education, and Welfare Joseph A. Califano Jr., CASA Columbia is a science-based, multidisciplinary organization focused on transforming society’s understanding of and response to the disease of addiction. CASA Columbia conducts research and utilizes the scientific findings of others to inform Americans of the economic and social costs of substance use and addiction and evaluates addiction treatment and prevention programs to determine what treatment models work best, while seeking to reduce the stigma attached to this disease by replacing shame with hope and giving people the tools to prevent and treat addiction.

It is my sincere hope that this book will provide both the medical and the counseling professions with a viable tool to help them understand the problems of addiction, as well as the full range of information and resources that is available to assist us in the fight against all forms of addictive behavior.