While few of its individual findings will come as much of a surprise to seasoned professionals in the addiction field, a newly issued report from the National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia) packs a punch in its assault on current substance use treatment practice.
Perhaps the most stinging, if still not stunning, comment in the report is its statement that the medical profession is largely absent from addiction practice and that the counseling professionals who deliver most of the treatment services to patients are often subject to few or no qualification standards.
“There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards,” CASA Columbia vice president Susan Foster said in a news release issued this week.
CASA this week released a mammoth report of nearly 600 pages, entitled Addiction Medicine: Closing the Gap Between Science and Practice. The research team led by Foster relied on numerous data sources that included but was not limited to five national data sets, a survey of more than 1,100 members of addiction treatment organizations, and a survey of 360 individuals in recovery. Grants from several charitable foundations financed the five-year project.
Here are some of the findings CASA is highlighting from its report:
· Only about 1 in 10 individuals who need treatment for addiction are receiving it, compared with 7 of 10 individuals with chronic illnesses such as diabetes and depression who are receiving treatment for those conditions.
· A total of $28 billion was spent in the United States in 2010 to treat addiction, an illness that affects 40 million people. By comparison, $107 billion was spent that year to treat heart disease, which affects 27 million people.
· Only 2 cents of every dollar spent on addiction-related costs pays for treatment and prevention efforts, as the vast majority of spending focuses on the health consequences of substance abuse.
· Addiction treatment remains largely disconnected from mainstream medical practice. The report cites research data showing that only 29% of individuals who visited a general medical practitioner in the past year were ever asked about alcohol or other drug use.
· The counselors who handle the majority of clinical care in addictions are subject to a hodgepodge of educational and credentialing requirements from state to state, with nearly one-third of states requiring no certification or licensure to practice and only half a dozen states requiring that counselors hold a bachelor’s degree or higher.
The report characterizes the gap between research and practice as “unfair to the thousands of addiction counselors who struggle, in the face of extreme resource limitations and no medical training, to provide help to patients with the disease of addiction and numerous co-occurring medical conditions.”
The report issued numerous recommendations to improve addiction treatment practice and policy, including:
· Developing core clinical competencies for addiction treatment and prevention and requiring that they be taught in all relevant education and training programs.
· Standardizing the language that is used to describe the full range of severity of substance use problems in the population.
· Requiring routine screening and brief intervention for individuals in all government service systems, from corrections to housing to child welfare.
· Requiring that all addiction treatment facilities be licensed under the same provisions and standards as other healthcare facilities.
· Implementing a national public health campaign coordinated by federal government agencies to educate citizens about all forms of risky substance use.