A milestone for addiction professionals was reached this year on May 2, when National Institute on Drug Abuse (NIDA) Director Nora Volkow, MD, gave the keynote address and participated with the leadership of the American Board of Addiction Medicine (ABAM) in conferring board certification on 1,452 physicians during ABAM's first diploma ceremony. This first group of board-certified physicians, drawn from 17 medical specialties, opens a new pipeline for medical doctors to join other addiction professionals in the interdisciplinary care of patients with addictive disorders. Physician specialists in addiction medicine will bring unique skills and competencies to the treatment team, equally sharing in the care of individuals and families with a multitude of needs, using all appropriate treatment modalities available.
Historically, there have been too few knowledgeable physicians to serve with counselors, therapists, social workers, nurses, psychologists and others on the addiction care team. The creation of the American Board of Addiction Medicine signals a coming of age for physicians as team members, working side by side with others dedicated to the service of patients, families and communities.
Importance of board certification
Board certification is the highest level of practice recognition given to physicians. It indicates that an addiction medicine physician has met certain clinical and educational criteria, including eligibility to sit for and successfully pass a rigorous examination. It also means that he or she is participating in ongoing maintenance of certification activities, and will be periodically re-examined to ensure and document current knowledge and skills.
There are more than 120 recognized medical specialties and subspecialties. Even though the harmful use of addictive substances causes so many of our nation's health and social problems, addiction medicine has never been a specialty recognized in its own right by a certifying medical board-until now.
Specialty societies and boards
The American Society of Addiction Medicine (ASAM) is the specialty society that encouraged and assisted in the creation of the new American Board of Addiction Medicine. To fill the void left for many years by the lack of a certifying board in addiction medicine, ASAM conferred its own certificates on physicians who passed a rigorous examination. Many addiction professionals have worked with ASAM-certified physicians, and are familiar with or may have used ASAM's Patient Placement Criteria. Founded in 1954, ASAM is a membership organization offering education, advocacy and other benefits, and is recognized as the primary organizing group for physicians treating patients with addictions.
A physician membership society such as ASAM, however, cannot confer “board certification.” A medical board such as ABAM has a separate and distinct purpose and mission: to promote and improve the quality of medical care through establishing and maintaining standards and procedures for credentialing and re-credentialing medical specialists.
Physician's role on team
There is a great need for more highly qualified physicians who understand addictive disorders. Increasing the availability of addiction medicine physicians is necessary if rehabilitation centers, hospital and outpatient programs, specialized programs such as adolescent units and methadone clinics, and other treatment programs are to be fully staffed. Addiction medicine specialists perform essential duties in these settings: medical assessments; evaluation of alcohol- or drug-induced diseases; specific treatment interventions; client and family education; medication reviews; and referrals, consultations and continuous care for co-occurring medical problems.
Four years ago in a cover story in this magazine, addiction leaders lamented the lack of qualified physicians.1 Sheldon Miller, MD, a leader in addictions training, noted that rural areas in the Midwest were hurting desperately from the lack of qualified professionals. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), reported that the nation's 1,150 methadone clinics rarely have relationships with qualified physicians. And Joseph Westermeyer, MD, director of mental health services at the Minneapolis Veterans Administration Medical Center, said his facility could easily take twice as many patients as it had treatment slots for, because more and more people are coming in with a dual diagnosis.
The American Board of Addiction Medicine seeks to solve this problem. We anticipate that more than 7,000 board-certified addiction medicine physicians will be credentialed by this new board within the next 10 years.
Making treatment more widely available
Physicians also routinely evaluate and treat patients with substance-induced illnesses and trauma on a daily basis in many venues outside of traditional addiction treatment settings. These include physician offices; public and private clinics; emergency departments; hospital wards; jails and prisons; and college health centers. Having an addiction medicine specialist in these settings, or readily available as a consultant, will ensure that the patient is medically attended and then referred, or immediately engaged, in treatment for a primary substance use disorder.