If addiction is a disease, why do families refer far more patients to specialists and treatment programs than internists, or emergency room physicians or family doctors do?
Those questions and others were raised by a groundbreaking five-year national study recently released by the National Center on Addiction and Substance Abuse at Columbia University, known as CASA Columbia.
About 70 percent of people with diseases such as high blood pressure, high cholesterol and diabetes receive treatment, compared with only 10 percent of people who need treatment for addiction involving alcohol or other drugs, according to the report.
“The Addiction Treatment Commission and other experts have shined a bright light on the dysfunction and disconnected relationship between addiction treatment and mainstream medical practice,” said Scott Teitelbaum, M.D., medical director of the UF&Shands Florida Recovery Center. “We have improved medical student education in tobacco, alcohol and drug misuse, abuse and addictions, but addicted patients are more likely to get a diagnosis when they need a new liver rather than when they see their physician for a routine exam.”
The CASA Columbia findings result from a review of more than 7,000 publications, analysis of five national data sets, focus groups, online and in-person surveys, interviews with 174 leading experts and more than 300 recovering addicts, and an in-depth review of state and the federal government licensing, certification and accreditation requirements.
The report draws on research conducted by CASA Columbia over two decades, and on a wide body of scientific and clinical research conducted by the department of psychiatry at the UF College of Medicine, among other groups.
While acknowledging that 20 percent of all deaths are caused by addictions and one-third of all hospital in-patient costs are addiction-related, few states have an approach to prevent, intervene or treat addictions, according to the report. Part of the reason is most medical schools are not equipped to teach addiction medicine.
“Unfortunately, addiction experts and programs are hard to find,” said Teitelbaum, an associate professor of psychiatry and pediatrics and the clinical chief of the addiction medicine division in the department of psychiatry. “Many states do not even require addiction counselors to be licensed and most universities do not have an addiction training, research and treatment program.”
UF has produced 60 fellows in addiction medicine, thereby supplying most of the new addiction specialists in Florida, and was the first medical school in the country to require a two-week clerkship in addiction. The school has also tested and refined a range of treatment options through the UF&Shands Florida Recovery Center, including inpatient, day and residential treatment, as well as outpatient education.
Improving care requires reducing the stigma surrounding addiction treatment, more detailed screening and intervention for risky substance use during routine medical practice, and upping the bar on expectations for physicians, according to Mark S. Gold, M.D., the Donald Dizney Eminent Scholar, chairman of the department of psychiatry and member of UF’s McKnight Brain Institute.
“We’d like to see a day whMcKnight Brain Instituteen health care professionals are identifying, intervening and referring patients to experts at rates like they do for other common diseases,” said Gold, who was a member of the CASA Columbia National Advisory Commission along with Drew E. Altman, Ph.D., president and CEO of the Kaiser Family Foundation; Harvey V. Fineberg, M.D., Ph.D., president of the Institute of Medicine of the National Academies; and 10 other leading authorities.
“The National Institutes of Health have helped physicians and other providers by developing and testing a wide range of evidence-based screening, intervention, treatment and disease management tools, but they are used infrequently,” Gold said. “Fewer than 30 percent of patient visits contain notations of current drinking, drug use or smoking. Instead of an intervention during a simple office visit, patients often have to come to the emergency department with an overdose to get a diagnosis for a problem that should have been addressed much earlier.”
In terms of resources, the report says in 2010 about $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.