-ii-addiction are this nation’s largest preventable
and most costly health problems, accounting for
one third of hospital inpatient costs, driving
crime and lost productivity and resulting in total
costs to government alone of at least $
billion each year.
In many ways, America’s approach to addiction
treatment today is similar to the state of
medicine in the early 1900s. In 1908, the
Council on Medical Education of the American
Medical Association turned to the Carnegie
Foundation for the Advancement of Teaching to
conduct a survey of Medical Education in the
U.S. That survey, which became known as the
Flexner Report, was led by Abraham Flexner
who famously observed of the discrepancy
among physicians’ qualifications, “there is
probably no other country in the world in which
there is so great a distance and so fatal a
difference between the best, the average and the
worst.” This CASA Columbia report identifies a
similar gulf in the knowledge and practice skills
of addiction treatment providers today. The
education and training of persons providing
addiction treatment vary considerably by state.
In many cases, entry requirements for the
profession are minimal in terms of education and
are based on apprenticeship models rather than
on science-based instruction.
Flexner noted that the turn of the 19th to 20th
century was a time of scientific progress in the
understanding of disease and its treatment;
however, due to the lack of a standardized and
rigorous education for physicians, society reaped
“but a small fraction of the advantage which
current knowledge has the power to confer.”
Similarly, 100 years later, advances in science
and medicine have drawn a much clearer picture
of addiction--including its causes, correlates and
how to treat it--yet we are woefully unprepared
to apply this evidence to practice. Our medical
professionals are not trained to look for risky use
and addiction or to intervene or treat the disease.
Without medical attention, the disease
progresses, forcing doctors to expend valuable
resources treating the more than 70 other
conditions requiring medical attention that result
from substance use and addiction, while
taxpayers shoulder the costs of these health and
other social consequences. This neglect by the
medical system has led to the creation of a
separate and unrelated system of addiction care
that struggles to treat the disease without the
resources or the knowledge base to keep pace
with science and medicine.Because addiction affects cognition and is
associated primarily with the difficult social
consequences that result from our failure to
prevent and treat it, those who suffer from the
disease are poor advocates for their own health.
And due in large part to the shame, stigma and
discrimination attached to the disease,
individuals with addiction and their family
members too often are isolated in their struggle
to understand the disease and find help. Only
recently have we begun to see those affected by
the disease working to raise awareness in ways,
for example, that families of breast cancer
victims have done. But these efforts are small,
challenged by public misunderstanding and have
failed to raise sufficient funding for needed
research.Even individuals who can transcend the stigma
face significant barriers to receiving effective
care, and this report paints a dismal picture of a
treatment ‘non-system.’ While almost half of
Americans say they would go to their health care
providers for help, most doctors are uninformed
about this disease and rarely are equipped to
offer a diagnosis, provide treatment or connect
patients with appropriate specialty care.
Insurance coverage varies widely. Services
rarely are tailored to individual needs and are
based primarily on an acute care model rather
than recognizing the chronic nature of the
disease. There are no national standards of care.
Patients face a patchwork of treatment programs
with vastly different approaches; many offer
unproven therapies and little medical
supervision. Some promise “one time” fixes;
others offer posh residential treatment at
astronomical prices with little evidence
justifying the cost. Even for those who do have
insurance coverage or can pay out-of-pocket,
there are no outcome data reflecting the quality
of treatment providers so that patients can make
informed decisions.