the past year,^12 and more than two-thirds of
people with addiction are estimated to be in
contact with a primary or emergency care
physician about twice a year,^13 most
physicians and other health professionals*
do not identify or diagnose the disease or
know what to do with patients who present
with identifiable and treatable signs and
symptoms. And, unlike other diseases,
physicians too often lack access to available,
trained and certified addiction physician
specialists for consultation or referral.
Instead of addressing addiction, the medical
field primarily has focused its efforts on
treating the secondary and tertiary
complications of addiction, allowing the
public health epidemic to advance
unchecked. Furthermore, whereas the main
criterion for determining whether health care
services should be provided to patients in
mainstream medicine is the principle of
medical necessity,^14 patients needing
addiction treatment may face stringent
eligibility criteria for treatment entry,
including insurance benefit restrictions,
limited availability of treatment slots, long
waiting lists, lack of child care and the
requirement to comply with all rules and
treatment protocols.^15 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. Inadequate Education and Training of
Addiction Treatment Providers: The
majority of those who currently make up the
addiction treatment provider workforce are
not equipped with the knowledge, skills or
credentials necessary to provide the full
range of evidence-based services to treat the
disease.
- The term “health professional” as used in this report
includes medical professionals (physicians, physician
assistants, nurses and nurse practitioners, dentists,
pharmacists) and graduate-level clinical mental
health professionals (psychologists, social workers,
counselors).
Addiction counselors, who make up the
largest share of providers of addiction
treatment services, provide care for
patients with a medical disease yet they
are not required to have any medical
training and most states do not require
them to have advanced education of any
sort.† Physicians and other medical
professionals, who make up the smallest
share of providers of addiction treatment
services, receive little education or
training in addiction science, prevention
and treatment. Inadequate Accountability for Addiction
Treatment Providers: Addiction treatment
providers, facilities and programs are not
adequately regulated or held accountable for
providing treatment consistent with medical† Only six states require a bachelor’s degree and only
one state requires a master’s degree.Published in the
American Journal of Public Health
July, 1919There is urgent need for widespread and early
education of the medical profession,
legislators, administrative authorities and laity
into the facts of addiction disease...As a definite clinical entity of physical
disease, addiction is practically untaught in
the school and unappreciated by the average
medical man...In the light of available clinical information
and study and in the light of competent
laboratory research we are forced as a
profession to admit that we have not treated
our addiction sufferers with sympathetic
understanding and clinical competency and
that the blame for the past failure to control
the [narcotic] drug problem rests largely upon
the educational inadequacy of our medical
profession, and institutions of scientific and
public health education.^16--Ernest S. Bishop, MD, FACP