Addiction Medicine: Closing the Gap between Science and Practice

The American Medical Association (AMA)
supports the ideal that all patients have “a basic
right to available, adequate health care”
regardless of the ability to pay.^7 This ideal is
based on several arguments which assert a moral
obligation to treat injuries or diseases that
impede normal functioning.* 8

Addiction is not unique as a health condition for
which a lack of understanding of the nature of
the disease and its causes has resulted in
assigning blame to the patient and to inadequate
or misguided interventions; other historical
examples include tuberculosis, cancer,
depression and HIV-AIDS.^9 However, once a
body of evidence exists about the nature of an
illness and how to address it, that information is
incorporated into medical practice and
reimbursement policies based on the obligation
of the profession to treat disease. Addiction is a
glaring example of practice lagging behind the
science.^10 The science is unambiguous--
addiction is a complex brain disease with
significant behavioral characteristics^11 that
results in unhealthy compulsive behaviors,^12
diminished cognitive control,^13 clinically-
significant impairment or distress^14 and that can
lead to long-term disability and death.^15 Our
continued failure to prevent and treat the disease
is inconsistent with ethical standards and the
goals of medical practice.

• The collective social protection argument posits that

certain essential services, including safety and health
care, are a “collective responsibility” of society and
should be provided to all. The principle of fair
equality of opportunity calls upon institutions to
provide individuals with basic services needed to
pursue the normal range of opportunities that are
essential to a good life--to cultivate one’s talents,
develop skills and formulate one’s own life goals.

Costs of Our Failure to Prevent and Treat Addiction as a Medical Condition ................

Risky substance use and addiction constitute the

leading cause of death and disability in the

United States.^16 The result of not providing

effective prevention and treatment services for

addiction is that the cost of addiction accrues,

driving many other diseases, later manifesting as

more expensive care and spilling out to costly

social consequences.†

Looking just at government spending, CASA

Columbia calculated that in 2005,‡ risky

substance use- and addiction-related spending

accounted for 10.7 percent of federal, state and

local spending, and that for every dollar federal

and state governments spent, 95.6 cents went to

pay for the consequences of substance use; only

1.9 cents was spent on any type of prevention or

treatment.§ The taxpayer tab for government

spending on the consequences of risky substance

use and addiction alone totals $467.7 billion a

year, almost $1,500 a year for every person in

America.^17

The Largest Share of Costs Falls to the Health Care System ....................................

The largest share of spending on the

consequences of risky substance use and

addiction is in health care.^18 Persons with

addictive diseases are among the highest-cost

health care users in America:^19 they have higher

utilization rates, more frequent hospital

admissions, longer hospital stays and require

more expensive health care services.^20 Nearly a

third (32.3 percent) of all hospital inpatient costs

is attributable to tobacco, alcohol and other drug

use and addiction.^21

Even family members of individuals with

addiction have approximately 30 percent greater

† See Chapter III.

‡ Most recent data available.

§ In addition, 0.4 cents was spent on research, 1.4

cents on taxation or regulation and 0.7 cents on

interdiction.