To document the research on the causes,
consequences and extent of risky substance use
and addiction; the available tools for effective
interventions and for treatment; the gap between
the need for such interventions and treatments
and the actual standard of care; the driving
forces behind this substantial gap; and to
develop concrete recommendations for
minimizing it, CASA Columbia conducted:*
A thorough review of more than 7,
scientific articles, reports, books and other
reference materials related to the science of
addiction, the consequences of risky use and
addiction, the prevention of risky use and
treatment of addiction and barriers to
improved care (see Appendix A);
Secondary analysis of five national data sets
(see Appendix A);
Interviews with and suggestions from 176
leading experts in a broad range of fields
relevant to the report, including researchers,
physicians and other health professionals,
other treatment providers, policymakers and
members of professional associations,
advocacy organizations, health insurers,
pharmaceutical companies and organizations
of people with the disease of addiction.
Whereas the majority of these experts
provided their thoughts in the context of an
open-ended interview guide designed by
CASA Columbia to explore key themes
related to this project, some provided advice,
suggestions and feedback about specific
content to be included in this report (see
Appendices A and B);
Focus groups and a national general
population survey assessing the attitudes and
beliefs of 1,303 adults with regard to
addiction and its treatment: the National
Addiction Belief and Attitude Survey
(NABAS) (see Appendices A and C);
Two statewide surveys of addiction
treatment providers in New York: one of 83
- See Appendix A for a more detailed description of
the key methodological components of the study.
program directors and one of 141 staff
treatment providers (see Appendices A, D
and E); A national panel of treatment providers and
an online survey of 1,142 members of
professional associations involved in
addiction care (see Appendices A and F); An online survey of 360 individuals with a
history of addiction who are managing the
disease (see Appendices A and G); An in-depth analysis of state and federal
governments’ and professional associations’
licensing and certification requirements for
individual treatment providers and addiction
treatment facilities and programs, as well as
accreditation requirements for facilities and
programs (see Appendix A); and A case study of addiction treatment in New
York State and New York City that drew
from the research described above and the
findings of which are incorporated into the
report where relevant (see Appendix A).Key Findings ........................................................................................................................
Addiction Is a Brain Disease..........................................................................................
Addiction is a complex brain disease with
significant behavioral characteristics.^23
Nicotine, alcohol, illicit drugs and controlled
prescription drugs all affect the pleasure and
reward circuitry of the brain in similar ways.^24
Over time, continued use of these substances can
physically alter the structure and function of the
brain, dramatically affect judgment and
behavior^25 and drive a compulsion to obtain and
use them, even in the face of mounting negative
consequences.^26 Growing evidence also points
to structural and functional differences in the
brain and to genetic factors that may predispose
certain individuals to addiction.^27