more other substances and 17.3 percent have
addiction involving multiple substances.^38
Emerging research also suggests that other
behavioral manifestations of addiction (e.g.,
obesity, gambling, sexual addiction) share
common neuropsychological and genetic
pathways with addiction involving substances,^39
underscoring the importance of treating the
antecedents, manifestations and consequences of
addiction more generally. When treatments are
too highly focused on a specific addictive
substance or behavior, they may not be
addressing the actual underlying disease of
addiction or the possibility of addiction
substitution, where a patient may replace one
form of addiction with another.^40
Public Attitudes about the Causes of Addiction Are Out of Sync with the Science .....
CASA Columbia’s national survey of the
attitudes and beliefs of adults in the U.S. with
regard to addiction and its treatment (the
NABAS) found that while there is public
recognition of the role of genetics and biological
factors in the development of addiction,
approximately one-third of Americans continue
to view addiction as a sign of lack of will power
or self-control.^41
Physicians and Other Health Professionals
Should Be on the Front Line Addressing
this Disease
As with other diseases, addiction should be
addressed within the medical system by
physicians (including multiple medical
specialties and sub-specialties) and a multi-
disciplinary team of health professionals
including physician assistants, nurses and nurse
practitioners, and graduate level clinical
psychologists, social workers and counselors.
In order to treat addiction and reduce risky
substance use and the related consequences,
physicians and other health professionals must:
Understand the risk factors, how these risks
vary across the lifespan, how risky
substance use that does not result in
addiction has far-reaching adverse
consequences and that addiction frequently
co-occurs with other health conditions; Educate patients, and their families if
relevant, about these risks, the nature of the
disease of addiction and the adverse
consequences of risky substance use; Screen for risky substance use and
symptoms of addiction and co-occurring
health conditions using tools that have been
proven to be effective; Provide brief interventions when
appropriate; and Treat and manage the disease or provide
referrals to specialty care if needed.Non-laboratory-based screening for risky
substance use can be conducted by a wide range
of trained health professionals and brief
interventions can be conducted by physicians
and by appropriately trained clinicians,
supervised as necessary. All aspects of
stabilization and treatment--including
laboratory-based screening, assessment, acute
care and disease management--should be
managed by a physician, as is the case with
other medical illnesses. Highly-trained clinical
mental health professionals can provide
psychosocial therapies as part of a treatment
plan established and managed by the patient’s
physician. Case management can be provided
by nurses and nurse practitioners, physician
assistants and clinical mental health
professionals if appropriately trained in
addiction and if the services are performed under
the supervision of a physician. Paraprofessionals
and non-clinically trained and credentialed
counselors can provide auxiliary services as part
of a comprehensive treatment and disease
management plan.