Addiction Medicine: Closing the Gap between Science and Practice

Chapter X

The Evidence-Practice Gap

The prevention and reduction of the risky use of

addictive substances and the treatment of

addiction, in practice, bear little resemblance to

the significant body of evidence-based practices

that have been developed and tested;* indeed

only a small fraction of individuals receive

interventions or treatment consistent with

scientific knowledge about what works.^1

Providing quality care to identify and reduce

risky use and diagnose, treat and manage

addiction requires a critical shift to science-

based interventions and treatment by medical

professionals--both primary care providers and

specialists.

Significant barriers stand in the way of making

this critical shift, including an addiction

treatment workforce that is largely unqualified

to implement evidence-based practices; a health

professional that should be responsible for

providing addiction screening, interventions,

treatment and management but does not

implement evidence-based addiction care

practices; inadequate oversight and quality

assurance of treatment providers and

intervention practices; limited advances in the

development of pharmaceutical treatments; and

a lack of adequate insurance coverage.

Recent efforts by government agencies and

professional associations have begun to tackle

these challenges to closing the evidence-practice

gap, but are insufficient.

Current Approaches to Risky

Substance Use and Addiction Are

Inconsistent with the Science and

with Evidence-Based Care

Unlike other public health problems and

diseases that are met with qualified medical care

* See Chapters IV-VI.