Referrals to specialty addiction care should be
made to trained and credentialed addiction
physician specialists.* 42
Screening and Intervention Are Effective
at Addressing Risky Substance Use and
Forestalling Addiction
Screening and brief interventions have been
found to be effective tools for addressing the
risky use of tobacco,^43 alcohol,^44 illicit drugs and
controlled prescription drugs^45 in multiple
settings and in many population groups.^46
A range of screening tools exist and typically
include written or oral questionnaires and, less
frequently, clinical and laboratory tests.
However, most screening tools are substance
specific; an instrument that screens for risky use
or addiction involving all substances as a unified
dimension--and that makes appropriate
distinctions for age, culture and gender--has yet
to be developed.
For those who screen positive for risky
substance use that does not meet the threshold of
clinical addiction, a brief intervention--typically
involving motivational interviewing techniques
and substance-related education--is an effective,
low-cost approach to reducing risky substance
use.^47
Effective Therapies to Treat and Manage Addiction Exist ............................................
For individuals showing signs of addiction, a
comprehensive assessment of the stage and
severity of the disease and the provision of
treatment and disease management are critical to
improving health and preventing further health
and social consequences.^48 As is true of other
chronic diseases, while all patients with
- There are two major categories of addiction
physician specialists: physician experts in addiction
medicine--Diplomates of the American Board of
Addiction Medicine (ABAM)--and physician experts
in addiction psychiatry (psychiatrists with sub-
specialty certification in addiction psychiatry)--
Diplomates of the American Board of Psychiatry and
Neurology (ABPN).
addiction will not respond equally well to
treatment, the provision of evidence-based
treatment does increase the odds of success.Addiction is a disease that can be treated and
managed effectively within the medical
profession using an array of evidence-based
pharmaceutical and psychosocial approaches. In
accordance with standard medical practice for
the treatment of other chronic diseases, best
practices for the effective treatment and
management of addiction must be consistent
with the scientific evidence of the causes and
course of the disease. Best practices require:^49 Comprehensive assessment of the extent
and severity of the disease, determination of
a clinical diagnosis, evaluation of co-
occurring health conditions and the
development of a tailored treatment plan; Stabilization of the patient’s condition via
cessation of substance use and medically
supervised detoxification, when necessary,
as a precursor to treatment; Acute Care delivered by qualified health
care professionals via evidence-based
pharmaceutical and/or psychosocial
addiction treatments, accompanied by
treatment for co-occurring health conditions; Chronic Disease Management to help the
patient maintain the progress achieved
during acute treatment and prevent relapse.
The process should be medically supervised
and should involve pharmaceutical and/or
psychosocial therapies and continued
management of co-occurring health
conditions as indicated; and Support Services including the provision of
auxiliary services such as legal, educational,
employment, housing and family supports,
as well as nutrition and exercise counseling
and connection to mutual support programs.