Addiction Medicine: Closing the Gap between Science and Practice

addiction treatment providers to have.* 155

CASA Columbia’s survey also found that only
11.3 percent of program directors and 8.1
percent of staff providers believe that the
addiction treatment system “should be integrated
into the medical system such that addiction is
treated as a health condition by health care
professionals.”^ Two-thirds of directors (66.3
percent) and 60.3 percent of staff providers,
however, say that the addiction treatment system
“should be two-tiered with health care
professionals providing psychotherapeutic and
pharmacological interventions and individuals
with histories of addiction (in recovery)
providing recovery support services.” Fewer
directors (7.5 percent) but more staff providers
(21.3 percent) indicated that “the system should
revolve around a recovery support model with
self-help/mutual support programs as the main
intervention.” Fifteen percent of directors and
10.3 percent of staff providers think that nothing
about the system should change.^156

Despite this variability in perceptions regarding
what the treatment system should look like,
there is general agreement that the current
system is riddled with organizational and
structural problems that impede the delivery of
quality care, including inadequate financial
resources, high staff turnover and restricted
professional advancement.^157 While limited
education and training of most providers and a
treatment culture largely steeped in the self-help
model stand in the way of adopting new,
science-based practices,^158 organizational and
structural problems within the current treatment
system compound these limitations and further
prevent the delivery of evidence-based care.^159

CASA Columbia’s survey of treatment providers
in New York State found that respondents were
most likely to cite a high volume of paperwork

• Among program directors, 28.9 percent said

personal experience is slightly important, 25.3
percent said it is moderately important and 7.2
percent said it is very important. Among staff
providers, 36.0 percent said personal experience is
slightly important, 21.6 percent said it is moderately
important and 18.7 percent said it is very important.

(reporting requirements that take up too much

time and resources), insufficient salaries to

attract and retain high-quality staff, insufficient

program funding and insufficient insurance

coverage for patients as barriers that “very

much” stand in the way of providers’ ability to

provide effective services to people in need of

addiction treatment--reflecting both frustration

with organizational barriers to quality care and a

non-medical approach to treatment. An

insufficient number of trained medical-level

(MD/DO) professionals was least likely to be

named by providers as a barrier that “very

much” stands in the way of providing effective

treatment services.^160 (Table 10.1)

Table 10.1

New York State Addiction Treatment Providers’ Opinions

of Barriers that “Very Much” Stand in the Way of

Providing Effective Addiction Services

Program

Directors

Staff

Providers

High volume of paperwork/reporting

requirements

76.8

72.7

Insufficient salaries to attract and retain

high-quality staff

74.7 69.8

Insufficient program funding 62.2 63.3

Insufficient insurance coverage 60.2 61.6

Insufficient number of appropriately trained

staff with the qualifications necessary to

provide treatment for co-morbid conditions

56.1

37.4

Insufficient number of trained master’s-

level professionals

28.0 20.9

Insufficient number of appropriately trained

staff with the qualifications necessary to

provide pharmacological therapies

26.5

19.7

Limited motivation among staff members to

be knowledgeable about evidence-based

best practices

24.1

19.7

Insufficient professional standards related

to knowledge and clinical skills for

individuals providing addiction treatment

20.5

21.7

Insufficient federal- or state-level education

and training requirements for individuals

providing addiction treatment

18.1

23.2

Insufficient access to information about

best practices

13.3 15.9

Insufficient number of trained medical-level

(MD/DO) professionals

12.3 13.0

Source: CASA Columbia Survey of New York State Addiction

Treatment Providers, 2009.