The Importance of Tailored Interventions and Treatment ...........................................
Each life phase presents unique vulnerabilities
for risky substance use and the onset of the
disease of addiction. Recognizing these
differences as well as the basic risk factors for
each is critical to reducing risky substance use
and addiction.
Certain populations--such as pregnant women,^50
the young^51 and the elderly^52 --are more
vulnerable to the damaging and addictive effects
of tobacco, alcohol and other drugs. Among
members of the military exposed to combat,^53
persons with co-occurring health conditions^54
and individuals involved in the justice system^55
the likelihood of addiction is significantly higher
than in the general population.
Treatment must be tailored to the particular
stage and severity of the disease, a patient’s
overall health status, past treatments and any
other personal characteristics and life
circumstances that might affect patient
outcomes.^56 These include patients with co-
occurring health conditions, adolescents,
women, older adults, racial and ethnic
minorities, individuals of minority sexual
orientation, veterans and individuals involved in
the justice system. The research evidence
clearly demonstrates that a one-size-fits-all
approach to addiction treatment typically is a
recipe for failure.^57
Public Attitudes about Addiction Treatment
Reflect the Prevailing Non-Medical
Approach to Addiction Care
CASA Columbia’s NABAS found that although
the American public appears to be supportive of
assuring that individuals with addiction receive
effective addiction treatment, public views about
what constitutes addiction treatment do not
comport with the science: more than half (60.1
percent) of respondents to the NABAS
spontaneously offered mutual support programs
such as AA or NA as a “treatment” intervention
when asked what kinds of treatment come to
mind when they think about treatment for
addiction,^58 despite the fact that such programs,
while very helpful sources of support to many
individuals with addiction, are not evidence-
based treatments for the disease.^59 The public
also does not seem to distinguish between risky
substance use and the disease of addiction.Most People in Need of Treatment Do Not Receive It ................................................
As an indicator of the lack of attention afforded
the disease of addiction, no single national data
source exists to compare the proportion of the
population in need of addiction treatment
involving any addictive substance to the
proportion that receives such treatment. While
about seven out of 10 people with hypertension,
major depression or diabetes get treatment for
their medical conditions, only about one in 10
people with addiction involving alcohol or drugs
other than nicotine do,* 60 (Figure 1.B), leaving a
treatment gap of 20.7 million individuals.^61
No data exist on the treatment gap for those with
addiction involving nicotine. The proportion of
individuals in need of addiction treatment
involving alcohol and drugs other than nicotine
who actually receive it has changed little since
2002, when 9.8 percent of those in need received
treatment.^62* For this comparison, CASA Columbia examined the
referenced national survey data to determine the
proportion of the population with each disease--those
with diagnosed or undiagnosed hypertension (59.3
million); those with diagnosed or undiagnosed
diabetes (25.8 million); those who met clinical
criteria for a major depressive episode in the past
year and/or received professional treatment (saw a
doctor, received medication, a combination thereof)
(22.4 million); and those who met clinical criteria for
addiction involving alcohol or other drugs excluding
nicotine in the past year and/or received professional
treatment for alcohol and/or other drugs in the past
year (23.2 million)--who received treatment.