No Overarching Organizing Body for Addiction Science and Treatment .................
Unlike other major health conditions, there is no
highly credible and unifying organization,
within or outside of the National Institutes of
Health (NIH), which sets standards and
advocates for addiction prevention and
treatment, including all manifestations of
addiction.
A key mission of the National Cancer Institute is
to conduct and support “research, training,
health information dissemination and other
programs with respect to the cause, diagnosis,
prevention and treatment of cancer,
rehabilitation from cancer, and the continuing
care of cancer patients and the families of cancer
patients.”^258 Likewise, according to the
American Heart Association’s description of its
organization, “we fund innovative research, fight
for stronger public health policies and provide
lifesaving tools and information to prevent and
treat these diseases.”^259
Although there are federal institutes and
organizations dedicated to substance use and
addiction, including the National Institute on
Drug Abuse (NIDA), the National Institute on
Alcohol Abuse and Alcoholism (NIAAA) and
the Substance Abuse and Mental Health
Services Administration (SAMHSA) as well as
other organizations and institutes for which
substance use and addiction are part of their
focus,* there is no unified body that promotes
research, public awareness and prevention and
treatment quality for the disease of addiction.
The result is a disjointed array of programs and
efforts that often have quite different
perspectives and approaches to addressing the
issues surrounding substance use and addiction,
which further contributes to the segmented view
of addiction as multiple substance- and
behavior-specific problems, rather than a single
disease with different manifestations.
- Such as the National Cancer Institute (NCI),
primarily in relation to smoking, the National
Institute of Mental Health (NIMH) and the Centers
for Disease Control and Prevention (CDC).
A recent plan by the NIH would combine public
health initiatives related to substance use and
all addiction-related research within the NIH
into a new institute focused on substance use
and addiction.^260 This proposal is controversial
with regard to how the merger will affect the
funding and research portfolios not only of
NIDA and NIAAA but also of other NIH
institutes with interests that involve substance
use and addiction (e.g., those that address
cancer, HIV, prenatal care, birth defects, obesity,
pain control).^261 Its strength is a clear and long-
overdue recognition of the nature of the disease
of addiction and the importance of addressing it
in a unified way.Efforts to Integrate Substance Use
Prevention and Treatment into
Mainstream Medicine
Recent efforts aimed at improving the
prevention of risky substance use and the
treatment of addiction have concentrated on the
application of quality improvement and quality
assurance measures such as those that have
gained traction in mainstream health care
practice: Developing, disseminating and promoting
evidence-based practices;^262 Improving the treatment provider workforce
through enhanced education and training;^263 Improving performance measures;^264 Shifting evaluation efforts from a focus on
performance-based measures that document
the process of service delivery to a focus on
patient outcomes, and rewarding those
programs that demonstrate positive patient
outcomes;^265 and Using electronic health records and other
forms of health information technology to
track and monitor patients and help improve
the coordination and delivery of care.^266