Many of these efforts, however, have been
aimed at shoring up and maintaining a separate
system of addiction treatment outside of
mainstream health care practice. Although these
are steps in the right direction, the research
documented in this report demonstrates clearly
that the current treatment infrastructure is
riddled with barriers to closing the vast gap
between research evidence and practice.^267 As
such, modifications to the existing system
simply will not suffice to make significant,
meaningful and lasting improvements in how
risky substance use and addiction are addressed
in the United States.
What is required is an integration of screening
and intervention for risky substance use and
treatment and management of addiction into
mainstream health care, assuring that addiction
treatment is managed by trained medical
professionals and supported by an array of
highly-trained clinical mental health
professionals and other providers of essential
support and auxiliary services.^268 Such
integrated care leads to improved patient
outcomes and significantly-reduced medical
costs.^269
Several recent developments have begun to
make significant strides in this direction:
Efforts to expand insurance coverage for
screening and brief interventions in primary
care settings, to offer equitable coverage for
addiction treatment services and to ensure
accountability by establishing quality
benchmarks in patient care as a condition for
coverage.^270
Efforts by professional societies and
associations to professionalize addiction
treatment, have the medical field respond to
risky substance use as a public health
problem and addiction as a medical
condition, and integrate care for risky
substance use and addiction into medical
practice. Notable examples include:
The American Society of Addiction
Medicine (ASAM) which is seeking to
improve the quality of care for riskysubstance use and addiction by:
educating physicians and other health
professionals about these issues;
supporting research and prevention
efforts; advocating for state and federal
policies that would expand access to
treatment; and working to establish
addiction medicine as a recognized
medical specialty.^271 The American Board of Addiction
Medicine (ABAM), which was founded
in 2007 with the encouragement and
assistance of ASAM, is working toward
the goal of establishing addiction
medicine as a medical specialty
recognized by the American Board of
Medical Specialties (ABMS). ABAM’s
sister organization, the ABAM
Foundation, began accrediting one- or
two-year fellowship training programs--
“secondary residencies”--in addiction
medicine open to physicians completing
training in any field certified by the
ABMS member boards.* Such
programs have the ability to train the
physician experts needed to meet the
demand within health care teams at all
locations where regular medical care is
received--from hospitals to community
clinics. The ABAM Foundation also is
working toward having its fellowship
training programs accredited by the
Accreditation Counsel for Graduate
Medical Education (ACGME).^272
NIAAA and NIDA recently awarded
grants to SUNY Buffalo and to Boston
University Medical Center to help
support this effort.^273 The American Society of Health-
Systems Pharmacists, a member of the
National Pharmacy Partnership for
Tobacco Cessation, which has created a
resource center to provide pharmacists
with tobacco cessation information and
tools to help patients stop smoking.^274* The ABAM Foundation to date has accredited 10
addiction medicine training programs across the
country, with more programs under development.