Addiction Medicine: Closing the Gap between Science and Practice

every person in America.^77 Nearly one-third
(32.3 percent) of all hospital inpatient costs are
attributable to substance use and addiction.^78

Most Funding for Addiction Treatment Comes from Public Sources .........................

Spending on addiction treatment totaled an
estimated $28.0 billion in 2010. Whereas
private payers (including private insurers and
self-payers) are responsible for 55.6 percent
($1.4 trillion) of medical expenditures in the
U.S., they are responsible for only 20.8 percent
($5.8 billion) of addiction treatment spending.^79

The concentration of spending for addiction
treatment in public programs suggests that
insurance across the board does not adequately
cover costs of intervention and treatment,
resulting in costly health and social
consequences that stem from untreated addiction
and that fall disproportionately to government
programs. National data indicate that
individuals with private insurance are three to
six times less likely than those with public
insurance to receive specialty addiction
treatment.^80

The Education, Training and Accountability Gap .......................................................

Compounding the profound gap between the
need for addiction treatment and the receipt of
such care is the enormous gulf between the
knowledge available about addiction and its
prevention and treatment and the education and
training received by those who provide or should
provide care. In spite of the evidence that
addiction is a disease:

 Most medical professionals who should be
providing addiction treatment are not
sufficiently trained to diagnose or treat it;

 Most of those who are providing addiction
treatment are not medical professionals and
are not equipped with the knowledge, skills
or credentials necessary to provide the full
range of evidence-based services to address
addiction effectively;^81 and

 Addiction treatment facilities and programs

are not adequately regulated or held

accountable for providing treatment

consistent with medical standards and

proven treatment practices.^82

Further complicating this education, training and

accountability gap is the fact that there are no

national standards for the provision of addiction

treatment and instead considerable inconsistency

among states in the regulation of individual

treatment providers and of the programs and

facilities that provide addiction treatment

services.*

The Profound Disconnect between Evidence and Practice ..........................................

The prevention and reduction of risky substance

use and the treatment of addiction, in practice,

bear little resemblance to the significant body of

evidence-based practices that have been

developed and tested; indeed only a small

fraction of individuals receive interventions or

treatment consistent with scientific knowledge

about what works.^83

Providing quality care to identify and reduce

risky substance use and diagnose, treat and

manage addiction requires a critical shift to

science-based interventions and treatment by

health care professionals--both primary care

providers and specialists.

Significant barriers stand in the way of making

this critical shift, including: an addiction

treatment workforce starved of resources,

operating outside the medical profession and

lacking capacity to provide the full range of

evidence-based practices including necessary

medical care; a health professional that should

be responsible for providing addiction screening,

interventions, treatment and management but

does not implement evidence-based addiction

care practices; inadequate oversight and quality

assurance of treatment providers and

intervention practices; limited advances in the

* With the notable exception of the regulation of

medication-assisted therapy for addiction involving

opioids.