development of pharmaceutical treatments and
the adoption of existing pharmaceutical
therapies; and a lack of adequate insurance
coverage.
Recent efforts by government agencies and
professional associations have begun to tackle
these challenges to closing the evidence-practice
gap, but are simply insufficient.
Nothing short of a significant overhaul in current
approaches is required to bring practice in line
with the evidence and with the standard of care
for other public health and medical conditions.
Given the prevalence of risky substance use and
addiction in America and the extensive evidence
on how to identify and address them, continued
failure to do so raises the question of whether
the insufficient care that patients with addiction
usually do receive constitutes a form of medical
malpractice. It also signals widespread system
failure in health care service delivery, financing,
professional education and quality assurance.
Recommendations and Next Steps.....................................................................................
It is time for health care practice to catch up
with the science. There is no silver bullet to
making this happen; instead, a broad set of
comprehensive reforms must be put in place.
Toward this end, CASA Columbia makes the
following recommendations:
Reform Health Care Practice .......................................................................................
Incorporate screening and intervention
for risky substance use, and diagnosis,
treatment and disease management for
addiction into routine medical practice.
As essential components of routine medical
care, all physicians and other medical
professionals should provide their patients
with addiction-related screening and, as
needed: brief interventions; comprehensive
assessment to determine disease stage,
severity and the presence of co-occurring
health conditions; stabilization; acute
treatment; chronic disease management; and
connection to support and auxiliary services.
Patients with severe cases of addiction
should be referred to an addiction physician
specialist. All medical schools and residency
training programs should educate and
train physicians to address risky
substance use and addiction. All
physicians should be educated and trained in
the origins of risky substance use and
addiction; prevention, intervention,
treatment and management options; co-
occurring conditions; and special population
and specialty-care needs. These core
clinical competencies should be required
components of all medical school curricula,
medical residency training programs,
medical licensing exams, board certification
exams and continuing medical education
(CME) requirements, including maintenance
of certification programs. Require non-physician health
professionals to be educated and trained
to address risky substance use and
addiction. Develop core clinical
competencies in addressing risky use and
preventing and treating addiction for each
type of non-physician health professional
including, physician assistants, nurses and
nurse practitioners, dentists, pharmacists and
graduate-level clinical mental health
professionals (psychologists, social workers,
counselors). Assure that these core clinical
competencies and specialized training are
required components of all professional
health care program curricula, graduate
fellowship training programs, professional
licensing exams and continuing education
(CE) requirements. Require all non-
physician health professionals providing
psychosocial addiction treatment services to
have graduate-level clinical training in
delivering these services. Require that all
pharmaceutical treatments for addiction be
provided only by a physician or in
accordance with a treatment plan managed
by a physician. Develop improved screening and
assessment instruments. Screening
instruments should be adjusted or developed