Addiction Medicine: Closing the Gap between Science and Practice

courses and limited time spent in courses on the
topic of addiction.^202

Inadequate training in risky use and addiction
means that many physicians do not recognize
these conditions in their patients, do not believe
that substance-related interventions are
effective,^203 are unaware of what do with a
patient who screens positive for risky use or
addiction or are uninformed about effective
resources to which they could refer patients in
need of more in-depth assessment or of specialty
treatment.^204

Most schools lack employees or consulting
personnel with the necessary training and
resources for identifying students who engage in
risky use of addictive substances and attaining
appropriate intervention services for those
students who need them.^205 CASA Columbia’s
survey of school personnel conducted for its
2011 report, Adolescent Substance Use:
America’s #1 Public Health Problem, found that
three-fourths of teachers are unable to identify a
professional in their schools who would be able
to help students with a substance use problem.
Only 26.9 percent of teachers report that their
schools train educators and other school staff to
identify and respond to student substance use.^206
Other national surveys likewise find that high
school counselors and school psychologists
generally report low competence in providing
direct substance-related intervention services to
students and a lack of relevant opportunities to
become trained in doing so.^207 Most schools
have not set up partnerships with health care
providers trained in conducting screening or
early interventions to refer students who engage
in risky use nor do they have links to appropriate
treatment programs to which they refer students
with addiction.^208

CASA Columbia’s 1999 report, No Safe Haven:
Children of Substance-Abusing Parents, found
that insufficient training among most child
welfare workers and family court judges greatly
contributes to the lack of effective screening
practices in the child welfare system.^209 CASA
Columbia’s research, published in its 2010
report Behind Bars II: Substance Abuse and
America's Prison Population, found that

probation and parole officers in the justice

system need to be better trained as well.^210

A related barrier to screening for risky use of

addictive substances and providing brief

interventions is the lack of effective and

appropriate specialty treatment services

available for referral when addiction is

identified.^211 Although having more trained

addiction physician specialists is critical to

providing care for those with severe forms of the

disease, the lack of such specialty providers is

not a legitimate barrier to providing screening

and brief interventions. Neither is it a legitimate

reason for general health care professionals to be

unprepared to provide addiction treatment that

does not require specialty care. These services

are designed to be provided in non-specialty care

settings, along with some forms of assessment

and treatment (see Chapter V). The real barrier

in this case remains the lack of knowledge about

risky use and addiction and insufficient training

in addressing these issues among health

professionals.

Competing Priorities/Insufficient Resources ...............................................................

Lack of time and resources in the face of

competing priorities is one of the most

prominent barriers to implementation of

screening and brief interventions among health

professionals,^212 school personnel^213 and

government agencies.^214

Because the general model in medicine today

(which is reflected or driven by insurance

reimbursement structures) is procedure-oriented

and reactive more than preventive, and because

insurance coverage for screening and brief

interventions for substance use has been rare,*

these services end up falling low on most

physicians’ lists of competing priorities for their

time and attention.^215

Schools and government agencies that

administer justice programs or provide social

services also face competing priorities and

financial constraints that serve as barriers to

* See Chapter VIII.