Addiction Medicine: Closing the Gap between Science and Practice

 Stabilization of the patient’s condition via
cessation of substance use and medically
supervised detoxification, when necessary,
as a precursor to treatment;

 Acute Care via evidence-based
pharmaceutical and/or psychosocial
addiction treatments, accompanied by
treatment for co-occurring health conditions,
delivered by qualified health professionals;

 Chronic Disease Management to help the
patient maintain the progress achieved
during acute treatment and prevent relapse.
The process should be medically supervised
and should involve pharmaceutical and/or
psychosocial therapies and continued
management of co-occurring health
conditions as indicated; and

 Support Services including encouragement
to participate in mutual support programs
and the provision of auxiliary support
services such as legal, educational,
employment, housing and family supports.

A Comprehensive Approach to Treatment ........................................................................

A comprehensive approach to addiction requires
recognition of addiction as a primary disease and
that all substances and behaviors associated with
addiction are addressed in treatment, rather than
a focus only on an individual addictive
substance. It is all too common, for example,
for addiction involving nicotine to be ignored in
the course of treating addiction involving
alcohol or other drugs. Accordingly, when
treating addiction, it is critical to recognize the
high rates of co-occurrence of different
manifestations of addiction and the possibility of
the existence of an addiction syndrome, in which
common pathways underlie related addictive
behaviors (e.g., obesity or bulimia and addiction
involving alcohol) and in which individuals may
switch from one object of addiction* to another
(e.g., from prescription opioids to heroin, from
addictive substances to pathological gambling).^5

• Including the source of reward or relief.

Similarly, treatments for one manifestation of

addiction tend to have spillover effects, either

ameliorating the symptoms of other

manifestations of addiction or proving effective

in the treatment of multiple expressions of

addiction (e.g., naltrexone for the treatment of

addiction involving opioids, alcohol as well as

gambling).^6

When treatment is too highly focused on a

specific substance or behavior, it may not be

addressing the actual underlying causes of the

addiction or the possibility of “addiction

Numerous studies have shown that addiction

treatments are just as effective as those for other

illnesses.^2

--Alan I. Leshner, PhD

Chief Executive Officer

American Association for the

Advancement of Science

Executive Publisher, Science

Former Director

National Institute on Drug Abuse (NIDA)

[I would define treatment for addiction] the way I

would define treatment for any medical problem--

good thorough evaluation, intervention tailored

for that specific person based on a good

assessment, use of a range of tools--behavioral,

pharmacological, family and other social support,

housing, jobs.^3

--John Rotrosen, MD

Professor, Department of Psychiatry

New York University School of Medicine

VA NY Harbor Healthcare System

The goal of the ‘good and modern’ system is to

provide a full range of high-quality services that

meet the range of age, gender, cultural and other

circumstances that the individual brings to

treatment. It is grounded in a public health model

that addresses system and service coordination;

health promotion and prevention, screening and

early intervention; treatment and recovery; and

resiliency supports to promote social integration

and optimal health and productivity.^4

--H. Westley Clark, MD, JD, MPH

Director

Center for Substance Abuse Treatment, SAMHSA