Addiction Medicine: Closing the Gap between Science and Practice

0.6

1.4

5.7

10.6

12.1

25.3

44.3

Employers

Schools

Health Care Providers

Addiction Treatment Providers

Community Sources

Individuals

Criminal Justice System

* Excluding nicotine.

Source: CASA Columbia analysis of The Treatment Episode

Data Set (TEDS), 2009.

P E R C E N T

Figure 7.K

Sources of Referral to Publicly-Funded

Addiction* Treatment

Another national survey found that 65 percent of
adults would turn to a health care provider for a
problem involving alcohol.^65 Despite these
findings, the smallest proportion of referrals to
publicly-funded addiction treatment comes from
health professionals.^66

Of all the admissions to publicly-funded
addiction treatment in 2009, 44.3 percent were
referred by the criminal justice system.* One-
quarter (25.3 percent) of referrals came from
individuals, including concerned family
members, friends and the self-referred;† 12.1
percent were referred by community sources
such as social welfare organizations, religious
organizations and mutual support programs;‡
10.6 percent were referred by addiction
treatment providers§ for additional treatment and

• Referrals from the criminal justice system include

referrals from any police official, judge, prosecutor,
probation officer or other person affiliated with a
federal, state or county judicial system. This
category also includes referrals by a court for
DWI/DUI, patients referred in lieu of or for deferred
prosecution, during pretrial release, before or after
official adjudication, as well as referrals of those on
pre-parole, pre-release, work or home furlough or
Treatment Alternatives for Safe Communities
(TASC).
† Separate data on each of these categories are not

available in the TEDS dataset.
‡ Community sources of referral also include

government agencies that provide aid in the areas of
poverty relief, unemployment, shelter or social
welfare and referrals from defense attorneys.
According to the TEDS data, defense attorneys are
not included in the criminal justice system category;
prosecutors are included in that category. These
community referral categories cannot be examined
separately in the TEDS dataset.
§ Addiction service providers are those programs,

clinics or health care providers whose principal
objective is treating patients with addiction, or where
a program’s services are related to substance use
prevention or education. TEDS distinguishes
between transfers within a single, continuous
treatment episode and the initiation of a new
treatment episode but, because TEDS relies on state
administrative systems that appear to differ greatly in
their ability to distinguish transfers within a
continuous treatment episode from the initiation of a
new treatment episode, some transfers may be
reported by TEDS as new treatment episodes.

5.7 percent were referred by a health care

provider.** Very few treatment referrals came

from schools (1.4 percent)†† or from employers

or Employee Assistance Programs (0.6

percent).^67 (Figure 7.K‡‡)

Given that addiction is a medical disease

requiring the intervention of trained medical

professionals and the high prevalence of this

disease in the general population,§§ the fact that

only 5.7 percent of treatment admissions are

referred by health professionals highlights the

extent to which health professionals fail to

address this disease in their practice. The fact

that the largest proportion of referrals to

addiction treatment comes from the criminal

justice system further underscores how

extensively we neglect to address addiction until

the consequences are too dire to ignore.^68 The

** Referrals to treatment programs from health care

providers include those from physicians (including

psychiatrists) or other licensed health professionals,

or from a general hospital, psychiatric hospital,

mental health program or nursing home.

†† Including a school principal, counselor, teacher,

student assistance program (SAP), the school system

or an educational agency.

‡‡ These data are from the TEDS dataset.

Comparable data on referral to treatment for nicotine

addiction (smoking cessation) are not available. The

data reported here do not include referrals to

detoxification programs.

§§ See Chapters II and III.