Assessment, Stabilization and Acute Treatment ........................................................
Despite the existence of effective assessment,
stabilization and treatment options, addiction
treatment today for the most part is not based in
the science of what works.^46 Depending on
disease stage and a range of other health and
social factors, some people with addiction may
be able to stop using addictive substances and
manage the disease with support services only;
however, most individuals with the disease
require clinical treatment.^47 The failure of many
providers to properly assess the stage and
severity of the disease and provide effective
psychosocial and pharmaceutical therapies
appears in large part to be due to a lack of
appropriate education and training.* 48
While physicians are somewhat better at
assessing tobacco use among their patients and
discussing options for treatment, there is still
much room for improvement. A recent national
survey found that approximately two-thirds of
primary care physicians (68.5 percent) and
psychiatrists (63.8 percent) report discussing
medication options for smoking cessation with
their patients, as do 22.6 percent of dentists and
14.5 percent of emergency medicine
physicians.^49
CASA Columbia’s 2000 survey of physicians
and patients found that 94 percent of primary
care physicians (excluding pediatricians) failed
to identify addiction as a possible diagnosis
when asked to offer five possible diagnoses of a
patient with symptoms of risky alcohol use.
Most patients responding to that survey (53.7
percent) reported that their primary care
physician did nothing about their addiction; 10.7
percent said their physician knew about it and
still did nothing. The majority of patients (74.1
percent) said their primary care physician was
not involved in their decision to seek treatment
and 16.7 percent said their physician was
involved only “a little.”^50
CASA Columbia’s research also found that 40.8
percent of pediatricians failed to diagnose
- See Chapter IX.
addiction when presented with a classic
description of an adolescent patient with
symptoms of addiction involving drugs (other
than nicotine or alcohol).^51 However, another
study found that, among adolescent patients
diagnosed with addiction, primary care
physicians recommended some type of follow-
up† for 94.7 percent of the patients.^52 A study of
adolescents admitted to an inpatient psychiatric
unit‡ found that one-third met clinical criteria for
addiction, but outpatient clinicians had not
identified addiction in any of these patients
before admission to the inpatient unit.^53Other research found that only 13 percent of
patients who received an addiction-related
diagnosis while visiting an ED received follow-
up addiction treatment services within two
weeks of the visit.§ More than 200 patients in
the study had another ED visit within two
months of their initial ED visit,^54 suggesting that
hospitals do not appropriately address patients’
addiction or provide them with referrals to
treatment.** 55 A study of ED patients admitted
with cocaine-related chest pain found that three-
quarters (74.7 percent) had not received any
treatment three months after discharge.^56Detoxification Frequently is Considered
Treatment Rather Than a Precursor to
Treatment. A minority of patients who
participate in detoxification programs go on to
receive treatment, despite evidence that† Defined in this study as any plan beyond periodic
screening, including notification of parents, referral
to counseling, return visit with the primary care
physician or noting that the patient already was in
counseling for substance use.
‡ Patients were admitted to the unit for psychiatric
conditions other than addiction.
§ The primary diagnosis for patients included in the
study was addiction for 28 percent of the sample,
mental health issues for 13 percent of the sample and
medical (non-psychiatric) disorders for 59 percent of
the sample.
** Another study found that patients with unmet
addiction treatment needs are nearly twice as likely to
be admitted to the hospital and nearly one-and-a-half
times as likely to have made at least one ED visit in
the past year compared to patients without unmet
treatment needs.