programs smoke--a rate more than three times
that in the general population.^73
Pharmaceutical Treatments are
Underutilized. A key factor in integrating
addiction treatment into mainstream medicine is
broader implementation of pharmaceutical
interventions, when indicated.^74 Yet providers
of addiction treatment vastly underutilize
evidence-based pharmaceutical therapies.^75
CASA Columbia’s survey of directors of
addiction treatment programs in New York State
found that less than half (47.0 percent) indicated
that pharmaceutical treatments are offered in
their addiction treatment programs.^76
A national longitudinal survey of programs that
offer addiction services* found that the
percentage of programs offering nicotine
replacement therapy (NRT) decreased
significantly from 38.0 percent during 2002-
2004 to 33.8 percent four years later. Programs
were more likely to continue offering NRT if
they were medically oriented (i.e., located in a
hospital setting with access to physicians).^77
Underutilization of pharmaceutical treatments is
particularly common in treatment programs that
are publicly funded, small, not located in a
hospital, not accredited† and have few medical
professionals--including physicians and nurses--
on staff.^78 National data indicate that among
privately- and publicly-funded treatment
programs, approximately half have adopted at
least one pharmaceutical treatment for
addiction.‡ 79
- Including privately-funded treatment organizations,
publicly-funded treatment organizations and
therapeutic communities.
† By the Joint Commission or the Commission on
Accreditation of Rehabilitation Facilities (CARF).
(See Chapter IX for a description of these accrediting
organizations.)
‡ Approximately 51 percent of privately-funded
programs and 25 percent of publicly-funded
programs adopted buprenorphine in their treatment of
addiction, 40 percent of private programs and 19
percent of public programs adopted acamprosate or
tablet naltrexone, 30 percent of private programs and
16 percent of public programs adopted disulfiram and
The limited adoption of pharmaceutical
treatments for addiction, when indicated, is due
in large part to a lack of qualified medical staff
in addiction treatment programs to prescribe and
monitor medication protocols.^80 Thirty-eight
percent of publicly-funded programs do not even
have access to a prescribing physician, nor do 23
percent of privately-funded programs.^81Treatment providers seem to have more negative
attitudes toward the use of pharmaceutical
therapies relative to psychosocial therapies.^82
Some treatment programs see pharmaceutical
treatments for addiction, such as the use of
methadone maintenance treatment for addiction
involving opioids, as incompatible with
abstinence-based treatment approaches;^83 there
is a stigma among some providers attached to
the use of pharmaceuticals to achieve abstinence
from a drug to which the patient is addicted.
One of the key predictors of the underutilization
of pharmaceutical treatments is adherence of
treatment providers to a strong 12-step ideology
for addiction treatment.^84CASA Columbia’s survey of treatment providers
in New York State found that respondents were
more likely to say that recreational therapy/
leisure skills training is a “very important”
intervention for a treatment facility to offer to
patients§ than to say the same of pharmaceutical
treatments.** 85Addiction treatment medications also may be
underutilized by physicians themselves due in
part to insufficient evidence regarding optimal
dosages of certain pharmaceutical therapies,
durations of use, how to combine the use of
medications with counseling and theless than 20 percent of private programs and less than
10 percent of public programs adopted injectable
naltrexone in their treatment protocols.
§ 51.8 percent of program directors, 54.7 percent of
staff providers.
** 28.0 percent of program directors, 33.8 percent of
staff providers for methadone maintenance treatment
and 43.9 percent of program directors, 45.7 percent
of staff providers for other medication treatments for
addiction such as buprenorphine, disulfiram or
naltrexone.