Addiction Medicine: Closing the Gap between Science and Practice

Nutrition and Exercise Are Not Integrated
into Addiction Treatment. Although good
nutrition and exercise are important components
of comprehensive addiction treatment* 103 --
particularly in light of recent research
underscoring common brain circuitry involved
in substance-related addiction and obesity^104 --the
extent to which nutrition and exercise are
incorporated into addiction treatment has not
been examined. One small study† found that 56
percent of dietitians and nutrition program
managers working in addiction treatment
facilities reported that their facilities offered
nutrition-related addiction education in group
settings to only about half of their patients.
Fifty-six percent of respondents reported
offering nutrition-related addiction education in
individual settings to an average of 18 percent of
their patients.^105

Formal Treatment Is Conflated with Support
Services. The overwhelming salience and
considerable evidence--although largely
anecdotal--of the benefits of mutual support
programs like Alcoholics Anonymous (AA), for
example, have led many people to conflate such
support services with actual addiction treatment
rather than to recognize them as highly useful
systems of support that should accompany or
follow evidence-based clinical treatment.‡ 106
Mutual support programs are facilitated by
members whose main credential is that they
themselves have experienced an addictive
disorder and have learned to manage it. Such
support, however, is quite different than
treatment for a medical condition.§ 107 Few
would argue that any other disease be treated

• See Chapter V.
  † Using a non-randomized sample.
  ‡ There are some exceptions where, depending on the

severity of disease symptoms and the patient’s health
status and degree of social support, certain patients
are able to manage their addiction with support
services only or no interventions at all. In addition, it
should be noted that Twelve-Step Facilitation,
discussed in Chapter V, is a formalization and
professionalization of the 12-step mutual support
model and has been deemed an evidence-based
treatment for addiction.
§ AA openly recognizes addiction as a medical

condition.

solely via support groups composed of those

who themselves have had the condition.

Tailored Treatment Services ......................................................................................

Whereas research clearly indicates that to be

effective interventions should be tailored not

only to the stage and severity of a patient’s

illness but also to a patient’s co-occurring

conditions and other personal characteristics and

life circumstances that might affect treatment

outcome, most health professionals and

addiction treatment programs follow a one-size-

fits-all approach to treatment.

Disease Severity Rarely is Assessed and

Interventions Rarely are Tailored to Stage

and Severity of Disease. It is standard

recommended medical practice to assess the

stage and severity of a patient’s disease in order

to develop an effective treatment plan and tailor

treatment accordingly.^108 Assessment of disease

severity is an essential part of addiction

treatment as well.^109 One of the most widely-

used tools, both in research and clinical practice,

for assessing the severity of addiction is the

Addiction Severity Index, although even this

instrument fails to address addiction involving

nicotine.^110 Yet, the extent to which treatment

providers tailor treatment protocols based on the

findings of such assessments is limited.^111

Instead, addiction treatment programs typically

utilize a non-tailored approach to patient care.^112

Having patients pass through a rigid, time-

limited treatment program that assumes

uniformity in disease symptoms and severity

simply burdens patients with unnecessarily

extensive interventions or with interventions that

are too brief or superficial to have a significant

impact on their symptoms. Yet the standard

treatment for addiction is non-intensive

outpatient treatment,^113 often without adequate

professional follow-up care and disease

management. Even residential treatment

typically is limited to a 28-day stay in a program

despite little evidence that the condition remits

after such a brief period of time.^114 Given this

standard approach to treatment that focuses

primarily on acute care only, it is little wonder

that relapse is so common and that addiction