Barriers to Closing the Evidence-Practice Gap ...............................................................
America’s approach to addressing risky
substance use and providing addiction treatment
has evolved outside of the mainstream public
health and medical systems.* 147 As a result:
Most primary providers of intervention and
treatment for risky substance use and
addiction do not have the requisite training
or qualifications to implement the existing
range of evidence-based practices and face
many organizational and structural barriers
to providing services;
Most health professionals do not implement
evidence-based addiction care practices;
Performance and outcome measures that
should be a routine part of quality assurance
in mainstream medicine are limited and
rarely implemented in addiction treatment;
The pharmaceutical industry lacks the
incentive to develop new and effective
pharmaceutical interventions for addiction
treatment; and
Insurance coverage for evidence-based
intervention, treatment and disease
management is inadequate.
Because of the vast chasm between the health
care system and approaches to preventing risky
substance use or treating addiction, medical
professionals fail to address risky substance use
or addiction or take responsibility for
intervention or treatment, risky substance use is
addressed primarily in terms of its consequences
and addiction treatment providers are not held to
the same standards as providers of mainstream
medical care.
- See Chapter IX for an in-depth discussion of the
education and training requirements for those
providing services for risky substance use and
addiction.
The lack of integration of screening and
intervention and addiction treatment into
mainstream health care has led to many missed
opportunities to help patients who engage in
risky substance use or who have addiction and
has contributed to the high rates of relapse and
enormous health and social consequences
associated with risky use and addiction.The Addiction Treatment Workforce is Not
Qualified to Implement Evidence-Based
Practices
For most illnesses, the preponderance of
treatment interventions, including coordination
of services, occurs within mainstream medicine
and is provided and managed by trained medical
professionals. Other highly-trained and
credentialed health professionals may be part of
a team of providers working with a physician.
Motivated and experienced non-professionals
may serve additional vital functions--such as
providing social support to encourage adherence
to a treatment plan and help patients maintain
important lifestyle changes that can reduce the
risk of relapse--but their roles and services do
not supersede or replace those of the medical
team.In contrast, the majority of care for individuals
with addiction is provided by people without any
medical training at all and rarely is supervised
by medical professionals. Physicians and other
medical professionals typically are absent from
or on the periphery of the treatment process,
occasionally being called in to provide a
prescription or medically monitor a
detoxification protocol.One of the fundamental barriers to providing
effective treatment is the fact that addiction is
not integrated into medical practice. And a lot
of medical people like and want it that way; they
do not want to deal with addiction; they do not
like to deal with the people and they do not feel
effective addressing the problem.^148--Keith Humphreys, PhD
Professor
Stanford Medical School