as a character flaw and a moral failing rather
than a preventable and treatable disease.
It is past time for health care practice to catch up
with the science. Efforts already underway to
close this gap must be expanded and accelerated.
Toward this end, CASA Columbia makes the
following recommendations:
Reform Health Care Practice
Incorporate Screening and Intervention for
Risky Substance Use, and Diagnosis,
Treatment and Disease Management for
Addiction into Routine Medical Practice
As essential components of routine medical care
practice, all physicians and other medical
professionals should provide their patients with:
Routine screening for all forms
of risky substance use--including tobacco,
alcohol, illicit drugs and controlled
prescription drugs--at initial visit to a
primary care or specialty care physician and
routinely thereafter, and upon entry into a
hospital, emergency department, trauma
center or clinic;
Brief interventions as needed;
Comprehensive assessment to determine
disease stage and severity as well as the
presence of co-occurring health conditions
and special population needs;
Patient stabilization (e.g., detoxification),
when necessary, as a precursor to treatment;
Development of a tailored treatment plan
that includes:
Acute treatment via evidence-based
psychosocial and/or pharmaceutical
interventions; Chronic disease management, as
needed; Connection to support and auxiliary
services--including legal, educational,
employment, housing and family
supports, nutrition and exercise
counseling, and mutual support
programs; and Referral to physicians trained in
addiction medicine or addiction
psychiatry for specialty care as needed.Evidence-based screening can be conducted by a
broad-range of licensed providers with general
training in addiction and specific training in how
to conduct such screens and what to do with
patients who screen positive. Brief interventions
can be provided by health professionals--
licensed graduate-level medical or mental health
clinicians--trained in addiction care.Treatment and disease management services can
be provided through a multi-disciplinary team of
appropriately trained and credentialed health
professionals managed by a physician: Comprehensive assessment, diagnosis,
stabilization, acute treatment and disease
management must be performed or managed
by physicians in collaboration with a team
of licensed graduate-level medical or mental
health clinicians trained in addiction care; Case management can be provided by
licensed physician assistants, nurses and
nurse practitioners and mental health
clinicians trained in addiction care; Auxiliary services can be provided by a
range of professional and paraprofessional
personnel working within the treatment and
disease management plan; Peer support, often an important component
of the larger treatment plan, can be provided
by those who have learned to manage the
disease.