Millions of people know what it’s like to lose everything to addiction. Millions more know what it’s like to live with a parent or family member who abuses drugs or alcohol. What too many don’t know is how to get better.
In spite of a large body of research showing that addiction is a chronic disease, only one in 10 addicts receives any form of treatment – often, treatment that falls woefully short of what we know works, according to a five-year study by The National Center on Addiction and Substance Abuse (CASA) at Columbia University.
Rather than helping, most forms of addiction treatment are hindering recovery and costing the public in the process. The CASA report identified the following specific problem areas:
• Stigma – One-third of Americans still regard addiction as a moral failing or a lack of willpower rather than a treatable disease. Addiction affects more Americans than other chronic health conditions, yet the disease is shunned by the medical community, CASA reports. Spending to treat addiction ($28 billion to treat 40 million people) falls far behind other conditions, such as diabetes ($44 billion to treat 26 million people), cancer ($87 billion to treat 19 million people) and heart conditions ($107 billion to treat 27 million people).
• Inadequate Training – Medical professionals are in a unique position to intervene in addiction. More than two-thirds of addicts are in contact with a physician about twice a year, CASA reports. But because most medical professionals have very little training or education in addiction, they are unprepared to provide simple screenings, a diagnosis, treatment or referrals.
While doctors routinely screen patients for other chronic health conditions, they just as routinely overlook addiction, even though addiction is at the root of 70 other health problems, 20 percent of deaths in the U.S. and one-third of all hospital inpatient costs, according to CASA.
Almost half of Americans say they would reach out to their health care provider for help with addiction, CASA reports, yet less than 6 percent of referrals to treatment come from health professionals. A much larger percentage (44.3 percent) comes from the criminal justice system, which is not surprising given our history of treating addiction as a crime rather than a disease.
• Lack of Quality Care – Because there are no clear national standards delineating who can provide addiction treatment in the U.S., the people providing care are often addiction counselors who may lack the knowledge and skills to provide evidence-based treatment. In some states, these individuals are not required to be licensed or certified, and may only need a high school diploma or GED to qualify.
Addiction counselors are valuable members of the treatment team, but do not always provide sufficient care alone. Because addiction is a medical illness, patients are better served by a multidisciplinary team that also includes physicians, nurses and graduate-level mental health professionals.
Instead of being treated as a chronic disease that requires individualized care and ongoing management, addiction is too often treated as an acute condition that can be addressed within a few days. While the most reputable addiction treatment centers are accredited by independent bodies like CARF, many facilities are not reviewed, regulated or held accountable for their treatment practices.
Because of these obstacles, patients are often left alone to sort through the vastly different treatment approaches without independent data to help them make informed decisions. Even when high-quality treatment is available, patients may be barred by cost considerations, stringent eligibility criteria, limited insurance benefits and long waiting lists.
• Insufficient Insurance Coverage – Private insurance has failed to provide adequate benefits for addiction treatment, leaving patients to try to cover their own costs. While private insurance covers 54.4 percent of costs in general health care spending, it covers only 20.8 percent of the costs of addiction treatment, CASA reports.
Thanks to scientific research, we know that addiction is a disease that changes the function and structure of the brain. We know the risk factors and have effective ways to screen for the disease and intervene promptly. We have more information about the science of addiction than ever before, yet more people are addicted now than at any time in our history.
Science has shown us how we get addicted, but it hasn’t helped us understand how we get better. Part of the problem, as CASA reports, is that treatment hasn’t kept pace with science. But another part of the problem has been largely ignored, even in the recent CASA report.
While treatment needs to catch up to science, I believe science also has some catching up to do. The millions of people suffering with addiction need more than scientific knowledge; they need practical, real world solutions that help them make critical decisions about their health. What is needed is a new blueprint for treatment – one that integrates a science-based model with 12-Step recovery programs.
Instead of treating addiction solely as a brain disease (like diabetes and other medical conditions, it is also a complex behavioral disorder) and focusing on pharmacotherapy, we also need to closely examine the movement that has helped millions of addicts sustain a drug-free life: 12-Step recovery. Recovery is more than going to meetings, sharing stories and embracing random recovery principles; it is part of a neurophysiological process that reshapes the brain by remedying the deficits caused by drug and alcohol abuse.
Addiction is a medical illness that requires medical care. We can, and must, do better in this area. But we would have an even greater impact if we also learned from the success of people in long-term recovery and considered the research supporting the efficacy of the 12-Step model. It is not an either/or proposition, for as any recovering addict knows, we need all the tools we can muster to beat this disease.
David Sack, M.D., is board certified in addiction psychiatry and addiction medicine. Dr. Sack served as a senior clinical scientist at the National Institute of Mental Health (NIMH) where his research interests included affective disorders, seasonal and circadian rhythms, and neuroendocrinology. He currently serves as CEO of Elements Behavioral Health, a network of treatment programs that includes Promises, The Recovery Place, The Sexual Recovery Institute, and The Ranch.
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Last reviewed: 30 Jun 2012