Addiction is the most neglected disease in the United States medical system. Disagree with this statement? Consider this:
- Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions (27 million), diabetes (26 million), or cancer (19 million).
- Another 80 million people, while not addicted, engage in using tobacco, alcohol and other drugs in ways that threaten health and safety.
- In 2010, we spent $28 billion to treat people with addiction. In that same year, we spent $44 billion on diabetes treatment; $87 billion on cancer treatment; and $107 billion to treat heart disease.
- Only 1 in 10 people with addiction involving alcohol and drugs other than nicotine receive any treatment; and even those who do receive treatment do not receive anything resembling evidence-based care.
With more people in need of treatment for addiction than for diabetes, cancer or heart conditions and the investment on addiction treatment being far less than the amount spent on the other diseases, what becomes crystal clear is that decades of marginalizing addiction as a social problem rather than treating it as a medical condition have had enormous and devastating consequences.
"Addiction Medicine: Closing the Gap Between Science and Practice," a five-year study released by CASA Columbia, exposes the gaping chasm between what we know about addiction and how to identify, treat and manage it, and what we actually do in current practice.
Misunderstandings about the nature and treatment of addiction are undermining medical care. There simply is no other disease for which appropriate medical treatment is available but is not provided by the health care system; patients instead must turn to a broad range of practitioners with limited, if any, medical training, many of whom do not provide evidence-based treatment services.
Despite the prevalence of addiction in our society, there are no consistent and regulated national standards that stipulate who may provide addiction treatment in the U.S.; treatment standards vary by state and by payer.
Much of what passes for "treatment" of addiction, such as mutual support groups, bears little resemblance to the treatment of other health conditions. Much of what is offered in addiction "rehabilitation" programs has not been subject to rigorous scientific study, and the existing research demonstrating principles of effective treatment has not been widely adopted or integrated effectively into many of the treatment programs operating nationwide.
This neglect is inexcusable given decades of accumulated scientific evidence attesting to the fact that addiction is a brain disease with significant behavioral components for which there are effective interventions and treatments.
Addiction and risky use constitute one of the largest preventable and most costly health problems facing the U.S. today. Since the tools exist to screen and intervene for risky substance use and to diagnose, treat, and manage addiction, the question is: Why are we failing to employ them?
The first reason is that the doctors who are responsible for diagnosing and treating disease are not trained in addiction, nor for the most part are they paid to address it.
The second reason is that most treatment providers are not medical professionals and therefore not equipped to provide the full range of available treatments. Minimum requirements for addiction counselors, who make up the largest group of treatment providers, are less than a bachelor's degree in 44 states. It would seem that addiction training resembles more of an apprenticeship model than a professional education model based on science and best practice.
And finally, addiction treatment facilities and programs are not adequately regulated or held accountable for treatment consistent with medical standards and proven practices.
Tragically, this neglect by the U.S. medical system results in 1) millions of sick Americans, since risky use and addiction account for one-third of inpatient hospital costs; 2) millions of deaths, since risky use and addiction account for 20 percent of deaths in U.S; and 3) an astronomical tax bill of $467 billion per year in government costs attributable to the disease, of which 95 cents of every dollar go to cope with the consequences of our failure to prevent and treat addiction and only two cents go toward disease prevention or treatment.
There is no other disease that affects so many people or has such far-reaching consequences, that is as neglected as the disease of addiction. With skyrocketing health care costs nationwide and the Supreme Court decision on the Affordable Care Act expected this week, there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction. It is time to bring treatment of addiction into mainstream health care.
William H. Foster, Ph.D., is President and CEO of The National Center on Addiction and Substance Abuse at Columbia University (CASAColumbia).
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