A recent comprehensive report by the National Center on Addiction and Substance Abuse (CASA) at Columbia University found that most doctors fail to identify or diagnose substance abuse “or know what to do with patients who present with treatable symptoms.”
Only about 10 percent of the 22 million Americans with a drug or alcohol problem receive treatment, the report found. After including 18 million other people whose only addiction is to nicotine, it estimated that 40 million Americans are addicted to one or more substances. And although effective treatments exist, “the vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care,” researchers concluded.
Despite its prevalence and impact — addiction is linked to more than 70 diseases or conditions and accounts for a third of inpatient hospital costs, according to CASA — the subject is rarely taught in medical school or residency training. Of the 985,375 practicing physicians in the United States, only about 1,200 are trained in addiction medicine, a scarcity of skills that poses a “formidable barrier” for patients, CASA concluded.
A new training program underway at 10 academic medical centers around the country, including the University of Maryland Medical Center in Baltimore, seeks to address this acute shortage by offering one- and two-year residencies in addiction medicine to physicians who have finished training in another specialty, such as family practice or internal medicine.
The program, launched in July 2011 and sponsored by the American Board of Addiction Medicine, seeks to attract more doctors to the field and to convince organized medicine to approve the medical treatment of addiction as an officially recognized subspecialty, similar to cardiology or sports medicine. Currently that designation belongs only to addiction psychiatry, which is open only to psychiatrists, not primary-care doctors.
“Addiction so much affects the quality of care we deliver,” said internist Jeffrey Samet, ABAM’s president and a professor at the Boston University School of Medicine. “If you don’t address drug or alcohol abuse, you can’t begin to control a patient’s diabetes.”
The training program could not come at a more auspicious time. The federal Substance Abuse and Mental Health Services Administration estimates that up to a third of the 30 million Americans who may gain health insurance under the Affordable Care Act have a substance abuse or mental health problem.