Forty million Americans ages 12 and older have addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer according to a five-year national study released today by The National Center on Addiction and Substance Abuse at Columbia University (CASA Columbia). Another 80 million people are risky substance users - using tobacco, alcohol and other drugs in ways that threaten health and safety.
The report, Addiction Medicine: Closing the Gap between Science and Practice, reveals that while about 7 in 10 people with diseases like hypertension, major depression and diabetes receive treatment, only about 1 in 10 people who need treatment for addiction involving alcohol or other drugs receive it. Of those who do receive treatment, most do not receive anything that approximates evidence-based care.
The CASA Columbia report finds that addiction treatment is largely disconnected from mainstream medical practice. While a wide range of evidence-based screening, intervention, treatment and disease management tools and practices exist, they rarely are employed. The report exposes the fact that most medical professionals who should be providing treatment are not sufficiently trained to diagnose or treat addiction, and most of those providing addiction treatment are not medical professionals and are not equipped with the knowledge, skills or credentials necessary to provide the full range of evidence-based services.
"This report shows that misperceptions about the disease of addiction are undermining medical care," said Drew Altman, Ph.D., President, The Henry J. Kaiser Family Foundation who chaired the report's National Advisory Commission. The report finds that while doctors routinely screen for a broad range of health problems like high blood pressure or high cholesterol, they rarely screen for risky substance use or signs of addiction and instead treat a long list of health problems that result, including accidents, unintended pregnancies, heart disease, cancers and many other costly conditions without examining the root cause.
This landmark report examines the science of addiction --a complex disease that involves changes in the structure and function of the brain--and the profound gap between what we know about the disease and how to prevent and treat it versus current health and medical practice.
Few Patients with Addiction Receive Quality Care
The CASA Columbia report found that while almost half of Americans say they would go to their health care providers if someone close needed help for addiction, less than six percent of all referrals to addiction treatment come from health professionals.
The report also found no clearly delineated, consistent and regulated national standards that stipulate who may provide addiction treatment in the U.S.; standards vary by state and by payer. Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices.
Most providers of addiction treatment are addiction counselors who are not required to have any medical training. CASA Columbia's analysis of minimum state requirements found:
- 14 states do not require all addiction counselors to be licensed or certified;
- 6 states do not mandate any educational degree to become credentialed;
- 14 states require only a high school diploma or GED;
- 10 states require an associate's degree;
- 6 states require a bachelor's degree; and s degree.
Physicians and other medical professionals who make up the smallest share of providers of addiction treatment receive little education in addiction science, prevention and treatment. In fact, CASA Columbia's report cites other research that found that of patients who had visited a general medical provider in the past year only 29 percent were even asked about alcohol or other drug use.
"Right now there are no accepted national standards for providers of addiction treatment," said Susan Foster, CASA Columbia's Vice President and Director of Policy Research and Analysis, who was the principal investigator for the report. "There simply is no other disease where appropriate medical treatment is not provided by the health care system and where patients instead must turn to a broad range of practitioners largely exempt from medical standards. Neglect by the medical profession has resulted in a separate and unrelated system of care that struggles to treat the disease without the resources or knowledge base to keep pace with science and medicine."
A Costly Disease
The CASA Columbia report reveals that addiction and risky use of tobacco, alcohol and other drugs constitute the largest preventable and most costly health problems facing the U.S. today, responsible for more than 20 percent of deaths in the U.S., causing or contributing to more than 70 other conditions requiring medical care and a wide range of costly social consequences and accounting for one-third of all hospital in-patient costs. Research suggests that effective health care interventions to prevent and treat addiction would significantly reduce these costs.
In 2010, only $28 billion was spent to treat the 40 million people with addiction. In comparison, the United States spent:
- $44 billion to treat diabetes which affects 26 million people;
- $87 billion to treat cancer which affects 19 million people;
- $107 billion to treat heart conditions which affect 27 million people.
"As our nation struggles to reduce skyrocketing health care costs, this report makes clear that there are few targets for cost savings that are as straightforward as preventing and treating risky substance use and addiction, " said Commission Chairman Altman.
Other Notable Findings
- Although addiction is often a chronic disease, treatment typically addresses it as an acute condition and does not include the necessary long term disease management.
- Public perceptions do not distinguish between risky substance use and the disease of addiction.
- Costs to federal, state and local governments amount to 11 percent of total spending; 95 cents of every dollar pay for the consequences and only 2 cents go to prevention and treatment.
The report offers a comprehensive set of recommendations to overhaul current intervention and treatment approaches and to bring practice in line with the scientific evidence and with the standard of care for other public health and medical conditions.
"It is time for health care practice to catch up with the science. Failure to do so causes untold human suffering and is a wasteful misuse of taxpayer dollars," noted Director Foster.
The National Center on Addiction and Substance Abuse (CASA) at Columbia University