Train doctors to recognize addiction
Author: William S. Jacobs, MD
Next year marks 60 years since the American Medical Association declared alcoholism a disease. Yet the stigma associated with addiction has persisted in the general community as well as the health care system.
Anonymity is a cornerstone of the 12-step treatment movement. But anonymity has also kept most of us in the dark about who among our friends, neighbors and co-workers has needed treatment for addiction.
The irony is that denial is a key component of addiction, and our society has suffered from a form of collective denial. Despite scientific evidence that addiction is a chronic brain disease that can affect anyone regardless of race or socio-economic status, most people tend to visualize addicts as a homeless person under the bridge drinking cheap wine from a paper bag, or a young woman prostituting herself to support her drug habit.
This bias crosses over into the health care system. Few are detected or diagnosed early in their disease before a catastrophe or full-blown addiction. People often first come to attention after an overdose or going to the emergency room. An estimated 6 million addicts visit an emergency room or primary care clinic each year, putting doctors in an ideal position to recognize and treat addiction. Yet research shows as many as 94 percent of primary care physicians fail to diagnose substance abuse when presented with early symptoms.
What is behind this institutional bias, and how do we train health care providers to recognize early signs of this pervasive disease?
At the heart of the problem is a lack of addiction medicine training, especially in medical schools. Our health care providers are the first line of defense identifying addiction and providing help to those who need it, yet they have not been trained to do so.
To ensure the next generation of practitioners are prepared to respond to substance abuse disorders, Michael Botticelli, director of national drug control policy, invited leading experts to the White House on Sept. 17 for a symposium entitled, “Medicine Responds to Addiction.” The symposium emphasized the importance of integrating addiction medicine training into health care certification and practice, and the need for physicians trained to prevent risky substance use and to treat and manage addiction.
Less than 10 percent of addicts receive treatment. The ones who do are often in crisis mode, where the illness has gotten so severe they realize, or someone in their life realizes, that they need immediate intervention. With nearly 8 percent of Georgians over the age of 12 suffering from a substance abuse disorder, we must do a better job identifying and treating those who need help as early as possible.
The most effective way of assuring the American public our health care system is equipped with the knowledge and skills to prevent, recognize and treat addiction is by expanding existing, specialized training programs in addiction medicine.
Currently, there are only 27 addiction medicine fellowship programs across the U.S., with a projected need of approximately 125. Even if addictions were treated as other diseases and we had true insurance parity, we do not have anywhere near as many board-certified addiction providers as we need. Training makes diagnosis possible and reduces stigma as physicians learn addiction is a disease and can be treated.
Now, Georgia joins the movement by unveiling an American Board of Addiction Medicine-certified fellowship through the Medical College of Georgia at Georgia Regents University in partnership with Bluff Plantation. A goal of these programs is to continue to establish addiction medicine as a recognized and much-needed specialty.
The Medical College of Georgia also has been awarded a three-year Substance Abuse and Mental Health Services Administration grant. SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to reduce the impact of substance abuse and mental illness on America’s communities.
This grant will fund training for the entire incoming medical school class — and primary care residents in a variety of disciplines — in SBIRT (Screening, Brief Intervention and Referral to Treatment). This evidence-based training enables health care providers to implement the screening process proven effective in identifying patients with problem drinking and/or drug use and, if necessary, move forward to screen them for a dependency diagnosis.
Part of the grant supports using the information gathered to establish addiction training as mandatory curriculum for health care professionals, or at least as part of continuing medical education for license maintenance.
Not only will well-trained medical professionals have the opportunity to identify the early signs of addiction and provide treatment options, they can play a key role in de-stigmatizing the disease. This is a critical step in stopping the trend of treating sufferers as second-class citizens. They’re not. They need help, and we have treatment that works.
Dr. William S. Jacobs is medical director of Georgia’s Bluff Plantation addiction treatment center and chief of addiction medicine at Medical College of Georgia.