Newswise — Three of North America’s top experts in addiction medicine, research, prevention, diagnosis and treatment have published a “Viewpoint” in the October 23/30 issue of the Journal of the American Medical Association (JAMA) in which they find that “many in the medical community fail to diagnose and treat substance use disorders, in part because of the failure to educate physicians about addiction medicine.” They note that a substantial number of diseases are caused by substance use disorders, and that American hospitals are “clogged” with patients suffering from the primary and secondary results of these disorders. A new training pathway, however, will help address this problem.
The article was authored by Evan Wood, MD, PhD, FRCPC, Professor of Medicine, Division of AIDS, Canada Research Chair in Inner City Medicine, University of British Columbia; Jeffrey H. Samet, MD, President, American Board of Addiction Medicine (ABAM) and The ABAM Foundation and Professor of Medicine, Boston University School of Medicine; and Nora D. Volkow, MD, Director, National Institute on Drug Abuse (NIDA).
The authors note that, “new therapies (for addictions) have the potential to create a momentous shift in society, whereby addiction is seen primarily as a health issue amenable to prevention and treatment, through the application of evidence-based tools.” They point to new understandings about the neurobiology of addictive disorders, which have contributed to the development of new medications for a number of addictions, as well as the existence of behavioral interventions that have been demonstrated to help reduce the use of some addictive drugs.
“Despite the availability of these evidence-based prevention and treatment strategies, only a small fraction of individuals receive prevention or treatment consistent with scientific knowledge about what works,” says Dr. Samet.
Currently, few physicians screen, intervene or refer, because they have not been educated about addiction medicine in medical school, nor trained in residencies. Until the establishment of the American Board of Addiction Medicine in 2007, one barrier to this training has been the lack of an addiction medicine subspecialty for primary care physicians. A subspecialty of addiction psychiatry exists within the field of psychiatry, however, this does not address the issue of primary care training. While there are excellent addiction psychiatry fellowships, there are no addiction medicine fellowships for other physicians pursuing primary care and other specialties among the 9,262 Accreditation Council for Graduate Medical Education accredited U.S. programs that are currently training 119,588 residents.
“There is a remarkable gap between the science of addiction medicine and the care that patients actually receive,” according to Dr. Wood. “Ultimately, this stems from the fact that investments in research have not been coupled with strategies to adequately train physicians to deliver evidence-based care.” For example, only about 10% of people with an alcohol addiction received recommended care, and evidence-based interventions for smoking cessation were similarly low.
Recent reports have found that most treatment for addiction in both the U.S. and Canada was provided by laypersons, who although supportive, have neither the mental health nor medical training required to effectively provide evidence-based care.
Failure to treat substance use disorders leads to worse outcomes in many diseases that result from substance abuse, such as HIV, lung disease, hepatitis and chronic pain, say the authors. The deficiency in addiction medicine training also contributes to the improper management of pain and to the epidemic of prescription opioid addiction, as these medications are both overprescribed and underprescribed.
To meet the need for properly trained medical doctors, The ABAM Foundation has accredited 19 fellowship programs in academic medical centers across North America to train physicians in addiction medicine. The Foundation plans to establish additional fellowship programs.
More than 3,000 physicians have been certified in addiction medicine by ABAM over the last few years. These physicians have demonstrated that they have the knowledge and skills to provide prevention, screening, intervention and treatment related to substance use disorders and addictions. ABAM-certified physicians also participate in Maintenance of Certification (MOC) activities, which ensure that they maintain competence in addiction medicine throughout their careers.
“Through the increased incorporation of addiction medicine into medical training, patients will be better served and the quality chasm in treating substance use disorders will be narrowed,” says Dr. Volkow. “Given the proper training, tools, and resources, physicians can be the first line of defense against substance abuse and addiction - identifying drug use early, preventing its escalation to abuse and addiction, and referring patients in need to treatment.”
About the American Board of Addiction Medicine and ABAM FoundationThe ABAM Foundation’s purpose is to establish and accredit addiction medicine training programs and support the mission of the American Board of Addiction Medicine. ABAM’s mission is to improve the quality of care in the medical specialty of addiction medicine, establish standards and procedures, and certify physicians as experts in this specialized field of medical practice. ABAM's goal is to have a member board of the American Board of Medical Specialties (ABMS) certify physicians in addiction medicine. ABAM and The ABAM Foundation are governed by 16 distinguished physicians from a range of medical specialties, each of whom is certified by a member board of the ABMS. For more information on ABAM, visit: http://www.abam.net. To learn more about The ABAM Foundation, go to www.abamfoundation.org.
RSS