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Tuesday, September 4, 2012

An Honest Report: US Physicians Lack Addiction Training, But Let's Remember: Honesty Is A Two Way Street

"As a rule, we go about with masks, we go about looking honest, and we are able to conceal ourselves all through the day."  ...speech 1902, Mark Twain Speaks for Himself

 New report focuses on US physicians lacking training regarding addiction

Yesterday The Washington Post published an article "Few doctors know how to treat addiction. A new program aims to change that."  The article focuses on a new report issued by the National Center On Addiction and Substance Abuse (CASA) at Columbia University following a five year study.  Here are some report highlights regarding addiction in the United States:
  • Forty million Americans ages 12 and older (16 percent) have the disease of addiction involving nicotine, alcohol or other drugs, a disease affecting more Americans than heart conditions, diabetes or cancer; another 80 million people are risky substance users – using tobacco, alcohol and other drugs in ways that threaten health and safety. 
  • 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 while the number receiving treatment for nicotine is not even known. 
  • Addiction treatment facilities and programs are not adequately regulated or held accountable for providing treatment consistent with medical standards and proven treatment practices. 
  • 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.
Startling statistics, but even more startling is that the report points out that most medical professionals who should be able to provide treatment for addiction are not trained sufficiently to either diagnose and/or treat addiction. If you are an alcoholic, addicted to drugs, a family member of an addict, then chances are this headline is not telling you something you don't already know.

Addiction diagnosis hinges on honesty... 

Honesty really is a two way street. Yes, physicians and other medical professionals need to be honest that they receive very little training about the disease of addiction, even though addiction affects a person's health in every aspect -  physically, emotionally and psychologically (addiction is linked to more than 70 diseases or conditions). However, most patients suffering from the disease of addiction are aware of their disease and will often fail to mention it when being questioned by their primary care physician or emergency room (ER) personnel. 

Think about the last time you met with a new primary care physician or were taken to an ER. Even if you really don't suffer from addiction, how honest are you when you are completing a health history form?  For example, how honestly do you answer these types of questions:
  1. How many cups of caffeinated coffee do you drink per day?
  2. Do you currently smoke cigarettes or have you quit within the past 6 months?
  3. Do you chew tobacco?
  4. Describe your regular physical activity or exercise program.
  5. Are you currently being treated for any other medical condition by a physician?
  6. Please list all prescription and over-the-counter medication you are currently taking.
  7. Have you ever been treated for depression or anxiety?
  8. How would you describe your alcohol use: none, occasional, moderate or heavy?
  9. Do you currently use recreational or street drugs?
  10. Is there any family health history or cause of death related to alcohol or drug abuse?
As Mark Twain said 110 years ago, "we go about with masks, we go about looking honest..." The honest truth is we are all humans. We don't want to look or appear weak or damaged. So we will go as long as we can, getting by, until our bodies start to exhibit symptoms and our organs start to shut down. Suddenly we become honest, if only momentarily, because the pain and discomfort has become unbearable; however, if the medical professional is not trained to spot signs and symptoms related to addiction, then the addict's lack of honesty plays into absurd outcomes on everyone's part.

Recovery and Honesty

The disease of addiction left untreated is terminal. Many addicts require inpatient or outpatient treatment for anywhere from 30-365 days. Most people seeking recovery will be introduced to Alcoholics Anonymous (AA), and many addicts will find sobriety and recovery by becoming active members of AA or another anonymous group.  If you have only been to one AA meeting, then you already know how important honesty is for recovery. Lying and living a lie is part of addiction. If you cannot learn to be honest with yourself and everyone associated with your life (family members, your doctor, your AA group, your therapist, your AA sponsor) then your chances of avoiding a relapse are diminished.  You can learn to be honest, it takes practice one day at a time.

The CASA study is brutally honest, but hopeful...

So now we know the problems, what solutions are proposed?
  • Fact: there are 985,375 practicing physicians in the US; however, only 1200 of these physicians are trained in addiction medicine. Proposed Solution: 10 academic medical centers in the United States are now offering two-year residencies in addiction medicine. This new program is sponsored by the American Board of Addiction Medicine. This should help train more doctors and have addiction treatment be recognized as an official sub-specialty, not unlike cardiology or sports medicine. Training funding may also come from the Center for Medicare and Medicaid Services or the Department of Veterans Affairs.
  • Fact: 22 million Americans suffer from a drug or alcohol problem, if you add in the 18 million who are addicted to nicotine, the number of addicted Americans reaches 40 million, and roughly 10% of the 22 million receive any kind of treatment. Proposed Solution: The federal Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that one-third of the 30 million Americans that may gain health insurance through the Affordable Care Act (ACA) have a mental health problem or substance abuse problem; therefore, more will be able to seek and receive treatment for the disease of addiction.
  • Fact: Professionals used to believe that a person suffering from addiction had a behavioral problem. Proposed Solution: Studies now support the view that addiction is a complex brain disease.
  • Fact: Qualifications for addiction counselors vary from state to state. Six states have no minimal requirements and 14 states only require a high school education. Possible Solutions: Working with the addicted population is not easy, as the disease can be baffling and relapse can be triggered by any number of events. It is not always about performing reimbursable procedures, but taking each day, one day at a time. Standard training for all levels of treatment professionals (physicians included) will help to clarify that recovery is possible and these professionals can and do have a profound impact on the addict.
  • Fact: Many people will lie about their disease or symptoms. Proposed Solution: Simply try being honest. For example: If you are an alcoholic and you know what you are experiencing is delirium tremens (DTs), then when you arrive at an ER help the medical personnel by admitting that you are an alcoholic. If you know your family member or friend is abusing drugs and you need to take them to the ER or doctor, answer all questions honestly so that there is no loss of time in responding to the symptoms presented. The bottom line is this: one moment of complete honesty may save your life or the life of your loved one. 

We all need to remove our masks...

 As with any disease, we need to treat the whole person and with addiction treatment and services should be available for the whole family. Medical professionals need to admit that they need more training, they should get more training, and the addicted need to learn how to take that first step...admitting they are powerless over alcohol and that their lives have become unmanageable. Let's all work toward a healthy and hopeful solution.



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