Op:Ed - Most Healthcare Providers Don't Know How To Treat Drug Addiction
The practice of addiction medicine saves lives.
As a board-certified specialist in psychiatry and addiction medicine, I find it deeply rewarding to help people take control of managing their disease so they can get back to caring for children, helping elderly parents, working and lifting up their neighborhoods and communities.
The science is clear: Drugs and alcohol change the brain. Using these substances repeatedly can lead to addiction. Addiction is not a moral failure. It is a chronic brain disease. Just like with any other chronic disease, patients can recover if they receive evidence-based treatment.
Unfortunately, persistent myths and misunderstandings about addiction fuel shame and stigma that keep patients from seeking treatment. Meanwhile, we are in the midst of an addiction epidemic.
Every year, 64,000 Americans die from drug overdose, and 88,000 die from alcohol-related causes. But only one in 10 Americans with addiction ever seeks treatment. And most of those who seek treatment do not get the effective care that board-certified doctors are trained to provide.
We can fight stigma with knowledge. The more we see addiction as a chronic brain disease, the more effectively we can treat patients. For example, occasionally using drugs or alcohol can be harmful, but it is not the same as the disease of addiction. A person with addiction, like those with any other chronic disease, needs evidence-based treatment to get into and stay in remission, which means there are no signs of active disease.
You can’t go to an inpatient environment for 30 days and have your diabetes or asthma cured. You don’t "graduate" from diabetes treatment when you learn to practice healthy diet and exercise behaviors. Chronic conditions require a long-term approach to help a person manage his/her disease and require medical involvement to lead the treatment team.
Further, FDA-approved medications can be central to treatment. If someone wants to stop smoking, we have strong evidence that prescribing the correct dose of nicotine replacement therapy greatly increases their chances of success. Similarly, for addiction involving opioid use, decades of studies show that FDA-approved medications help patients stay healthier and reduce their risk of fatal overdose.
Unfortunately, too many patients complete an inpatient treatment program for addiction involving opioid use and go home without receiving ongoing necessary medications. These patients are extremely likely to start using opioids again. They also are more likely to die of opioid overdose than if they had not completed a month of inpatient treatment.
Why, in 2018, does this continue to happen? One problem is that most healthcare providers do not know how to treat addiction. I tell my patients that when we start a medication for addiction, the goal is not to stop taking it. The goal is to stay in remission, free of symptoms. If someone has another chronic disease, such as asthma, diabetes, or arthritis, we don’t treat briefly and then stop. This is equally true of addiction.
Because many providers and programs do not provide effective and evidence-based addiction care, and most physicians are not trained in addiction medicine, it’s crucial to seek treatment from a board-certified physician specialist. Both the American Society of Addiction Medicine (ASAM) and the American Board of Addiction Medicine list these physicians on their websites, and primary care providers can help with referrals.
We do need more addiction doctors, and we are working to fill this gap. Last year, more than 1,200 physicians became board-certified in addiction medicine, and more than 5,000 nurse practitioners and physician assistants completed an intensive course in treating opioid use disorder.
We have lost too much ground against the opioid epidemic by sticking to outdated, ineffective ideas and methods. Slogans like "just say no" are ineffective. Simply warning children about drugs does not work. We need to talk with our children repeatedly, in an attentive and caring way, about how they can develop life skills, manage stress and become more resilient, and we need to model these healthy behaviors for them.
If you have questions about addiction or are wondering about a loved one, many more excellent resources are available from ASAM and the Substance Abuse and Mental Health Services Administration. I strongly encourage you to review them.
As a doctor who has treated thousands of patients with addiction, I know that they are our neighbors, coworkers, and the people we see at school, in faith communities, and at work. People with addiction have a chronic brain disease, and they are suffering. They often need evidence-based treatment from physician specialists to get better. Addiction is not a moral failure. It is not someone else’s problem. It affects all of us.
Dr. Kelly J. Clark is board-certified in addiction medicine and psychiatry. She is president of the American Society of Addiction Medicine, representing over 5,300 addiction specialist physicians and allied health providers.
Studies clearly show that adults simply warning children about the dangers of drugs does not help prevent early substance use and can actually backfire. Instead, we should advocate strongly for evidence-based programs in our schools, like resiliency skill training, and other proven community-based strategies. Additionally, adults can help children avoid substance use by teaching and modeling healthy behaviors and ways to increase resilience and manage stress.
We also can help kids stay off drugs by cleaning out our medicine cabinets and disposing safely of all unneeded medications; locking up controlled substances, such as medications for pain, sleep, anxiety, or weight loss; and minimizing their access to alcohol, nicotine, and cannabis. Signs of drug use are like those of many psychiatric conditions, but signs of intoxication, like slurred speech and sedation, are more specific to drug use.Article written by: Kelly J. Clark Dr. Kelly J. Clark is board-certified in addiction medicine and psychiatry. She is president of the American Society of Addiction Medicine, representing over 5,300 addiction specialist physicians and allied health providers. Original article here on www.courier-journal.com]]>