Only 10 percent of the 20 million Americans with a substance use disorder receive treatment for it. In an effort to close the gap, the American Society of Addiction Medicine has designated April as the first Treatment Gap Awareness Month. This is important because people who participate in treatment for their addiction do benefit from it, especially when compared to people with other chronic illnesses such as diabetes and hypertension. The reasons for the gap are numerous. The first step toward closing it is the increased awareness that it exists. Thus, the current ASAM campaign.
A second reason is the high level of pessimism within the medical community. The need for the slogan “Treatment Works!” is an indication of this negativity, which frequently discourages the addict from seeking treatment and can serve as a self-fulfilling prophecy. I believe that this pessimism is rooted in the experience of medical professionals early in their training. The addicts who are the sickest and have the poorest prognosis tend to gravitate to university-affiliated hospitals where medical students are getting their first exposure and are very impressionable. Medical supervisors and attending physicians who share their experiences tend to reinforce the pessimism.
In my own training, I received a clear message that I should avoid those patients because they were beyond help. In fact, I did not see an addict recover until I completed my training and was exposed to an alcohol treatment program run by the U.S. Navy. This situation persists today. When I teach psychiatric residents and ask for a show of hands of those who, while in medical school, had seen an addict recover, none are raised. To try and remedy that situation, I have, for many years, arranged for the entire third-year class at Georgetown University’s School of Medicine, where I am a Clinical Professor, to rotate in small groups through Kolmac’s outpatient treatment program so they can see for themselves that recovery from addiction is possible. The students are usually moved by this experience, which many say is an educational highlight.
A third reason for the gap is the pessimism of the lay community at large. Grassroots advocacy movements supporting addiction treatment have not been successful in changing these beliefs. A newly established one called “Facing Addiction” may be succeeding where others have failed. Also of help is the recently released Surgeon General’s Report, “Facing Addiction in America” which focused on the progress being made in the field of addiction treatment.
A final reason for the treatment gap is the paucity of medical addiction professionals. Until now, only psychiatrists could receive formal board certification as addiction specialists. This gap is finally being addressed by the establishment of a more inclusive addiction medicine specialty, which offers a path to board certification physicians from a broad range of medical specialties. The first board examination is scheduled for Fall 2017.
We will see over the next few years just how successful these efforts will be in closing this tragic gap.