Addiction is officially a preventable and treatable disease in the eyes of medicine, thanks to a landmark decision by the American Board of Medical Specialties (ABMS). I had no idea that the medical community hadn’t already arrived at this conclusion many years ago, but on March 14, 2016, the ABMS announced that it was adding Addiction Medicine as a medical subspecialty. This action that not only paves the way for more board-certified addiction specialists, but serves to chip away at the stigma of addiction.
An ABMS subspecialty is sort of like getting a three-star Michelin rating in physician certification: it demonstrates the very highest standard in learning, development and care. It also sends a clear signal that physicians are no longer viewing addiction as something unfortunate that happens to people. It’s actually a condition worthy of treatment and, moreover, respect.
Broadly defined, Addiction Medicine is focused on treating those people who are grappling with substance abuse or suffering from health issues related to alcohol, prescription medication, nicotine and other drugs. It’s also dedicated to preventing addiction. Just as addiction knows no boundaries, the field cuts across many areas, including psychology, social work, psychiatry and internal medicine. Addiction specialists are described by the American Society of Addiction Medicine (ASAM) as those who have “demonstrated by education, experience, and examination the requisite knowledge and skills to provide prevention, screening, intervention, and treatment for substance use and addiction.” In other words, they really know their shit.
According to a news release detailing the ABMS decision, 16% of Americans—more than 40 million people—are addicted to one substance or another, including alcohol and nicotine. When I was drinking, I couldn’t pass a questionnaire asking me what I had for breakfast without lying, so I secretly suspect that 16% figure is probably low. The American Bureau of Addiction Medicine (ABAM) puts a finer point on this startling statistic: fewer Americans have cancer, diabetes or heart problems—combined. That’s as eye-opening a number as it is disconcerting.
The ABAM says that in 2014 alone, nearly 23 million Americans sought some form of treatment for addiction—inpatient, outpatient, residential—but only 11.6% of them received it. In fact, the ABAM claims that substance abuse and untreated addiction account for one-third of inpatient hospital costs and 20% of all deaths in the US. These are very real costs that the country can’t afford—literally and figuratively.
The summary results of an incredibly comprehensive study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA) only confirm those statistics. They also paint a stark portrait of America’s behavioral health trends, reporting that in 2014, “Twenty-seven million people aged 12 or older used an illicit drug in the past 30 days, which corresponds to about 1 in 10 Americans.” That’s not taking into consideration tobacco and alcohol use data collected by SAMHSA, either. Yikes.
What Message Does This Send?
In a piece picked up by the Huffington Post, Nora Volkow, Director of National Institute of Drug Abuse (NIDA), observes that, “the emergence of this standard credential for Addiction Medicine considerably raises the bar for the quality of care in this crucial medical domain, and it will lead to major enhancement of the health care workforce.” Only psychiatrists have been able to get certified in addiction treatment so far. Now, the subspecialty is expected to attract a wide range of physician specialists, including everyone from pediatricians to obstetrician/gynecologists. Volkow notes that, “None of the more than 9,500 accredited US graduate medical education residency programs have had training programs in Addiction Medicine.” That’s all about to change.
The new subspecialty carries a real and a symbolic weight. In addition to shifting the public perception of those who struggle with addiction, by increasing the amount of specialists, we’re closing an ever-growing medical gap between addicts and physicians. As ABAM President Robert J. Sukol stated, “It sends a strong message to the public that American medicine is committed to providing expert care for this disease and services designed to prevent the risky substance use that precedes it.”
Following the decision, several key details still need to be nailed down. The ABPM is currently working out exactly how the subspecialty will be rolled out, including the design of the first Board Certification exam in Addiction Medicine. No dates have been set, though announcements will be made on the ABPM website.
Until then, ABMS recognition means more than just career options, higher standards of care and the increased availability of services. For the very first time, the medical community is committed to providing expert treatment for a disease it didn’t even formally recognize just a few weeks ago. To me, more than anything, it means acceptance. It’s a collective surrender to the disease concept of addiction which, of course, is one of the most crucial steps toward recovery.
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