Surgeon General’s Report: Calling on Doctors to Treat Addiction
The Surgeon General’s report calls for modernizing addiction treatment and integrating care with the rest of the health care system. The specific recommendations are based on strong evidence and, if enacted, will significantly improve treatment for the 40 million Americans suffering from a substance use problem. But, as the Surgeon General points out, “integration of substance use disorder care into general health care will not be possible without a workforce that is competently cross-educated and trained in all these areas.”
One of the barriers to addiction treatment is that there are too few qualified providers to meet the current demand and few medical professionals are trained to recognize and treat addiction. This creates a real problem for people with addiction, who often can’t find a treatment provider who is taking new patients and so they get put on a waitlist, making accessing care when it’s needed difficult or impossible.
Our landmark report, Addiction Medicine: Closing the Gap between Science and Practice, found that physicians, for the most part, lack the basic education and training needed to screen for substance use problems, diagnose addiction, provide treatment or refer patients to specialists when needed. This is because medical schools devote little time to teaching addiction — only a few hours over the course of four years. The same is true of the training for many mental health professionals, nurses and other health care providers.
The Surgeon General calls on “medical, nursing, dental, pharmacy, and other clinical professional schools to provide mandatory courses to properly equip young health care professionals to address substance misuse and related health consequences.” This would be a tremendous step forward, but it won’t get us all the way there.
Simply training more doctors won’t guarantee that they will offer addiction treatment or contract with insurance companies who will pay for it. Data from the American Board of Addiction Medicine suggest that fewer than half of physicians certified in addiction medicine are practicing full time. While the reason for this is unclear, a major factor likely is the very low reimbursement rates insurers pay for addiction care services.
In addition to better education for providers, the federal government and states should create incentives to attract people to the field of addiction care, including more money for research and more residency/fellowship opportunities. Insurance plans need to reimburse for addiction treatment services at higher rates that accurately reflect the complexity involved in treating this disease. Until we reward addiction treatment professionals adequately for their work, we won’t have enough of them to provide the treatments that are available and proven effective for eradicating this disease.
Emily Feinstein, JD
Emily is Director of Health Law and Policy and Center on Addiction