Wanted: Educators in Addiction Treatment
By Richard Frances M.D., Clinical Professor Of Psychiatry, New York University Medical School
The American healthcare system needs a major overhaul in approaching the huge national crisis that is addiction. There is an enormous need to train all health care disciplines in the skills, attitudes and knowledge to provide evidence based medication assisted and cognitive therapy to patients with opioids and other substance related problems. Generational failings in adequate training of healthcare professionals in substance related disorders along with psychiatric comorbidities has contributed to under diagnosis of substance problems and to over prescription of opioids for pain and benzodiazepines for sleep and anxiety disorders. Failings in the healthcare system to regulate the pharmaceutical industry led to heavily industry funded systematic false advertising and marketing claims to doctors and the public and contributed to the epidemic over use of opioids and benzodiazepines. Reversal of progress toward providing well-funded universal access to quality prevention and health care generally, and for substance related problems, threatens any hope of facing up to the crisis. Additionally, inadequate public and private provision of insurance coverage, increasing legalization of marijuana use, inappropriate medical uses for marijuana, lack of parity in funding for mental health including addiction treatment and massive overuse of prison as a solution to the drug problem are public policy areas that will not be fixed by building walls or increasing police brutality. For anyone starting a career in healthcare seeking to choose an area with leadership opportunity, addiction and addiction psychiatry should rank high on a list that might include cancer and heart disease . It is a fascinating significant health problem causing huge and widespread suffering to children and adults at vast cost, and it is treatable.
The US Council of Economic Advisers estimated that the true cost of the opioid drug epidemic in 2015 was a half trillion dollars and add to that the vast costs of tobacco, alcohol, cocaine, marijuana and other addictions estimated by the National Institute of Drug Abuse at around $740 billion, and we have a national disaster. Approximately 64,000 Americans died from a drug overdose in 2016, mostly related to prescription painkillers, heroin and fentanyl, with large numbers of adolescents, young adults and especial young women among the victims. Unfortunately it is not widely enough known that fentanyl, which is cheap and available, kills even if patients are taking Naltrexone or buprenorphine to treat opioid addiction, and it is hard to reverse these overdoses with naloxone. While there has been a recent study finding decreased use of opioids and some other drugs in adolescence, alarmingly marijuana abuse is growing among high school students as a result of lack of awareness of risk and increased availability. Marijuana is a gateway drug, contributes to mental illness, negatively affects motivation and is harmful especially to young minds.
Thus the need for knowledgeable and skillful teachers with positive attitudes in medical, social work, nursing, and counseling disciplines to battle for quality curriculum in addiction treatment has never been greater. The challenge of helping patients and their families get motivated for treatment starts with identifying addiction problems, instilling hope, providing tools, alleviating withdrawal symptoms, and helping patients to stick with a program of recovery. Every student in healthcare should attend a 12 step meeting in order to learn about the optimism and hope of having role models in recovery and the value of patients having a sponsor.
Once clinicians master the necessary skills, few categories of patients are as rewarding to treat or as grateful in recovery as those with substance related illnesses. #