New addiction board emphasizes widespread need
For those physicians who already practiced addiction medicine, there is the opportunity to join the board, which will feature residencies and fellowships for new physicians in the future. Several Tarrant County and North Texas physicians are among those who have joined or are joining ABAM by being grandfathered into the organization, and although they work in various settings, they all said they hope the board will encourage more physicians to take notice of a disease that has widespread and under-addressed consequences.
Dr. Joseph Burkett, medical director for MHMR of Tarrant County and certified by the American Society of Addiction Medicine (he is being grandfathered into ABAM), estimated somewhere between 15 and 20 percent of the American population may be susceptible to addiction, although not as many are actively addicted.
The National Institute on Drug Abuse defines addiction as “a chronic, relapsing brain disease that is characterized by compulsive drug seeking and use, despite harmful consequences.” Dr. Larry Gentilello, on the board of directors for ABAM and chair of the public education and policy committee, said about 23 million Americans need treatment for addiction, but less than 10 percent get it.
Gentilello, who is a professor of surgery at the University of Texas Southwestern Medical Center, is a trauma surgeon and has seen many patients end up in critical care centers or emergency departments due to addiction-related incidents, like car crashes from driving while intoxicated. Until this year, the physicians who focused on addiction the most were addiction psychiatrists, he said, but the new board certification by ABAM will let more physicians who see patients in varied settings do something against addiction.
“It brings it right to the front lines of care,” he said.
Dr. M. A. Rahim Haqqani, medical director of inpatient psychiatric services at JPS Health Network’s Trinity Springs Pavilion, said patients often don’t think they are addicts or are in denial, and so it becomes difficult for them to find addiction specialists.
“It’s not easy. I don’t think it was easy, and I don’t think it’s easy now,” he said.
Haqqani, who also is being grandfathered into ABAM, teaches about addiction at the Texas College of Osteopathic Medicine, where he is an assistant professor of psychiatry and behavioral health. He said in his classes he asks students who should be screened for addiction.
“The answer is everyone,” he said
Screening for addiction can be as easy as asking a few pointed questions in any medical setting, he said. A physician or nurse can ask how many alcoholic beverages a patient has had during the past week, for example, or can ask if the patient has used illegal or prescription drugs that are sometimes linked to addiction.
An increasing issue in addiction medicine is that it’s physicians themselves who don’t know how to handle the issue, said Dr. William Moore, who is a physician-owner of Capstone Pain Management and on staff at Texas Health Harris Methodist Hospital Southwest Fort Worth. Moore specializes in patients with severe, chronic pain, which is sometimes treated with drugs like opiates, which can be addictive. Patients are monitored to make sure they don’t use the drugs at inappropriate or non-prescribed times, he said, and the amounts of drugs are carefully calculated so patients don’t go through physical withdrawal. While patients may become physically dependent on a drug, he said, that is not the same thing as addiction, which involves an addict seeking a high of some sort.
“A lot of that goes back to genetic factors,” Moore said. “Some patients take opiate-like medications and get a high off of them; some patients take it and it relieves their pain but they don’t get that high off them.”
There are many effective treatments available for addicts, Haqqani said, but relapse is more the rule than the exception and addiction requires long-term treatment. He compared its chronic nature to diabetes—the diseases can be controlled, but only if regular treatment and support is there. Encouraging all health care professionals to know how to deal with addiction, or at least know where to refer patients for treatment, will foster a healthier population, lower health care costs spent on treatments for critical addicts and reduce deaths linked to substance abuse.
Gentilello said addiction always has a starting place, and health care workers who are not interested in being certified by ABAM should be on the lookout for inappropriate substance use. Not everyone who inappropriately uses drugs or alcohol is an addict, he said, but it is part of the spectrum of substance use, and at the far end is addiction. Although ABAM will hopefully continue its fast growth, addiction medicine is larger than the organization’s reach, he said.
“The last thing we want is to give the message that addressing unhealthy use is only for specialists,” he said.
