How are physicians influencing treatment?

Fueled by the availability of easily administered alcohol and drug assessment instruments, along with new financial incentives to use them, generalist physicians appear more poised than ever to play a pivotal role in treating problem substance use. Many observers assume that a greater physician presence in alcohol and drug intervention will bolster the science basis for substance use treatment services in general. But a thought-provoking panel discussion at last November's SECAD 2007 conference showed that even those physicians with the richest background in addiction issues still offer divergent opinions on some of the field's most fundamental topics.

Six medical directors of nationally known addiction treatment facilities, plus one private-practice physician and medical consultant, were asked in the session to address this question: Does a patient's maintenance treatment on buprenorphine constitute “recovery”? The replies took off in so many different directions that they left the observer realizing how difficult a task the addiction field has in reaching consensus definitions of widely used terms in their community.

Paul Earley, MD, FASAM, of Talbott Recovery Campus in Atlanta, suggested in his comments that buprenorphine maintenance cannot be considered “recovery” because the patient's psychic experience on the drug does not reflect the strife and struggle that an addict in a drug-free program for opiate addiction would face. Ron Pike, MD, of AdCare Hospital in Worcester, Massachusetts, said that he's seen buprenorphine make recovery possible for many patients, in that it opens the door to improving their relationships, re-establishing a financial footing, and affecting many other factors important to a good quality of life. Neither physician was saying the medication is inherently good or bad, but they and the other participants on the panel certainly differed in their characterization of what it accomplishes.

Now that some generalist physicians appear ready to be more hands-on in addressing substance use issues in their patients, non-physician professionals in the addiction field may tend to see physicians as a monolith with the influence to alter treatment as we know it. But just as counselors don't all share the same therapeutic techniques, physicians still will maintain a diversity of opinions on the addict and the addiction. The mere presence of new codes to bill for screening and intervention services will not necessarily change their core beliefs.

We at Addiction Professional believe this is an opportune time to showcase the work of physicians, as well as their perspectives, as they help shape substance use services throughout the country. In the coming issues of the magazine, we will feature writings from some of the leading voices in addiction medicine. Their opinions and initiatives regarding medication developments, integrated health services, and other topics carry immense potential for advancing the field.

If you are affiliated with an addiction treatment facility that employs a medical director, and you think that person would be an ideal candidate to write a feature article for Addiction Professional, please contact me at (401) 353-1316 or genos1@cox.net with your suggestions. We look forward to a robust exchange of ideas from some of the field's most experienced medical authorities.

Gary A. Enos, Editor