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Substance use disorder treatment must become mainstream

Substance use disorder treatment must become mainstream says former Obama Deputy Drug Czar

1 September 2011

A visiting drug policy expert and one-time “Deputy Drug Czar” to the Obama Administration has told a conference in Auckland today that the historical approach to treating substance use disorders has missed the mark and has had serious costs and consequences for healthcare in general.

Tom McLellan, Professor of Psychology in Psychiatry and Director of the Centre for Substance Abuse Solutions at the University of Pennsylvania, said the substance abuse field has become segregated from the rest of medicine.

“Addiction is currently the only illness for which we have specialty care, but no meaningful involvement from primary care professionals such as GPs. That means there is little available to treat those with substance use disorders before they get to the stage where we deem them addicts.”

Professor McLellan said there is a difference between addiction and a substance use disorder.

“Imagine if, in the treatment of diabetes, we didn't decide someone needed treatment until they got to the stage where they lost their toes or their eyesight.

“If we took that approach we'd put little time or effort into diabetes prevention or early intervention, and we wouldn't bother teaching about its early symptoms in medical schools. That’s exactly what’s happening with substance use disorders right now.

“The result is addicts are marginalised, stigmatised and pushed to the outer edges of society, much as sufferers from TB, polio, breast cancer and depression once were – with generally poor outcomes and significant social costs.

“When substance use problems are involved, even at a low level, diagnosis, treatment and management of conditions become complicated because of the lack of knowledge and training among those in the general medical field. This seriously impairs the ability of mainstream healthcare to treat most chronic illnesses effectively and economically.”

Professor McLellan says America’s healthcare reforms and the Parity Act have paved the way for better integration of substance use disorder care into mainstream healthcare.

“There will be many bumps along the road but I foresee big improvements in the decade.

“I don't want to presume too much from the American experience but if there is similar segregation of prevention and treatment of substance use disorders from the rest of mainstream healthcare in New Zealand, I think you may have many of the same problems and the same unnecessary costs.”

Professor McLellan was speaking at Cutting Edge, an annual nationwide addiction treatment conference, covering alcohol, other drugs, problem gambling and smoking cessation. In 2011 it is being held at the Rendezvous Hotel 1-2 September, with around 400 participants.


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