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Science-based views of drug addiction and its treatment.

MORE THAN TWO THIRDS OF people with addiction see a primary care or urgent care physician every 6 months, and many others are regularly seen by other medical specialists. These physicians are therefore in a prime position to help patients who may have drug abuse problems by recognizing and diagnosing the addiction, helping to direct patients to a program that can meet their treatment needs, and helping to monitor progress after specialty treatment and during recovery. Many physicians, however, find the domain of drug abuse particularly daunting and often avoid the issue with their patients. This is understandable given the relatively short shrift drug abuse is given in formal medical education. There is a widespread misperception that drug abuse treatment is not effective, which may account for the reluctance of physicians to even broach the subject of drug abuse or treatment with their patients. On the other hand, over the past 15 to 20 years, advances in science have revolutionized our fundamental understanding of the nature of drug abuse and addiction and what to do about it. In addition, there are now extensive data showing that addiction is eminently treatable if the treatment is welldelivered and tailored to the needs of the particular patient. There is an array of both behavioral and pharmacological treatments that can effectively reduce drug use, help manage drug cravings and prevent relapses, and restore people to productive functioning in society. Of course, not all drug abuse treatments are equally effective, and there is no single treatment appropriate for all patients. Fortunately, recent scientific advances have provided insights both into the nature of drug abuse and addiction and into the principles that characterize the most effective treatment approaches and programs. These treatment principles should make the primary care or nonaddiction specialty care physician’s tasks of screening and referral much easier.