Magazine article Clinical Psychiatry News

Health Law May Bolster Addiction Treatment

Magazine article Clinical Psychiatry News

Health Law May Bolster Addiction Treatment

Article excerpt

BOCA RATON, FLA. -- Pharmacologic strategies are underused for alcohol use disorders, Dr. Charles P. O'Brien said, despite backing from evidence-based medicine. "This is terrible that we have such a divorce in this field between evidence-based medicine and treatment."

However, use of medication is expected to get a big boost from the recent health care reform legislation. "There is an understanding they [insurers] will pay for medication, including monthly depot injections," Dr. O'Brien, chair of the DSM-5 Substance Use Disorders Committee, said at the meeting.

Overall treatment of substance use is mandated in the new law, including coverage for screening and brief interventions done in primary care settings.

"We need to identify these patients, treat them earlier, and intervene before they need really expensive [interventions] like liver transplants, said Dr. O'Brien, director of the Center for the Study of Addiction at the University of Pennsylvania in Philadelphia. "This is big news, [and is] going to impact your practice and the training programs."

Treatment of all addictions is going to be an integral part of health care reform, Dr. O'Brien said. "Economists in the Obama administration agree that treating addiction saves money. Doctors will be mandated to look for problems. Most of the people involved in substance abuse are not at the level that they [initially] come to the attention of the primary care provider. The health care system is going to have to look for the early signs of substance use problems and treat that."

Meanwhile, Dr. O'Brien confirmed that the next revision of the Diagnostic and Statistical Manual on Mental Disorders (the DSM-5) probably will feature several important changes in terminology for alcohol and other substance use disorders ("'Substance Use Disorder' Diagnosis Gains Favor," CLINICAL PSYCHIATRY NEWS, July 2010, p. 17).

"'Dependence' is no longer there in DSM-5," Dr. O'Brien said to a round of applause at the meeting. "We got rid of it ... everyone agrees dependence is not addiction."

He explained that physical dependence might be normal with a whole range of prescription pain medications, Dr. O'Brien said. Some patients become tolerant after a few days and "we don't want it to count if that is the only symptom, because it's normal."

"I insisted in the DSM-5 that they don't count this as a symptom of addiction as it has [been] in the past. So we are excluding physical dependence from DSM-5 criteria for substance use disorder," Dr. …

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