Showing papers on "Addiction medicine published in 2000"

The impact of managed care on substance abuse treatment: a report of the American Society of Addiction Medicine.

Abstract: This report examines the impact of managed care (MC) and related developments on substance abuse treatment, and evaluates how it has been associated with a decline in the availability of proper treatment for many addicted patients. A trend toward carve-out and for-profit MC organizations is associated with lower financial incentives for intensive treatment than in earlier staff-model and not-for-profit MC organizations. The value of substance abuse insurance coverage has declined by 75% between 1988 and 1998 for employees of mid-to large-size companies, compared with only an 11.5% decline for general health insurance. The shift towards MC has also been associated with a drastic reduction in frequency and duration of inpatient hospitalization, and there is no clear evidence that this reduction has been offset by a corresponding increase in outpatient support. In a survey of physicians treating addiction, the majority felt that MC had a negative impact on detoxification and rehabilitation, and on their ethical practice of addiction medicine.

Professional Counseling versus Specialized Programs for Alcohol and Drug Abuse Treatment.

Abstract: This article reviews major recent studies supporting the effectiveness of professional counseling, Alcoholics Anonymous, and specialty programs for treating alcohol and drug problems. The American Society of Addiction Medicine's guidelines for referral to substance abuse services are described along with examples of integrated treatment approaches.

Drug addiction: a general review of new concepts and future challenges.

Abstract: Relevant papers published in peer reviewed journals in the past 2 decades were identified and screened to abstract pertinent information. Substance dependence/addiction, involving both a common brain reward mechanism and longer-lasting molecular and cellular changes, is a preventable chronic, relapsing brain disease and as such a public health problem. Physical and psychological dependence, characterized by withdrawal syndrome, are now given less weight compared with compulsive behaviour and uncontrolled use of drugs in the comprehension of addiction. The challenging components of drug addictions, including counteradaptation, sensitization, abstinence, craving and relapse need further neurobiological and non-neurobiological exploration and understanding, which may be possible through the use of advanced imaging and genetic techniques and animal models of drug addiction together with relevant human studies.

The role of recovering physicians in 19th century addiction medicine : An organizational case study

Abstract: An elaborate network of inebriate homes, inebriate asylums, nationally franchised private addiction treatment institutes, and proprietary home cures for addiction arose on the American landscape between 1850 and 1900. The pinnacle of the movement to professionalize America's first addiction treatment field was the founding of the American Association for the Cure of Inebriety in 1870 and its publication of the first issue of the Journal of Inebriety in 1876. One of the most contentious issues among the various branches of this new professional field was the question of the use of "reformed men" as physicians, managers and attendants within treatment institutions. This article describes the employment of recovering physicians within one 19th century addiction treatment franchise--the Keeley Institutes--and documents the nature of the professional debate stirred by what was then a controversial practice.

Innovative Clinical Addiction Research Training Track in Preventive Medicine.

Abstract: Medical education related to identification, diagnosis and management of alcohol and other drug problems receives inadequate attention in the undergraduate curriculum and during residency training. This article describes the design, implementation, and evaluation of a new track in Clinical Addiction Research Training (CART) in a General Preventive Medicine (GPM) residency program. CART is comprised of a new course in Addiction Medicine, new practicum sites in addiction medicine research and treatment, and a CART-designated resident. An Advisory Group of educators, researchers, scholars, and administrators in addiction medicine, has provided guidance and support for this new track. Evaluation of the CART track suggested improvements in residents' knowledge and attitudes. Residents engaged in high caliber clinical addiction research projects. The development of the CART track within the GPM residency is an approach that can be integrated into other specialties, such as internal medicine, family practice, and adolescent medicine, to develop residents' interest and expertise in the addictive behaviors.

The Science of Addiction: Research and Public Health Perspectives

Abstract: Drug abuse and addiction are among the most serious and costly problems facing our society. Fortunately, advances in science made over the last several decades have dramatically increased our understanding of these disorders and led to the development of effective strategies for their prevention and treatment. This article focuses on the biological, behavioral, and social mechanisms of drug abuse and addiction and their implications for prevention, treatment and policy. The role of the family as a potential risk or protective factor for drug use is also discussed.

Reflection on alternative nicotine delivery systems

Abstract: There has been a recent trend in part of the tobacco-control community to advocate the development and promotion of alternative nicotine delivery systems, as exemplified by a conference held in Toronto in early 1997 (Alternative Nicotine Delivery Systems. Harm Reduction and Public Health’, held jointly by the Addiction Research Foundation, the Ontario Tobacco Research Unit and the American Society of Addiction Medicine). The underlying premise of many advocates of alternative nicotine delivery systems is that only a fraction of the very large number of nicotine addicts who receive their dose of nicotine through tobacco products will be able to quit smoking. A further assumption of this harm-reduction approach is that providing nicotine to these addicts in a vehicle which does not involve ingesting tobacco could dramatically reduce the aggregate health consequences of tobacco use. One proponent of alternative nicotine delivery systems cautioned at the conference held in Toronto: ‘unless we establish an aggressive harm reduction strategy that promotes the use of alternative nicotine delivery products our campaign may not achieve our goal of reducing [smoking] prevalence to 15%’ (G.N. Connolly, ‘Closing the gaps: A public health agenda for nicotine harm reduction’).

Multi-faceted treatment of tobacco addiction in a group of health professionals

Abstract: Health professionals are a reference for a healthy lifestyle in the minds of the public. Thus, health professionals who do not smoke influence the public not to smoke and contribute to the understanding that tobacco damages health. Those who smoke counteract measures designed to control the epidemic of addiction to tobacco. Health professionald should be conscious of the example they give. We therefore developed a specific tobacco cessation programme directed to this population group.