Substance Abuse and Addiction

Substance abuse and addiction are complex health and societal problems. Substance abuse is the inappropriate and harmful use of any substance, including prescription drugs, OTC medications, supplements and alcohol. Addiction to substances includes the element of loss of control and is recognized as a chronic relapsing disease.

The AAFP promotes a society which is free of alcohol, drug and substance abuse. The AAFP strongly urges its members to be involved in the diagnosis, treatment and prevention of substance abuse and addictive disorders as well as the secondary diseases related to their use. Education in the treatment of all aspects of these complex disorders, including knowledge and usage of evidence-based strategies, should be a defined part of medical school and family medicine residency curricula.

To better care for patients with such disorders, a comprehensive strategy should be adopted by physicians that includes:

  1. Recognition of the gravity, extent, and broad-based nature of substance abuse and addiction in our society, including the development of novel mechanisms to ingest medications and alcohol;
  2. Inclusion of substance abuse prevention in patient education;
  3. Early diagnosis, treatment and referral of those struggling with substance abuse and addictive disorders;
  4. Recognizition of the effects of addiction on family members, especially children, offering support and treatment for family members and inclusion of family members in the treatment of the addicted member when possible; and
  5. Partnering with community resources in the prevention, education and treatment of substance abuse and addiction.
  6. Advocating for inclusion of and parity for substance abuse treatment in all health care plans;
  7. Advocating for legislation and governmental policies facilitating the prevention, diagnosis and treatment of substance abuse, including funding for further research into substance abuse;
  8. Reinforcement of laws and strategies to limit exposure of the population, particularly adolescents and children, to the abuse and misuse of these substances;
  9. Supporting harm reduction strategies such as bystander naloxone programs, syringe exchange programs, educational programs and policy initiatives to prevent the secondary diseases associated with abuse and addiction.

Opioid Pain Relievers and Abuse

Concurrent with the increased use of opioid analgesics for pain control has been an explosive growth in the rate of abuse, misuse and overdose of these prescription medications. The AAFP recognizes the vital role that family physicians and other primary care clinicians have in the proper provision of pain management services including prescribing opioid analgesics. The AAFP supports the training of family physicians regarding the proper assessment, referral and treatment of chronic pain patients in an effort to lessen the diversion, misuse and abuse of opioid pain relievers. The AAFP also supports further research into evidence-based guidelines for the treatment of chronic pain syndromes, implementation of prescription drug monitoring programs nationwide and greater physician input into pain management regulation and legislation. Please see the AAFP position paper, “Pain Management and Opioid Abuse, A Public Health Concern” for further information.

Heroin

Heroin, which can be sniffed, smoked or injected, is experiencing a rebound in usage, partially related to efforts to reduce the abuse of prescription pain relievers and with increased usage there has been a corresponding increase in overdose related deaths. The AAFP encourages its members to be aware of this and other trends in substance abuse and to recognize injection drug use as a vector in the transmission of HIV and hepatitis B and C.

Marijuana, Medical Use of

The AAFP recognizes that there is support for the medical use of marijuana but advocates that usage be based on high quality, patient-centered, evidence-based research and advocates for further studies into the use of medical marijuana and related compounds. The AAFP requests that the Food and Drug Administration change marijuana’s classification for the purpose of facilitating clinical research. This process should also ensure that funding be available for such research.

The AAFP also recognizes that some states have passed laws approving the medical use of marijuana; the AAFP does not endorse such laws. The AAFP encourages its members to be knowledgeable of the laws of their states and consult with their state medical boards for guidance regarding the use of medical marijuana.

Marijuana, Recreational Use of

The AAFP opposes the recreational use of marijuana. The AAFP recognizes that several states have passed laws approving limited recreational use of marijuana but advocates for further research into the overall safety and health effects of recreational use as well as the effects of those laws on patient and societal health.

Alcohol Abuse

A significant portion of the population is affected by alcoholism. The American Academy of Family Physicians promotes a society, free of alcohol abuse. The AAFP strongly urges its members to be involved in the diagnosis, treatment and prevention of alcoholism as well as diseases related to alcohol use and abuse. Detoxification is only the beginning of treatment and must be followed by adequate rehabilitation under expert guidance. Education in the treatment of all aspects of this complex disease should be a defined part of medical school and family medicine residency curricula.

The AAFP recommends that hospitals not discriminate against the admission and treatment of patients with alcohol-related illness or injury. The AAFP encourages its members to document alcohol abuse and alcohol related disease in the medical record and encourages members document alcohol abuse on death certificates when implicated as a contributing cause of illness, injury or death.

Alcohol Abuse in Adolescents

The AAFP recommends that all youth not consume alcohol. Although overall alcohol consumption by adolescents has decreased modestly over the past decade, alcohol use and abuse remains a signficant public health concern for that population. The AAFP urges its members to educate themselves and the public regarding the recognition, prevention and treatment of this medical problem in our nation's youth. Please also see the AAFP position paper, "Alcohol Advertising and Youth."

Advertising

The AAFP supports of a ban on the advertising of alcoholic beverages, particularly those advertisements which appeal to adolescents. Please also see the AAFP position paper, "Alcohol Advertising and Youth."

Drinking and Driving

The AAFP supports efforts to reduce the number of alcohol and substance impaired drivers on our highways. Significant reduction in morbidity and mortality have been widely reported when laws provide a strong deterrence to driving while impaired and the AAFP recommends the adoption of such laws in the interest of public safety. The AAFPrecognizes the impaired driver as having a medical problem and recommends that impaired drivers receive appropriate referral and treatment for their condition. The AAFP supportd the following  recommendations:

  1. Reduction of the legal blood alcohol concentration (BAC) for drivers to 0.04 gm/dl.;
  2. State legislation to fund comprehensive alcohol-impaired driving prevention and treatment programs;
  3. State legislation to immediately confiscate drivers' licenses for those found to be above the legal BAC while driving (this is known as administrative license revocation);
  4. Increased enforcement of drinking and driving laws and expanded use of sobriety checkpoints;
  5. Support of state and federal messaging regarding alcohol and substance abuse and its effects on driving.

Standardized Drinking Age

The AAFP favors age 21 as the minimum legal age to purchase or consume alcohol.

Taxes on Alcohol Beverages

The AAFP, along with other professional and public health organizations advocates for the following:

  1. Strong support for increased federal taxes on beer, wine, and distilled spirits equally based on alcohol content withh a substantial portion of that revenue earmarked for the prevention and treatment of alcohol abuse and drunk driving;
  2. Strong support for increased state and local taxes on beer, wine, and distilled spirits with funds earmarked as outlined in #1.

Parity

Substance abuse is a treatable medical illness that, if left untreated or inadequately treated, incurs undue costs for the affected individual and for society as a whole. Treatment of substance abuse is often long-term and may be lifelong for selected individuals. Therefore, the AAFP supports full parity for substance abuse treatment in health care plans.

Pregnant Women, Substance Use and Abuse by

The AAFP recognizes that the literature does not support any lower limit of substance use at which potential fetal harm is mitigated. As such, the AAFP supports public and individual education about the risks of any substance use and abuse during pregnancy.

The AAFP opposes imprisonment or other criminal sanctions of pregnant woman solely for substance abuse during pregnancy, but encourages facilitated access to an established drug and alcohol rehabilitation program for such women.

Neonatal Drug Withdrawal

As described in the preceding section, no level of substance abuse during pregnancy is noted in which fetal harm is mitigated. In addition to the congenital anomalies and growth impairment associated with substance abuse, family physicians involved in newborn care are increasingly noting the problem of neonatal drug withdrawal or neonatal abstinence syndrome. The AAFP encourages the education of all its members providing newborn care into the recognition, diagnosis and treatment of this syndrome.

Injection Drug Use

The AAFP supports a comprehensive public health policy to prevent infectious diseases and other complications associated with injection drug use and abuse.

The AAFP supports dispensing and prescribing of injection equipment to patients as a means of preventing the transmission of disease where permitted by law. It also supports syringe exchange programs as a component of that strategy and supports the modification/passage of laws to accommodate those injection equipment programs. The AAFP recommends that physicians and other health care workers counsel their injection drug-use patients about using sterile syringes to inject drugs while simultaneously educating those patients about the harms of continued drug use and their treatment options.

Prevention of Overdose Deaths

In addition to efforts to improve the treatment of overdoses in the EMS and healthcare facility settings, efforts have begun to educate the lay public about the early recognition and treatment of overdoses. This includes efforts to ensure improved access to naloxone for management of overdoses, including its usage by the lay public, and efforts to encourage the public to access EMS earlier when an overdose is suspected. The AAFP supports those efforts including the promotion of naloxone kits for lay public usage as part of overdose prevention programs and promotes the passage of 911 Good Samaritan Immunity laws to exempt the lay public from prosecution when contacting EMS to report overdoses.

AAFP Resources

American Family Physician
Substance Abuse
http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=27

Alcohol Abuse and Dependence
http://www.aafp.org/afp/topicModules/viewTopicModule.htm?topicModuleId=1

FamilyDoctor.org
Alcohol Abuse: Alcohol Withdrawal Syndrome
http://familydoctor.org/familydoctor/en/diseases-conditions/alcoholabuse/treatment/alcohol-withdrawal-syndrome.html(familydoctor.org)

Alcohol Abuse—For Parents: Kids and Alcohol
http://familydoctor.org/familydoctor/en/diseases-conditions/alcohol-abuse/kids-andalcohol(familydoctor.org)
html

Alcohol Abuse—For Kids and Teens: Coping with an Alcoholic Parent
http://familydoctor.org/familydoctor/en/diseases-conditions/alcohol-abuse/coping-withan-alcoholic-parent.html(familydoctor.org)

Alcohol Abuse—Taking Medicines Safely After Alcohol or Drug Abuse Recovery
http://familydoctor.org/familydoctor/en/diseases-conditions/alcoholabuse/treatment/taking-medicines-safely-after-alcohol-or-drug-abuse-recovery-yourdoctor-can-help.html(familydoctor.org)

Alcohol Abuse: Treatment
http://familydoctor.org/familydoctor/en/diseases-conditions/alcohol-abuse/treatment.html(familydoctor.org)

Club Drug Use: Gamma-Hydroxybutyrate (GHB)
http://familydoctor.org/familydoctor/en/diseases-conditions/club-drug- use/gammahydroxybutyrate-GHB.html(familydoctor.org)

Inhalant Abuse Overview
http://familydoctor.org/familydoctor/en/diseases-conditions/inhalant-abuse.html(familydoctor.org)

Opioid Addiction: Overview
http://familydoctor.org/familydoctor/en/diseases-conditions/opioid-addiction.html(familydoctor.org)

Prescription Drug Abuse in the Elderly
http://familydoctor.org/familydoctor/en/diseases-conditions/opioidaddiction/prescription-drug-abuse-in-the-elderly.html(familydoctor.org)

Safe Use, Storage, and Disposal of Opioid Drugs
http://familydoctor.org/familydoctor/en/drugs-procedures-devices/prescriptionmedicines/safeuse/patient-counseling-for-use-of-extended-release-long-acting-opioi.html(familydoctor.org)

Substance Abuse: Overview
http://familydoctor.org/familydoctor/en/diseases-conditions/substance-abuse.html(familydoctor.org)

Substance Abuse: Symptoms
http://familydoctor.org/familydoctor/en/diseases-conditions/substanceabuse/symptoms.html(familydoctor.org)

Substance Abuse: Questions to Ask Your Doctor
http://familydoctor.org/familydoctor/en/diseases-conditions/substance-abuse/questionsto-ask-your-doctor.html(familydoctor.org)

Substance Abuse: Treatment
http://familydoctor.org/familydoctor/en/diseases-conditions/substanceabuse/treatment.html(familydoctor.org)

(2003) (2014 COD)