Substance and Alcohol Abuse and Addiction

Substance abuse and addiction are complex health and societal problems. Abuse of substances 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 treatment and prevention of some addictive diseases are cost-effective as confirmed by a number of scientific studies.

To better care for patients with such disorders and to effectively collaborate with substance abuse and addiction treatment professionals in the prevention, early recognition, and treatment of substance abuse and addiction, physicians should:

  1. recognize the gravity, extent, and broad-based nature of substance abuse and addiction in our society;
  2. include substance abuse prevention in patient education;
  3. diagnose substance abuse and addiction in the earliest stage possible, and treat or refer for treatment;
  4. be aware of the criteria for outpatient, intensive outpatient, partial hospitalization, and in-patient treatment in order to recommend the appropriate level of treatment for each patient;
  5. recognize the effects of addiction on family members, especially children, offer support and treatment for family members, and include them in treatment for the addicted member whenever possible; and
  6. partner with community resources in prevention, education and treatment of substance abuse and addiction.

Marijuana

The American Academy of Family Physicians opposes the recreational use of marijuana. With regards to the medical use of marijuana, the AAFP defers to all applicable federal and state laws ("applicable laws") and encourages its members to abide accordingly. The AAFP supports the rights of individual physicians to determine patient treatment in their clinical practice.

Alcohol Abuse

A significant portion of the population is affected by alcoholism. The American Academy of Family Physicians publicly favors a society, which is 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 the use of alcohol. 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 Academy recommends that hospitals not discriminate against the admission and treatment of patients with alcohol-related illness or injury. The Academy encourages its members to document alcohol abuse in the medical record. It should also be recorded on the death certificates when implicated as a contributing cause of illness, injury or death.

Alcohol Abuse in Adolescents

Alcohol abuse has increased significantly among adolescents. It impairs the development of personal and social maturity, and seriously interferes with the development of adequate self-esteem and attainment of life goals. Therefore, the Academy urges its members to educate themselves and the public regarding the recognition, prevention and treatment of this medical problem in our nation's youth.

Advertising

The AAFP urges strong support of a ban on the advertising of alcoholic beverages.

Drinking and Driving

The Academy believes the alcohol-impaired driver is a deadly public menace. It supports all efforts to remove this driver from our streets and highways. Significant reduction in morbidity and mortality have been widely reported when the law provides a strong deterrent to driving while under the influence. The Academy recommends the adoption of such laws in the interest of public safety. The Academy also believes that drunken drivers should be recognized as having a medical problem and should be referred to appropriate sources of treatments.

The AAFP urges strong support of the following four 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 (this is known as administrative license revocation),
  4. Increased enforcement of drinking and driving laws and expansion of the use of sobriety checkpoints.

Standardized Drinking Age

Although the American Academy of Family Physicians does not recommend consumption of alcohol, it does support a national standard minimum age for the legal purchase of alcohol.

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

Taxes

The AAFP adopted as policy the following two recommendations from the proceedings of the Surgeon General's Workshop on Drunk Driving, as presented by C. Everett Koop on May 31, 1989:

  1. Strong support for increased taxes on alcoholic beverages and tax on beer, wine, and distilled spirits equally based on alcohol content.
  2. Support for designating a portion of the increased revenues to match the level of alcoholic beverage advertising with an equal number of pro-health and pro-safety messages.

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. 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.

Syringe Exchange Programs

The AAFP supports syringe exchange programs (SEPs) as a vital component of a comprehensive strategy to prevent infectious diseases associated with illicit injection drug use.

The ability to establish effective SEPs may require the modification or repeal of existing drug paraphernalia/syringe possession and syringe prescription laws. SEPs should not be subject to regulations that diminish their overall effectiveness.

Local discretion should be permitted in the decision to establish SEPs and should take into consideration prevalence of injection drug use and disease, overall safety to the community, neighborhood, children, and SEP participants along with the overall risks and benefits of allocating funds to SEPs.

Components of SEPs may include but are not be limited to:

  • Drug abuse and addiction referral,
  • HIV testing and counseling,
  • Hepatitis B testing and immunization,
  • Referral for social services, health care and reproductive health services,
  • Referral for mental health services,
  • Proper training of involved staff of SEPs,
  • Health education, including alcohol and other substance abuse,
  • Education regarding prevention of sexual and injectable disease transmission,
  • Education regarding methods of further reduction of harm associated with drug use,
  • Processes to assure the safe disposal of exchanged syringes and needles
  • Funding adequate for continuity and consistency of syringe exchange services.

Syringe Prescribing and Dispensing

The AAFP supports dispensing and prescribing of injection equipment to patients as a means of preventing the transmission of disease where permitted by law. The AAFP further recommends that physicians and other health care workers counsel injection drug users who continue using these drugs to use a new sterile syringe each time they prepare and inject drugs while also educating on the harms of drug use and treatment options. These are essential components of a comprehensive public health strategy to prevent infectious diseases associated with illicit injection drug use.

(2003) (2009 COD)