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 substance abuse disorders and to effectively participate with substance abuse and addiction treatment professionals in the prevention, early recognition, and treatment of substance abuse and addiction, physicians should:

The American Academy of Family Physicians opposes the use of marijuana except under medical supervision and control for specific medical indications as allowed by law.

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 and diseases relating 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 the medical school and family practice 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 report the abuse of alcohol on patient records, hospital records and death certificates when implicated as a contributing cause of illness, injury or death.

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. Reports from various sources show significant reduction in morbidity and mortality where 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.

Alcohol abuse has increased significantly among adolescents. It impairs the development of personal and social maturity, and interferes seriously and sometimes permanently, with the development of adequate self-esteem as well as with the development 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, placing specific emphasis on youth education.

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

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. Reports from various sources show significant reduction in morbidity and mortality where 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:

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 alcohol.

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:

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.

Many states are proposing legislation which would impose criminal sanctions on pregnant women who are substance abusers, the AAFP opposes any imprisonment of pregnant woman solely for substance abuse during pregnancy and legislation which would interfere with a pregnant woman seeking prenatal care, but encourages easy access to an established drug rehabilitation program.

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 issues of injection drug use and disease prevalence, overall safety to the community, neighborhood, workers and participants and the overall risks and benefits of allocation of funding to SEPs.

Components of SEPs may include but not be limited to:

The AAFP supports dispensing and prescribing of injection equipment where legally required to patients as a means of preventing the transmission of disease. 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. This is an essential component of a comprehensive public health strategy to prevent infectious diseases associated with illicit injection drug use.

(2003)