Addiction Medicine as a Medical Specialty

ASAM MISSION

• Increase access to and improve the quality of addictions treatment.

• Educate physicians, medical and osteopathic students and the public.

• Promote research and prevention, and

• Establish addiction medicine as a specialty recognized by the American Board of Medical Specialties (ABMS).

Purpose of Board Certification

• “…to provide assurance to the public that a physician specialist certified by a Member Board of the ABMS has successfully completed an approved educational program and an evaluation which includes an examination designed to assess the knowledge, skills and experience required to provide qualtiy patient care” (Adopted by ABMS 9. 23.93)

ASAM cannot fully realize its mission,

unless addiction medicine is an ABMS

board certified medical specialty.

ABMS Essentials for Approval

of

Examining Boards in Medical Specialties(Twelfth Revision, November 2005)

The following is a précis of Section IV of the

Essentials: “Criteria for Recommending

Approval of New ABMS Certifying Boards.”

(The material in parentheses indicates how

addiction medicine meets the Essentials.)

A. The new specialty board is based on substantial advancement in medical science, and represents a distinct field of medical practice.

(Principles of Addiction Medicine [3rd ed.]

demonstrates the basic and clinical science

of the field.)

B. Only one specialty board will be recognized in each specialty.

(The ABMS has not yet recognized a specialty board in addiction medicine. Asubspecialty certificate was approved in addiction psychiatry in 1991. 1,895 have been certified as of 2005.)

C. Training must be distinct; it is not feasible to have it included in training for existing Boards.

(Training in addiction medicine crosses several specialties; it cannot be subsumed into training for any existing specialty.)

D. Show that candidates will acquire, and diplomates will maintain capability, and demonstrate special knowledge and competencies in that field.

(The ASAM credentialing program includes

education, practice and written examination

requirements for certification and

recertification.)

E. Present evidence that the Board will establish standards for training. Havetraining programs accredited by the ACGMEor present a plan for establishing training.(Training standards exist in The ASAM Guidelines for Fellowship Training Programs. These require revision. ACGME training does not exist. A plan can be prepared for establishing training )

F. Demonstrate support from the field of medical practice, and broad professional support.

• 3,851 are certified in addiction medicine by ASAM. • 3,000 physicians are ASAM Members. Membership in other societies.• ASAM members are psychiatrists, internists, family physicians, emergency physicians, pediatricians, etc. • Two NIH Institutes (NIDA and NIAAA) are

dedicated to research in the addictions

• Refereed journals in the addictions.

• Prevalence of the addiction problem, and the health consequences.

• Allocation of public resources to preventions, research, treatment.

• JCAHO standards on addiction.

• Legislation (DATA 2000) permitting physicians to treat opioid addiction.

• Requirements in some states that certain treatment programs have a medical director who is “a licensed physician with knowledge of substance abuse disorders.”

• Existence of committees or task forces in medical specialty societies on alcohol and other drug dependencies.

• Acceptance by the AMA of addiction medicine as a self-designated practice specialty that physicians may select as their area of medical practice, and assignment of a special practice code (ADM).

G. Present an operational plan for the new board:

1. Governance Structure: Representation on the Board from appropriate organizations, and with members with expertise and stature.

2. Business Plan: Show financial support for diplomate evaluation and training.

3. Content of the Field: Define the core content, competencies and scope of practice.

4. Requirements for Certification: A plan for development and validation of the requirements for certification.

5. Evaluation Plan: For candidates for certification and recertification.

(Elements of a plan exist, or are available:

1. Governance Structure: ASAM would be the principal sponsoring organization; board members who are both expert and prominent are readily available.

2. Business Plan: Financial support for start up and board maintenance and to establish and maintain training must be identified.

3. Content of the field: This is described in

Content of Addiction Medicine (update

required), and in Principles (3rd ed.).

4. Requirements for Certification: These are

described in the requirements for ASAM

certification.

5. Evaluation Plan: The basic elements of an evaluation plan are contained in the ASAM requirements for certification, and in the ASAM Certification Council procedures.

Benefits of ABMS Board Certification

• Insurers will cover treatment for addiction. • Physicians will be able to make a living

practicing addiction medicine. • Training will be available for those who

want to specialize in addiction medicine.• Referrals and consultations would

increase significantly (because addiction medicine would be seen as "real medicine")

• ER screening can become routine.

• Families will have someone to turn to in the medical community to discuss prevention and treatment.

• The stigma of being addicted will lessen.

• Pharmaceutical companies will increase research on addiction treatment drugs.

• Attendance at ASAM CME conferences will increase.

• ASAM membership will increase.

• Sub-specialties will emerge as more research is done on the various types of addiction, or on patient populations.

• Textbooks will be written, in addition to Principles of Addiction Medicine.