In a major milestone for the addiction field, the American Board of Addiction Medicine (ABAM) recently named the first group of board-certified addiction-medicine specialists, recognizing 1,240 doctors who previously had been certified by the American Society of Addiction Medicine (ASAM).

More than 100 of the "grandfathered" addiction-medicine specialists attended the ASAM annual medical-scientific meeting in New Orleans earlier this month to receive their ABAM certification in person. ABAM, formed in 2007, is the only national medical board dedicated exclusively to addiction medicine, with a mission that includes setting standards for physician education, assessing physicians' knowledge, and facilitating continuing education.

ABAM certification will be offered to physicians in Internal Medicine, Family Medicine, Obstetrics & Gynecology, Pediatrics, Emergency Medicine, Surgery, Preventive Medicine, Psychiatry, Neurology and other medical specialties. "Physicians are often at a loss for what to do about substance use and addiction issues, and may even misdiagnose the problem," said ABAM President Kevin B. Kunz, M.D. "We hope to change this by creating a cadre of thousands of specialized physicians across medical specialties."

The timing is right for standardizing and improving professional education in the field of addiction medicine, according to Kunz and others who pointed to a recent paradigm shift around addiction that has taken place in the medical community. "Over time, people have begun to recognize that this should look more like other medical specialties," said addiction researcher Richard Saitz, M.D, of the Boston University School of Medicine. "Years ago, addiction was not viewed as a health problem. In the past 10-12 years, enough people in the health community have recognized addiction as a health problem that attitudes have changed sharply."

"Years of scientific research have proven drug addiction is a brain disease caused by biological, environmental and developmental factors -- a disease which can have far-reaching medical consequences," added Nora D. Volkow, M.D., director of the National Institute on Drug Abuse. "Given the proper training, tools, and resources, physicians can be the first line of defense against substance abuse and addiction -- identifying drug use early, preventing its escalation to abuse and addiction, and referring patients in need to treatment."

"This will bring addiction as a disease the recognition that the rest of the country already has," said Kunz. "Essentially, medicine is catching up with the rest of society."

Addiction certification and specialization among M.D.s does not pose a threat to traditional counselors, Kunz stressed. "We consider ourselves partners in the total care of patients, not just prescribing meds and doing detox," he said. "We need a team approach, and addiction physicians have a very high regard for those who do tremendous work in 12-step programs."

Long-Term Plans Outlined

Kunz said that ABAM expects to grandfather a few hundred more ASAM-certified doctors before offering its first board-certification exam in 2010. The group also is working on establishing a continuing medical education (CME) program (and requirements) for certified addiction doctors. Kunz said the ultimate goal is for ABAM -- and addiction medicine -- to win recognition by the American Board of Medical Specialties (ABMS).

"The implications are monumental," said Saitz, who said ABMS recognition would open the door for more young doctors to choose addiction medicine as a specialty and get training, as well as encouraging medical centers to establish separate departments of addiction diseases -- which exist for all other medical specialties but not addictions, he said.

ABAM hopes to have a model residency program finalized within the next 18 months, said Kunz, and 25-50 addiction-medicine residency programs established nationwide within three years. Currently, there are no addiction medicine residencies among the 8,200 accredited residency programs in the nation's hospitals.

ASAM, which was instrumental in founding ABAM, had about 500 doctors take its certification exam last year; Kunz said he hopes to have 1,000 physicians seek ABAM certification in 2010, and that a goal of 3,000-6,000 ABAM-certified physicians within the next 8 years is not unrealistic.

"We want addiction prevention, screening, intervention and treatment to become routine aspects of medical care, available virtually any place health care is provided," Kunz said.

How many certified addiction specialists does the U.S. require to meet the needs of the population? Kunz notes that about 10 percent of the population has an addiction problem, but only 10 percent of those with addictions currently get the help they need. He compared addiction medicine to radiology, another medical specialty that cuts across multiple areas of health care, from emergency medicine to oncology; since 1935, 37,000 radiologists have been board-certified in the U.S.

"My guess is we will need at least 10,000 board-certified addiction specialists to make this work," said Kunz.

"We need the prestige and recognition of certification in order to be at the table so that our patients get the care they deserve," added Saitz. "There are a lot of things our patients put up with because of the lack of prestige and stigma. Imagine the outcry if we said that most people with breast cancer don't get treatment?"