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Surgeon General’s Report Summary – Chapter 6

Surgeon General’s Report Summary – Chapter 6
Surgeon General’s Report Summary – Chapter 6

Chapter 6 focuses mainly on integration of general health care with substance abuse services. Because of this, I have chosen not to summarize this chapter in detail. For further information, please see the chapter link at the end of this post. There are, however, a few key components shared within this chapter that I would like to review.

While integration of general health and substance abuse services can be beneficial, many factors prevent such integration from happening. Lack of staffing, lack of training, and restrictions on insurance availability and Medicare/ Medicaid payments.

Lack of training is due in part to insufficient training in medical and psychiatry school. For example, a study done in 2006 by the Institute of Medicine (IOM) called Improving the Quality of Health Care for Mental and Substance Use Conditions found that:

  • Only 8 percent of medical schools had a separate required course on addiction medicine and 36 percent had an elective course
  • On average, the residency curriculum for psychiatrists included only 8 hours on substance use disorders
  • Schools and social work and psychology also provided little, and sometimes no, mandatory education on substance use-related problems
  • Pg. 6-32

However, the American Board of Medical Specialties recently recognized addiction medicine as a subspecialty, which is thought to increase focus and maybe attract more physicians to this area.

Transference of Medical Information

In the early 1970’s, the federal government passed Confidentiality of Alcohol and Drug Abuse Patient Records, as well as regulations which protect the confidentiality of treatment data from substance use disorder. This protection (42 CFR Part 2) was put in place because of possible discrimination of individuals which would prevent them from seeking treatment, and patient’s methadone records being used during criminal cases. These protections are also more rigorous than other health privacy laws like HIPAA.

While HIPAA does not require a patient to authorize the sharing of health information for payment, purposes of treatment, or health care operations, 42 CFR Part 2 requires consent from the patient to share information that identifies them as having, or having had, a substance use disorder.

However, individuals with illicit drug substance use disorders are not protected under laws that prohibit discrimination, such as the Americans with Disabilities Act (ADA).

Authors Note On Changes To the ACA

Much of Chapter 6 focuses on improvements made possible through the Affordable Care Act (ACA) with the expansion of Medicaid and Medicare, and the greater availability of persons eligible for health insurance. Because of this, and the current state of our health care system, I have decided to forgo this information. While this information is still currently available and pertinent now, the future of our health care system, and insurance system, is in limbo pending the decision of our government.

To view the PDF file of this chapter, please follow this link:

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