At the recent "New Frontier in Addiction Treatment" conference (see Reform May Jolt Field Plagued By Frustration), Paul Roman, Ph.D., a distinguished research professor of sociology at the University of Georgia, argued that medications used to treat substance abuse, such as naltrexone, acamprosate, and buprenorphine, hold great promise but are "frozen."

"We have failed to educate the public about medication-assisted treatments, or MAT," he asserted. "The public doesn't know anything about this stuff. It needs to know something or we are not going to get anywhere with it." This is especially the case regarding youth with substance abuse problems, he believes.

Only about one-third of substance abuse programs in the United States are using MAT in one way or another, he continued. Usually they are larger programs located in a hospital setting or that have a physician on staff.

But even 41 percent of private substance abuse programs with a physician on staff do not use MAT, and 82 percent of public substance abuse programs with a physician on staff do not do so. Programs that place a strong emphasis on the 12-step model of treatment are significantly less likely to use MAT than other types of programs.

Another barrier to the use of MAT is lack of physician training in how to deploy the medication treatments, Roman pointed out. For example, psychiatrists may need guidance in using injectable naltrexone (Vivitrol).

"We would like to move MAT into primary care," said Roman, "but that is only a dream at this point. Peter Miller, Ph.D., a professor at the Medical University of South Carolina's Center for Drug and Alcohol Programs, agreed. The larger problem, Miller said, is that detecting or treating alcohol use disorders in primary care is far from routine.

"So is the fact that the glass is only one-third full in terms of using MAT a cause for alarm?" Roman asked. "I don't know," he said. "We have made progress, but this is a field that remains on the defensive."