Medical Education About Addiction

This article focused upon a critical issue that has been an obstacle to effective addiction treatment for the past thirty years - educating doctors about addiction and it's treatment.  The article emphasizes the fact that in spite of improvements in medical education it's still relatively rare for medical students to get comprehensive training on identifying and treating addiction.

Advocacy by leading national organizations has done little to improve the hands training in addiction that is received by most medical professionals.  Even though guidelines for teaching about addiction in the fields of internal medicine, pediatrics, psychiatry, family medicine, emergency medicine, and obstetrics/gynecology have been developed, these courses are usually offered as electives rather than core courses at major medical schools.  

A survey of medical-school directors published in the November 2000 edition of the Journal of Studies on Alcohol, Isaacson found that while 95 percent of schools for psychiatry required addiction classroom training, just 75 percent of schools for family physicians did so. And even fewer required residents to do a rotation at an addiction-treatment facility.  Only 55 percent of curricula for emergency medicine included any course hours for addictive disorders; for internal medicine, 51 percent; for osteopathy, 41 percent; for OB/GYN, 39 percent; and for pediatrics, 31.8 percent.  Physician training programs for emergency physicians and OB/GYNs included an average of only 3 hours of addiction training, and even psychiatry schools required only 8 hours of training on addictions. 

Given such limitations, it's not surprising that students rarely learned more than simple screening techniques and information about detoxification, and heard little about treatment follow-up or brief interventions. 

The question is why -- why are the nation's physicians ignoring one of the nation's leading health problems?  

The answer really isn't as complicated as it might seem.  Alcoholism and drug addiction are disorders carrying a negative social stigma.  This social stigma prevents doctors from looking at addicted patients as a priority.  

Our national approach to alcohol and drug control problems is one of criminalization and punishment.  Problems related to alcohol and alcoholism have virtually disappeared from the national agenda.  Drug addiction has been criminalized and drug addicts demonized.

The nation currently follows a criminal drug prohibition policy that makes the possession and use of illegal drugs a felony and stigmatizes addicts as 'drug-crazed criminals'.  

The role of physicians in the treatment of addiction is severely limited by drug control and enforcement policies.  Recently the Drug Enforcement Agency (DEA) has emphasized that prescription drug abuse is a crime and physicians could be implicated for improperly prescribing mood altering drugs.  This has sent fear through the medical community.  

ASAM sent a letter to the DEA asking for clarification of the physician's role in deciding what is appropriate use of mind altering drugs in addiction medicine.  The response basically said that the DEA determines what constitutes legitimate medical use and abuse of prescription drugs, not medical experts.  This puts physicians at legal risk in treating addicts, chronic pain patients, and other people who require prescription of controlled substances.  Most physicians shy away from such legal threats.  <Click here to read the ASAM letter and the DEA response>

The solution to getting better physician education in the treatment of addiction lies in developing a comprehensive national plan for addiction treatment in America.  This involves a review of our current drug control policies and laws.  It means getting the nation focused upon intervention and treatment of addiction rather than incarceration and punishment of addicts.  

Unfortunately, until this nation embraces a Public Health Addiction Policy and abandons its failed War On Drugs Policy few meaningful changes in the treatment of addiction can occur.  

Few Medical Students Learn About Addiction

Feature article by Bob Curley for Join Together Online 
June 1, 2001.

Medical education on addictions has improved in the 25 years since the founding of the Association for Medical Education and Research in Substance Abuse, but it's still relatively rare for medical students to get comprehensive training on identifying and treating addictive disorders. 

Over the years, AMERSA has advocated for improved physician training, and agencies like the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have provided funding for medical-school curriculum development and faculty education. Results of these efforts have included the development of guidelines for teaching about addiction in the fields of internal medicine, pediatrics, psychiatry, family medicine, emergency medicine, and obstetrics/gynecology, and a significant expansion of elective courses on addictions offered at major medical schools. 

"But few require substance abuse in their [core] curriculum," noted Bud Isaacson, M.D., vice chairman of the Department of General Internal Medicine at the Cleveland Clinic, who spoke at the recent annual meeting of the American Society of Addiction Medicine in Los Angeles, Calif.

In a survey of medical-school directors published in the November 2000 edition of the Journal of Studies on Alcohol, Isaacson found that while 95 percent of schools for psychiatry required addiction classroom training, just 75 percent of schools for family physicians did so. And even fewer required residents to do a rotation at an addiction-treatment facility. 

In spite of the pervasive presence of addiction problems in emergency rooms and fetal alcohol syndrome's status as the nation's leading cause of preventable birth defects, Isaacson's survey found that these and other areas of medicine gave especially short shrift to addiction training. Only 55 percent of curricula for emergency medicine included any course hours for addictive disorders; for internal medicine, 51 percent; for osteopathy, 41 percent; for OB/GYN, 39 percent; and for pediatrics, 31.8 percent. 

Even course requirements were no guarantee of an immersive experience: Isaacson pointed out that programs for emergency physicians and OB/GYNs included an average of only 3 hours of addiction training, and even psychiatry schools required only 8 hours of training on addictions. "The number of hours was really quite small," Isaacson noted. 

Given such limitations, it's not surprising that students rarely learned more than simple screening techniques and information about detoxification, and heard little about treatment follow-up or brief interventions. Such programs stand in sharp contrast to models like the Brody School of Medicine at East Carolina University in Greenville, N.C., where students not only receive extensive classroom training, but must attend local A.A. meetings, which counts as 15 percent of their grade. Graduates have shown a "dramatic improvement" in their assessment skills, confidence in making referrals to treatment and self-help groups, and overcoming preconceptions of addiction as a moral weakness or issue of willpower, said Jerome Schulz, M.D., a clinical professor at the school. 

Medical-school directors said that lack of time, faculty experience, institutional support, and training sites were to blame for the dearth of addiction training. "Overall, psychiatry and family medicine are the most involved, but we have a long way to go," said Isaacson. 

To address the problem, Isaacson and other advocates for medical training look to the Health Resources and Services Administration's Project Mainstream, intended to bring addiction training into the mainstream of medicine. Physicians also need to put pressure on residency review committees to enforce training requirements for addiction, said Isaacson. 

Stephen F. Grinstead
Specializing in Training & Consultation
For Addiction & Coexisting Personality & Mental Health Problems

An Author & Nationally Recognized Expert
In Preventing Relapse Related To Chronic Pain Disorders

Developer of the Addiction-Free Pain Management System

sgrinstead@addiction-free.com  

www.addiction-free.com 

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is www.relapse.org.

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