Substance Abuse: Improving Treatment by Improving Medical Education
Physicians from Yale University and other institutions assert that medical residents need far more rigorous training and medical schools need stronger infrastructure in order to adequately deal with the medical, behavioral, financial and social problems created by substance abuse disorders. Their paper appears in the Annals of Internal Medicine.
The authors write that each year in the United States, more than 100,000 deaths and $300 billion in costs are attributed directly to the use of alcohol and other drugs, but that physicians have not been adequately trained to recognize patients with substance abuse disorders.
According to lead author Patrick G. O’Connor, M.D., chief of the Section of General Internal Medicine at Yale School of Medicine, “Despite the fact that the substance use is responsible for an enormous burden of disease in their patients and evidence-based screening approaches have been developed, physicians often fail to identify and treat substance abuse routinely. This may result not only in ongoing substance use and its complications, but also in inadequate treatment of the medical conditions for which their patients are being seen.”
The authors make five recommendations for integrating addiction medicine into graduate medical education in primary care, in order to help future doctors better identify substance abusers and properly treat and counsel them:
- Integrating core competencies into residency training; training on the full spectrum of substance use, from risky use to advanced addiction.
- Assigning the same priority to teaching about substance use as is given to teaching about common chronic conditions such as cardiovascular disease.
- Enhancing faculty development: Residency accreditation organizations should require faculty expertise in substance use disorders and addiction medicine as they do with other specialties.
- Providing organizational infrastructure: Academic medical centers have an infrastructure that assumes responsibility for discipline-specific educational, clinical and research activities. But generally, no such infrastructure exists for addiction medicine.
- Integrate substance abuse screening and management into routine care: Substance abuse is best addressed by a multidisciplinary team, including physicians, nurses and others, in a continuous and coordinated manner, say the authors.
“Creating an educational environment that fully integrates and adequately prioritizes substance abuse competencies into residency education as well as in medical school itself is critical to assuring that physicians are armed with the tools to provide adequate evidence-based care to their patients,” O’Connor said. “Programs and their institutions and certifying organizations must take responsibility for assuring that trainees have adequate curricular time and resources along with suitably trained core faculty to support this critical educational effort.”
Other authors are Julie G. Nyquist of the Keck School of Medicine at the University of Southern California, and Thomas McLellan of the University of Pennsylvania, who is also deputy director of the White House Office of National Drug Control Policy. The study was funded by a grant from The Betty Ford Institute and the Norlien Foundation.