Medical student and physician education in substance use disorders

Abstract

Research consistently demonstrates that substance use disorders (SUDs) constitute a major public health problem in the USA and around the world. In fact, SUDs account for approximately one in four deaths in the USA each year and result in more lives lost, illness, and disability than any other preventable health condition (Hanson and Li, JAMA 289(8):1031-1032; 2003). Persons with SUDs include those who use illicit drugs as well as those who use alcohol, prescription medications, or over-the-counter products in ways that vary from recommended practices. SUDs are conceptualized as occurring on a continuum that ranges from at-risk or hazardous use; through problematic or harmful use and abuse; and ultimately leading to dependence or addiction. The general health care system in the USA offers an ideal opportunity to identify and treat persons afflicted with SUDs and thereby to reduce associated adverse health, family, and societal effects (Association for Medical Education and Research in Substance Abuse. Strategic plan for interdisciplinary faculty development: arming the nation's health professional workforce for a new approach to substance use disorders. Providence, RI: The Association; 2002). Physicians are particularly well positioned to intervene effectively with patients who have these disorders (National Institute on Drug Abuse. The economic costs of alcohol and drug abuse in the United States-1992. Rockville, MD: NIDA, National Institutes of Health; 1998). Yet there is evidence that physicians are not adequately prepared to take advantage of this opportunity (Fiellin DA et al. The physician's role in caring for patients with substance use disorders: implications for medical education and training. In: Project mainstream: strategic plan for interdisciplinary faculty development: arming the nation's health professional workforce for a new approach to substance use disorders: part II. Discipline-specific recommendations for faculty development. Providence, RI: Association for Medical Education and Research in Substance Abuse; 2002). In a survey of 1,082 physicians that asked about screening practices regarding illicit drug use, 68% reported that they routinely screen patients, while 55% said they routinely offer referral to treatment to those patients who screen positive. However, 15% reported that they do not intervene, even when signs of SUD are apparent (Kessler et al., Arch Gen Psychiatry 51:8-18, 1994). This chapter outlines the rationale for greater physician involvement in recognizing and treating patients with SUDs, describes core clinical competencies and didactic initiatives for all physicians, reviews current barriers to improved medical education about SUDs, and presents strategies for overcoming those barriers.