Medical education on the addictions has improved over the past 25 years, but it is still relatively rare for medical students to receive comprehensive training in how to identify and manage patients with addictive disorders, according to Bud Isaacson, MD, vice chairman of the Department of General Internal Medicine at the Cleveland Clinic, who participated in a recent ASAM conference in Los Angeles.

Dr. Isaacson noted that agencies such as 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.

In a survey of medical schools published in the Journal of Scientific Studies (November 2000), Dr. Isaacson reported that while 95% of programs in psychiatry required classroom training on addictive disorders, only 75% of programs for family physicians did so. Even fewer required that residents complete a rotation at an addiction treatment facility.

In spite of the pervasive presence of addiction problems in emergency departments and the fact that fetal alcohol syndrome is the leading cause of preventable birth defects, Dr. Isaacson’s survey found that emergency medicine and OB-Gyn gave especially short shrift to addiction training.

Even course requirements were no guarantee of an in-depth learning experience. Dr. Isaacson pointed out that programs for emergency physicians and OB/Gyns included an average of only 3 hours of addiction training, and even psychiatry programs required only 8 hours of training on addictions. He said it was not surprising that students rarely learn 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, NC. There, students not only receive extensive classroom training, but must attend local AA meetings, which count as 15% of their grade. ECU graduates have shown a “dramatic improvement” in their assessment skills, confidence in making referrals to treatment and self-help groups, and ability to overcome preconceptions of addiction as a moral weakness or issue of willpower, according to Jerome Schulz, MD, a clinical professor at the school.

Taken from ASAM News,

July-August 2001 Issue