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Drug Abuse and Addiction in Medical Illness pp 531–544Cite as

Medical Student and Physician Education in Substance Use Disorders

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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.

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Acknowledgments

The research assistance of Mary A. Kelly, MSLS, is acknowledged with gratitude, as is the editorial assistance of Heather L. Talbert, MA.

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Authors and Affiliations

  1. Dual Diagnosis Program, Middlesex Hospital, 20 Jericho Drive, Old Lyme, CT, 06371, USA

    Stephen A. Wyatt DO

  2. Coalition on Physician Education in Substance Use Disorders (COPE) at Yale University School of Medicine, 210 Marlboro Avenue, Suite 31, PMB 187, Easton, MD, 21601, USA

    Bonnie B. Wilford MS

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  1. Stephen A. Wyatt DO
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Correspondence to Stephen A. Wyatt DO .

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Editors and Affiliations

  1. Inst. Pharmaceutical Sciences, Department of Psychopharmacology, Utrecht University, Universiteitsweg 99, Utrecht, 3584CG, Netherlands

    Joris C. Verster

  2. Dept. Psychiatry, Medical University of South Carolina, President St. 67, Charleston, 29425, South Carolina, USA

    Kathleen Brady

  3. School of Medicine, Div. Alcoholism & Drug Abuse, New York University, First Ave. 550, New York, 10016, New York, USA

    Marc Galanter

  4. Institute of Psychiatry, King's College London, National Addiction Centre, Windsor Walk 4, London, SE5 8AF, United Kingdom

    Patricia Conrod

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Wyatt, S.A., Wilford, B.B. (2012). Medical Student and Physician Education in Substance Use Disorders. In: Verster, J., Brady, K., Galanter, M., Conrod, P. (eds) Drug Abuse and Addiction in Medical Illness. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3375-0_45

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