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Physician Substance Abuse Training ’Inadequate,’ Experts Say


According to educators at Yale School of Medicine and other U.S. medical schools, doctors-to-be require a lot more training to address substance abuse than they currently receive, reported Jan. 6.

Substance use disorders are at the root of a staggering array of medical, behavioral, and social problems, said the authors. In the U.S. alone, drug and alcohol abuse caused more than 100,000 deaths and cost the country more than $300 billion annually.

“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,” said Patrick O’Connor, M.D., chief of the Section of General Internal Medicine at Yale and lead author of the paper.

“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.”

O’Connor and his colleagues made the following recommendations to address the training deficit: 

  • raise the priority for substance abuse education (give it the same importance as training for other chronic diseases);
  • enhance faculty development (accrediting organizations should require faculty expertise in addiction medicine);
  • provide organizational infrastructure (put specific faculty and departments in charge of substance abuse education — preferably, a multidisciplinary team);
  • integrate core competencies into resident training (epidemiology, screening, assessment, intervention, and pharmacological management); and
  • make substance abuse screening and management routine in primary care.

“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,” he said.

“Programs … 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.”

The article was published in the Jan. 4 issue of Annals of Internal Medicine.

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