The Time is Now: Improving Substance Abuse Training in Medical Schools

Abstract

This commentary highlights the growing demand for substance abuse prevention and treatment, summarizes the literature regarding the current insufficiencies in substance abuse training in medical schools, and suggests strategies to address this gap in physician education. The authors describe how the combination of mandated coverage for substance abuse services and expanding treatment needs means that more physicians, regardless of their patient populations, will be faced with addressing the problem of substance use. The authors review the literature on substance abuse training in medical schools, which indicates insufficient exposure to this topic. The authors describe how current substance abuse training at medical schools is focused on transmitting scientific knowledge with relatively little education or training in attitudes and skills central to effective prevention and treatment. Given the gap between clinical need and physician education, the authors suggest several strategies for medical schools to increase training in substance abuse knowledge, attitudes, and skills, which will enhance the practice of evidence-based care. The authors posit that medical curricular reform, combined with initiatives to change clinical culture around substance abuse, will translate into improved rates of screening, shorter overall length of treatment, effective referrals for continued treatment, and increased access to care for individuals who use substances and so reduce the morbidity and mortality associated with substance use.

Gaps in the Substance Use Disorder Treatment Referral Process: Provider Perceptions

“…However, clinicians often lack training regarding empirically-based practices for substance use treatment. On average, medical school students receive 12 hours or less or substance use education, most of which involves the biological bases of substance use disorder rather than empirically-supported treatment (Ram and Chisolm, 2016). Non-physicians, such as social workers and case managers, often make referrals and have little to no required training in empirically-supported treatment of substance use disorder (Russett and Williams, 2015).…”

Substance Use Disorders Education: Are We Heeding the Call?

“…We must think creatively about how to enhance our efforts in education and to ensure that all physicians-irrespective of degree of formal specialization in addictions-receive adequate preparation for caring for patients with substance use disorders. Several areas for improvements include increased curricular time devoted to education and training, more interprofessional learning opportunities, and greater first-person experiences with successful treatment of this patient population [5,6]. In the February 2020 issue of Academic Psychiatry, these areas are further explored in a collection of seven articles [7][8][9][10][11][12].…”

“…Given the scope of substance use disorders in the USA, psychiatrists will not be able to approach this education alone but must include providers outside of psychiatry in our efforts. When addressing deficits in education related to substance use disorders in 2016, Ram and Chisolm [6] wrote, "The time is now." Four years later, are we heeding this call?…”

Opioid Overdose Prevention in Family Medicine Clerkships:

“…Although medical schools have responded to the opioid crisis by implementing pain management/addiction curricular changes, medical education literature is scarce regarding overdose prevention, including naloxone prescription. [3][4][5][6][7][8][9][10][11][12] Overdose education in medical training is vital as PCPs are uniquely positioned to practice prevention and implement harm reduction. 13,14 While timely naloxone administration is effective in reversing overdose, naloxone awareness remains low among PCPs, 15 and physicians cite inadequate addictions education as a barrier to naloxone use.…”