Miller: Why Physicians Are Unprepared to Treat Patients With Alcohol and Drug-Related Disorders (2001)

Type: Document
Downloadable: Yes
Comments: 0
The authors, Norman S. Miller, M.D. and others, review the findings of the literature on these problems, discuss the barriers to educational reform, and propose recommendations for developing an effective medical school curriculum about alcohol- and drug-related disorders. J Acad Med 2001;7:410-418.

Isaacson: National Survey of Training Substance Use Disorders in Residency Programs (2000)

Type: Document
Downloadable: Yes
Comments: 0
To determine the amount of formal training in substance use disorders that occurs in selected residency programs and to identify the perceived barriers to such training, a national survey was conducted (by Isaacson JH, Fleming M, Kraus M, Kahn R) of program directors in emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics and psychiatry. J Stud Alcohol 2000; 61: 912-915.

Internal Medicine Residency Training for Unhealthy Alcohol and Other Drug Use: Recommendations for Curriculum Design (2010)

Type: Document
Downloadable: Yes
Comments: 0
An outline of a curriculum in unhealthy substance use with examples from common teaching venues. Specific topics are recommended and the content is linked to ACGME core competencies. Commissioned by the Betty Ford Institute and MERF; published on line at Biomedical Central Section on Medical Education.

Integrating Addiction Medicine Into Graduate Medical Education in Primary Care: The Time Has Come (2011)

Type: Document
Downloadable: Yes
Comments: 0
This article (from Annals of Internal Medicine, January 2011) discusses five specific recommendations for getting core competencies about addiction into the curriculum of residency training programs in internal medicine and family medicine. The recommendations were made at the consensus conference held by the Betty Ford Institute and MERF in 2008.

Healthcare Access Among U.S. Adults Who Drink Excessively: Missed Opportunities for Prevention (2006)

Type: Document
Downloadable: Yes
Comments: 0
Data from a 2002 Behavioral Risk Factor Surveillance System of 246,964 study participants. Results indicate 79% of “excessive drinkers” have health insurance and 78% had a “recent” check up with a physician. Highlights low screening rates of excessive drinkers and physician missed opportunities to help persons with harmful or potentially harmful drinking practices. Prev Chronic Dis 2006; 3(2):A53.

Fleming: Who Teaches Residents About the Prevention and Treatment of Substance Use Disorders? (1999)

Type: Document
Downloadable: Yes
Comments: 0
1999 national survey by Michael F. Fleming and others, via telephone interviews, of the faculty who taught residents about substance use disorders. J Fam Pract 1999; 48(9):725-9.

El-Guebaly: Medical Education in Substance-Related Disorders—Components and Outcome (2000)

Type: Document
Downloadable: Yes
Comments: 0
Research published in Addiction by Nady El-Guebaly et. al. Aims. To analyze the process of acquisition by physicians of a body of knowledge and skills in the management of substance abuse. Design. A comprehensive search of English-speaking literature was conducted over 20 years. Articles assessing the outcome of educational strategies in undergraduate, graduate and continuing medical education were examined to determine the targeted sample, the educational strategies involved and the outcomes assessed. Findings. Nine studies in undergraduate education, 11 in graduate and 11 in continuing education met the inclusion criteria. They were generally difficult to compare in design, strategy and outcome analysis. Cognitive knowledge and behavioral skills appear to be easier to obtain compared to more complex attitudinal shifts. Conclusions. There is growing consensus in the selection of a combined didactic and interactive educational strategy but few empirical data as to the more cost-effective learning interventions. Training must be reinforced at regular intervals. While the expanding panoply of interventions available to physicians should enhance the perceptions of role legitimacy and treatment optimism, cohort studies across levels of education, specialty groups and across-substance and other addictive behaviors are required to determine cost-effective educational strategies. Addiction 2000; 95(6): 949-957.

Davis: Substance Abuse Units Taught by Four Specialties in Medical Schools and Residency Programs (1988)

Type: Document
Downloadable: Yes
Comments: 0
A survey by Ardis K. Davis, F. Cotter and D. Czechowicz of medical schools and residency programs in four specialties (family practice, internal medicine, pediatrics, and psychiatry) sought information on the number and type of curriculum units on substance abuse offered by them. Considerable variation in offerings was found among the specialties. J Med Educ 1988; 63(10):739-746.

D'Onofrio: Improving Emergency Medicine Residents' Approach to Patients With Alcohol Problems (2002)

Type: Document
Downloadable: Yes
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Two groups in a Level 1 trauma center were studied: the intervention group and a control group. The intervention was a 4-hour didactic, a video and a skills-based workshop. Change was measured by record review before and after intervention. Ann Emerg Med July 2002; 40:50-62.

Christison: Requiring a One-Week Addiction Treatment Experience (2003)

Type: Document
Downloadable: Yes
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Medical education shapes student attitudes toward substance-abusing patients,often in negative ways. Curricular interventions to foster more positive attitudes toward such patients and their treatment can have lasting effects on clinical practice. The nature and duration of such interventions, however, requires clarification. To test the hypothesis that spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site would improve attitudes toward substance-abusing patients without reducing the clerkship benefits on attitudes toward, and knowledge about, psychiatry patients. Conclusions: Spending 1 week of a 6-week psychiatry clerkship on an addiction treatment site increased regard for patients with alcoholism without adversely affecting measures of attitudes toward, and knowledge about, psychiatric patients. Teach Learn Med 2003; 15(2): 93-97.

CASA–Missed Opportunity: National Survey on Substance Abuse (2000)

Type: Document
Downloadable: Yes
Comments: 0
An outstanding, and the most comprehensive, survey of primary care physicians and patients with substance abuse. The paper reveals how physicians identify, or fail to identify, substance abuse in their patients, efforts that physicians make, or don’t make, to help patients with substance use problems. The article includes an extensive discussion and assessment of the barriers to effective diagnosis and treatment. The Forward (pages i-iv), authored by Joseph Califano, is a “must read” for any primary care physician.

Bigby: Editorial—Substance Abuse Education During Internal Medicine Training (1989)

Type: Document
Downloadable: Yes
Comments: 0
Bigby: Editorial—Substance Abuse Education During Internal Medicine Training (1989)

Arnsten: Teaching About Substance Abuse with Objective Structured Clinical Exams–OSCE (2006)

Type: Document
Downloadable: Yes
Comments: 0
Julia H. Arnsten et. al. wrote case scenarios for OSCE stations based on their clinical experience and the core competencies described by Fiellin et. al., in the AMERSA "Strategic Plan." This article describes the process and the results. The immediate feedback provided during an OSCE helped teach needed skills for assessing and managing substance abuse disorders. J Gen Intern Med 2006; 21(5): 453-459.

AMERSA Strategic Plan: A New Approach to Substance Use Disorders (2002)

Type: Document
Downloadable: Yes
Comments: 0
This document contains the most commonly cited list of core competencies (starting on page 207) in the chapter written by David Fiellin, MD, Gail D’Onofrio, MD, Richard Brown, MD, Patrick O’Connor, MD, Richard Butler, DO.

Alford: An Evaluation of the Chief Resident Immersion Training (CRIT) (2008)

Type: Document
Downloadable: Yes
Comments: 0
This paper by Daniel P. Alford, M.D. et. al. describes the Chief Resident Immersion Training (CRIT) program in addiction medicine and evaluates its impact on chief resident (CR) physicians' substance use knowledge, skills, clinical practice, and teaching. The CRIT program in addiction medicine effectively transferred evidence-based SU knowledge and practice to 64 CRs in generalist disciplines and more importantly, enhanced the substance use curriculum in 47 residency programs. CRIT is designed to capitalize on the potential to shift the values and culture of a residency program to include more substance use training. J Gen Intern Med DOI: 10.1007/s11606-008-0819-2

ACGME Program Requirements for Internal Medicine—Proposed Revisions (2008)

Type: Document
Downloadable: Yes
Comments: 0
The RRC for Internal Medicine revises its requirements about every two years and posts them for comment. The comment period ended May 2008. This 25-page document shows the revisions, which will become effective July 2009.

ACGME Program Requirements for Internal Medicine—Impact Statement (2008)

Type: Document
Downloadable: Yes
Comments: 0
The RRC proposed these revisions “to match the intent of the Outcomes Project and base the residency training on the competencies, rather than on curriculum or process.” This 6-page impact statement discusses the intended impact of the changes.

ACGME Program Requirements for Internal Medicine (2007)

Type: Document
Downloadable: Yes
Comments: 0
ACGME Program Requirements for Internal Medicine (2007)

ACGME Program Requirements for Family Medicine (2007)

Type: Document
Downloadable: Yes
Comments: 0
ACGME program requirements for residents in Family Medicine

ACGME Program Requirements for Addiction Psychiatry (2003)

Type: Document
Downloadable: Yes
Comments: 0
ACGME program requirements for residents in Addiction Psychiatry

ACGME Policies and Procedures (2008)

Type: Document
Downloadable: Yes
Comments: 0
Pages one to five (the table of contents) give a detailed list of everything covered in this 110-page document. For example, the section "Procedures for the Develoment and Approval of Requirements" shows that changes originate with the Residency Review Committees and proceed through specific steps itemized here, including notifying the "communities of interest."

ACGME Description

Type: Document
Downloadable: Yes
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This brief, one-page overview describing the structure of ACGME and listing the organizations that make up the governing body sets the stage for learning how ACGME works.

NESARC–Prevalence, Correlates, Disability and Comorbidity of DSM-IV Alcohol Abuse and Dependence (2007)

Type: Document
Downloadable: Yes
Comments: 0
Best large epidemiologic study of the course of alcoholism in the US. The authors, Deborah S. Hasin, PhD. and others, provide statistics on prevalence of lifetime and 12 month alcohol abuse and dependence. Based solely on self report of 43,093 study participants. The study suffers from a lack of interviews with persons who corroborate study participants alcohol use. Arch Gen Psych 2007; 64(7):830-842.

Urine Drug Testing in Clinical Practice (3rd Ed, 2006)

Type: Document
Downloadable: Yes
Comments: 0
This is the 3rd edition (2006) of this widely respected monograph. Twenty-two pages chock full of practical specifics and explanation of clinical uses. Includes sections on Why to Test, When to Test, Urine Testing Methods, Interpretation of Results. Brief reviews of the technologies using saliva, hair, sweat, blood. Three case studies from clinical practice. The glossary alone is helpful. Available as a PDF from the website of the California Academy of Family Physicians.

Screening for Alcohol Problems in Primary Care: A Systematic Review (2000)

Type: Document
Downloadable: Yes
Comments: 0
By David A. Fiellin M.D. and others. For clinicians interested in a review of evidence supporting the clinical use of formal screening instruments (CAGE, AUDIT). Arch Intern Med 2000; 160:1977-1989.

Samet: Beyond Cage—A Brief Clinical Approach After Detection of Substance Abuse (1996)

Type: Document
Downloadable: Yes
Comments: 0
What do you do if your patient screens positive on the CAGE? This article, by Jeffrey H. Samet, M.D., et. al., is a brief overview of how to tailor your response to be most effective to the particular patient. Arch Intern Med 1996; 156: 2287-2293.

Role of the Primary Care Physician in Problems of Substance Abuse (1999)

Type: Document
Downloadable: Yes
Comments: 0
For the motivated primary care physician. The authors, Michael F. Weaver M.D. and others, provide guidelines on how to recognize (and treat if appropriate) intoxication and withdrawal of most drugs of abuse. Also includes techniques for brief intervention plus guidelines on how to provide long-term primary care for patients with substance use problems. Arch Intern Med 1999; 159:913-924.

Outpatient Management of Patients with Alcohol Problems (2000)

Type: Document
Downloadable: Yes
Comments: 0
From Annals of Internal Medicine series in primary care. The authors, David A. Fiellin M.D. and others, provide information on how to screen and effective methods of screening. Assessing harmful drinking, clinical care, outpatient management and referral are clearly outlined. Ann Intern Med 2000; 133:815-827.

NIDA Principles of Drug Addiction Treatment: A Research-based Guide

Type: Document
Downloadable: Yes
Comments: 0
An excellent publications for all readers -- clinicians and patients. This 54-page booklet does not mince words. In clear, straightforward language, it states principles, some perhaps controversial, succinctly and candidly.

NIAAA Clinician's Pocket Guide

Type: Document
Downloadable: Yes
Comments: 0
A quick and easy to use accordion folded 3 ½ “ X 7” booklet on screening and brief intervention. Simple to follow guidelines and algorithms.

NIAAA Clinician's Guide: "Helping Patients Who Drink Too Much"

Type: Document
Downloadable: Yes
Comments: 0
All physicians should be familiar with the contents of the guide. A copy should be in every physician’s office. Easy access to information on screening, intervention, management, resources, patient education handouts. How to screen for alcohol related problems; how to talk with patients. Also available at: www.niaaa.nih.gov. Includes forms, Spanish version of booklet, on-line education on how to screen for alcohol related problems, clinical manuals from the COMBINE study, etc..

Methodone for Pain Guidelines (2004)

Type: Document
Downloadable: Yes
Comments: 0
Guidelines for physicians who use, in office practice, methadone for chronic pain management. From the College of Physicians and Surgeons of Ontario, Canada.

Methadone-Drug Interactions (3rd Ed, 2005)

Type: Document
Downloadable: Yes
Comments: 0
From Addiction Treatment Forum, a comprehensive and detailed review of medications that interact with methadone to increase or reduce its metabolism and its effects. Available as a PDF.

Biomarkers for Alcohol Use and Abuse (2005)

Type: Document
Downloadable: Yes
Comments: 0
From Addiction Treatment Forum, a comprehensive and detailed review of medications that interact with methadone to increase or reduce its metabolism and its effects. Available as a PDF.

ASAM AAPM APS Consensus Definitions of Addiction and Related Terms (2006)

Type: Document
Downloadable: Yes
Comments: 0
A consensus document that clarifies the definition of addiction and related terms. The consensus statement was developed and agreed upon by The American Academy of Pain Medicine (AAPM), The American Pain Society (APS) and the American Society of Addiction Medicine (ASAM). The most recent update published is February 28, 2006 on the ASAM web site in Public Policy Statements. Paraphrasing the ASAM publication: Clear terminology is necessary for effective communication regarding medical issues. Scientists, clinicians, regulators and the lay public use disparate definitions of terms related to addiction. These disparities contribute to a misunderstanding of the nature of addiction and the risk of addiction, especially in situations in which opioids are used, or are being considered for use, to manage pain. Confusion regarding the treatment of pain results in unnecessary suffering, economic burdens to society, and inappropriate adverse actions against patients and professionals. The consensus statement provides distinct and clear definitions for ADDICTION, PHYSICAL DEPENDENCE and TOLERANCE to eliminate confusion and promote better patient care and communication between scientists, health care providers, regulators, patients and the lay public.

AA–Does It Work? (2005)

Type: Document
Downloadable: Yes
Comments: 0
Good overview for physicians by Hilary Smith Connery, MD, PhD, and others. Covers the important role physicians play in patients benefiting from AA, how patients benefit from AA, the effectiveness of AA, attendance vs. participation. 12 Step resources are included on the final page, all linked to internet sites. Curr Psychiatry 2005; 4(5): 56-67.

In Search of How People Change: Applications to Addictive Behaviors (1992)

Type: Document
Downloadable: Yes
Comments: 0
This paper by James Prochaska et. al. studies the process by which people intentionally change their behavior, with and without treatment interventions, and develops the key concept of stages of change, which is the basis for many current psychosocial approaches to addiction. It models an integrative approach across several theoretical frameworks, and provides a way of seeing patient behavior as a continuous process toward change, including relapse as part of this cycling and recovery as maintenance of change. It argues for a tailoring of intervention according to stage. Am Psychol 1992; 47(9):1102-1114

Drug Abuse: Hedonic Homeostatic Dysregulation (1997)

Type: Document
Downloadable: Yes
Comments: 0
Research by George F. Koob and Michel Le Moal published in Science which explains some of the neurobiology of addiction, focusing on the disruption to the stress hormones. They discuss animal models for reward, sensitization, motivation, withdrawal, craving and relapse. This paper is one of several examples of the research base that informs our daily work in addiction treatment and form a powerful argument for stability and balance as a therapeutic goal. Science 1997; 278:275-281.

Addiction: A Disease of Learning and Memory (2005)

Type: Document
Downloadable: Yes
Comments: 0
For the motivated physician who wishes to understand the neurobiology of addiction. The author, Steven E. Hyman, M.D., presents evidence that addiction represents a pathological usurpation or hijacking of neural mechanism of learning and memory. Highly recommended for those interested in learning Dopamine’s importance in addiction, “liking,” “wanting,” and assignment of “incentive salience” to reward and reward related cues. Am J Psychiatry 2005; 162:1414-1422.
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