TWEAK—Test for Screening Alcohol Risk During Pregnancy (1994)

Type: Document
Downloadable: Yes
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TWEAK is a five-item scale developed originally to screen for risk of drinking during pregnancy. See also TWEAK for high tolerance individuals and TWEAK for those who can hold more than 5 drinks.

Single Screening Question May Accurately Identify Unhealthy Alcohol Use

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Downloadable: Yes
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The single screening question recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) accurately identifies unhealthy alcohol use in a sample of primary care patients, supporting use of this brief screen in primary care, according to the results of a cross-sectional study reported in the March 12, 2009 Online First issue of the Journal of General Internal Medicine.

SBIRT Funding Announcement from CSAT

Type: Document
Downloadable: Yes
Comments: 0
CSAT’s RFA for the SBIRT Medical Residency Program (TI-08-003). [Applications were due April 30,2008.] This announcement shows the details of the SBIRT programs. CSAT will fund ten SBIRT Medical Residencs Programs to develop and implement training to teach medical residents skills toprovide evidence-based screening, brief intervention, brief treatment andreferral to specialty treatment for patients who have, or are at risk for, asubstance use disorder. Another purpose of the program is to promote adoptionof SBIRT through delivery of training to local and Statewide medicalcommunities for wider dissemination of SBIRT practices.

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.

NIAAA Alcohol Alert—Screening for Alcohol Problems (2002)

Type: Document
Downloadable: Yes
Comments: 0
A 2002 NIAAA alert with an overview of screening techniques for alcohol problems.

Madras: SBIRT for Illicit Drug and Alcohol Use at Multiple Healthcare Sites (2008)

Type: Document
Downloadable: Yes
Comments: 0
Research by Bertha K. Madras et. al. published in Drug and Alcohol Dependence. Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered. Drug and Alcohol Dependence 2009; 99:280–295.

How Primary Care Providers Talk to Patients About Alcohol (2006)

Type: Document
Downloadable: Yes
Comments: 0
Study and analysis of 29 male VA outpatients in a general internal medical clinic who screened positive for alcohol related problems. This is an interesting and illustrative analysis of audio taped interviews between patients and providers. Three themes were identified: 1) patients disclose information about alcohol use and providers often fail to explore patient comments, 2) the advice about alcohol was typically vague, and 3) the discomfort of the providers was evident in alcohol-related discussions. J Gen Int Med 2006; 21:966-972.

Helping Patients Who Drink Too Much: A Clinician's Guide (2005)

Type: Document
Downloadable: Yes
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Written for primary care and mental health clinician, and produced by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) with guidance from physicians, nurses, advanced practice nurses, physician assistants, and clinical researchers, this Guide helps treating physicians determine how much drinking is "too much" and what are suitable interventions. With this Guide, you have what you need to begin incorporating alcohol and screening and intervention into your practice.

Friedman: Screening and Intervention for Illicit Drug Abuse (2001)

Type: Document
Downloadable: Yes
Comments: 0
National survey by Peter D. Friedmann, M.D. and others of 1082 physicians to learn whether they asked about drug use and what they did if the diagnosis of drug abuse was made. Arch Intern Med 2001;161:248-251.

CRAFFT Screening Instrument for Teens

Type: Document
Downloadable: Yes
Comments: 0
The CRAFFT is a behavioral health screening tool for use with children under the age of 21 and is recommended by the American Academy of Pediatrics' Committee on Substance Abuse for use with adolescents. It consists of a series of 6 questions developed to screen adolescents for high risk alcohol and other drug use disorders simultaneously. It is a short, effective screening tool meant to assess whether a longer conversation about the context of use, frequency, and other risks and consequences of alcohol and other drug use is warranted. Screening using the CRAFFT begins by asking the adolescent to "Please answer these next questions honestly"; telling him/her "Your answers will be kept confidential"; and then asking three opening questions.If the adolescent answers "No" to all three opening questions, the provider only needs to ask the adolescent the first question—the CAR question. If the adolescent answers "Yes" to any one or more of the three opening questions, the provider asks all six CRAFFT questions. CRAFFT is a mnemonic acronym of first letters of key words in the six screening questions. The questions should be asked exactly as written. A list of references is included on the second page of the document.

Clinical Opiate Withdrawal Scale (COWS)

Type: Document
Downloadable: Yes
Comments: 0
The clinical opiate withdrawal scale (COWS) is a clinician-administered, pen and paper instrument that rates eleven common opiate withdrawal signs or symptoms. The summed score of the eleven items can be used to assess a patient's level of opiate withdrawal and to make inferences about their level of physical dependence on opioids: 5-12 mild withdrawal; 13-24 moderate; 26-36 moderately severe; more than 36 severe withdrawal. Available as a PDF document from CSAM-ASAM.

CIWA-Ar Scale

Type: Document
Downloadable: Yes
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Clinical Institute Withdrawal Assessment of Alcohol Scale–Alcohol Revised (CIWA-Ar) measures and scores 10 symptoms that indicate the severity of a patient's withdrawal. It requires 2 minutes to perform.

AUDIT–Alcohol Use Disorders Identification Test (2nd Ed, 2000)

Type: Document
Downloadable: Yes
Comments: 0
(See also AUDIT survey and AUDIT info and scoring.) The AUDIT was developed by the World Health Organization (WHO) as a simple method of screening for excessive drinking and to assist in brief assessment. It can help in identifying excessive drinking as the cause of the presenting illness. This manual, offered here as a PDF from the WHO website, is written primarily for health care practitioners, but other professionals who encounter persons with alcohol-related problems may also find it useful. It is designed to be used in conjunction with a companion document that provides complementary information about early intervention procedures, entitled “Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care”. Together these manuals describe a comprehensive approach to screening and brief intervention for alcohol-related problems in primary health care.

White: Addiction Recovery—Its Definition and Conceptual Boundaries (2007)

Type: Document
Downloadable: Yes
Comments: 0
Research by William L. White from the special "Recovery" issue of the Journal of Substance Abuse Treatment. The addiction field's failure to achieve consensus on a definition of “recovery” from severe and persistent alcohol and other drug problems undermines clinical research, compromises clinical practice, and muddles the field's communications to service constituents, allied service professionals, the public, and policymakers. This essay discusses 10 questions critical to the achievement of such a definition and offers a working definition of recovery that attempts to meet the criteria of precision, inclusiveness, exclusiveness, measurability, acceptability, and simplicity. The key questions explore who has professional and cultural authority to define recovery, the defining ingredients of recovery, the boundaries (scope and depth) of recovery, and temporal benchmarks of recovery (when recovery begins and ends). The process of defining recovery touches on some of the most controversial issues within the addictions field. J Subst Abuse Treat 2007; 33: 229-241.

What is Recovery? A Working Definition from Betty Ford Institute (2007)

Type: Document
Downloadable: Yes
Comments: 0
This is the lead article in a special "Recovery" issue of the Journal of Substance Abuse Treatment that also includes four background papers and three commentaries on defining and measuring recovery. Recovery is defined with three elements–sobriety, personal health, and citizenship–with rationale and research implications for each. This landmark work is the consensus of a group of researchers, treatment providers, recovery advocates, and policymakers convened in 2006 by the Betty Ford Institute. J Subst Abuse Treat 2007; 33: 221-228.

Ramstad: Commentary on the Recovery Issue of JSAT (2007)

Type: Document
Downloadable: Yes
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Commentary by Congressman Jim Ramstad, Minnesota's third district, from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 273.

Laudet: What Does Recovery Mean to You? Lessons from the Recovery Experience (2007)

Type: Document
Downloadable: Yes
Comments: 0
Research by Alexandre Laudet Ph.D. from the special "Recovery" issue of the Journal of Substance Abuse Treatment. Recovery is a ubiquitous concept but remains poorly understood and ill defined, hindering the development of assessment tools necessary to evaluate treatment effectiveness. This study examines recovery definitions and experiences among persons who self-identify as “in recovery.” Two questions are addressed: (a) Does recovery require total abstinence from all drugs and alcohol? (b) Is recovery defined solely in terms of substance use or does it extend to other areas of functioning as well? Inner-city residents with resolved dependence to crack or heroin were interviewed yearly three times (N = 289). Most defined recovery as total abstinence. However, recovery goes well beyond abstinence; it is experienced as a bountiful “new life,” an ongoing process of growth, self-change, and reclaiming the self. Implications for clinical and assessment practice are discussed, including the need to effect paradigmatic shifts from pathology to wellness and from acute to continuing models. J Subst Abuse Treat 2007; 33: 243-256.

Gitlow: Recovery and Research—A Better Paradigm (2007)

Type: Document
Downloadable: Yes
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Commentary by Stuart Gitlow from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 277-278.

Galanter: Spirituality and Recovery in 12-Step Programs—An Empirical Model (2007)

Type: Document
Downloadable: Yes
Comments: 0
Research by Marc Galanter published in the special "Recovery" issue of the Journal of Substance Abuse Treatment. Alcoholics Anonymous (AA) and other 12-step programs are widely employed in the addiction rehabilitation community. It is therefore important for researchers and clinicians to have a better understanding of how recovery from addiction takes place, in terms of psychological mechanisms associated with spiritual renewal. A program like AA is described here as a spiritual recovery movement, that is, one that effects compliance with its behavioral norms by engaging recruits in a social system that promotes new and transcendent meaning in their lives. The mechanisms underlying the attribution of new meaning in AA are considered by recourse to the models of positive psychology and social network support; both models have been found to be associated with constructive health outcomes in a variety of contexts. By drawing on available empirical research, it is possible to define the diagnosis of addiction and the criteria for recovery in spiritually oriented terms. J Subst Abuse Treat 2007; 33: 265-272.

Galanter: Assessment of Spirituality and Its Relevance to Addiction Treatment (2007)

Type: Document
Downloadable: Yes
Comments: 0
The authors, Marc Galanter et. al., developed a six-item Spirituality Self-Rating Scale designed to reflect a global measure of spiritual orientation to life, and demonstrated its internal consistency reliability in substance abusers on treatment and in nonsubstance abusers. Three treatment settings were used: a general hospital inpatient psychiatry service, a residential therapeutic community, and methadone maintenance programs. Findings on these patient groups were compared to responses given by undergraduate college students, medical students, addiction faculty, and chaplaincy trainees. These suggest that, for certain patients, spiritual orientation is an important aspect of their recovery. Furthermore, the relevance of this issue may be underestimated in the way treatment is framed in a range of clinical facilities. J Subst Abuse Treat 2007; 33: 257-264.

Arndt & Taylor: Defining and Measuring 'Recovery' (2007)

Type: Document
Downloadable: Yes
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Commentary by Stephan Arndt and Pat Taylor from the special "Recovery" issue of the Journal of Substance Abuse Treatment. J Subst Abuse Treat 2007; 33: 275.

Research Gaps on Use of Opioids for Chronic Noncancer Pain (2009)

Type: Document
Downloadable: Yes
Comments: 0
The authors conclude that clinical decisions regarding the use of opioids for chronic noncancer pain need to be made based on weak evidence. Research funding priorities need to address these critical needs if the care of patients with chronic noncancer pain is to improve. J Pain 2009; 10(2): 147-159.

APS/AAPM Clinical Guidelines For the Use of Chronic Opioid Therapy in Chronic Noncancer Pain (2009)

Type: Document
Downloadable: Yes
Comments: 0
This clinical practice guideline was developed by a multi-disciplinary panel of experts representing the American Pain Society and the American Academy of Pain Medicine. Based on a systematic review of the literature through November 2007, 25 recommendations were developed to guide the use of opioids for carefully selected and monitored patients with chronic non-cancer pain. However, the panel identified numerous research gaps and they did not rate any of the recommendations as supported by high-quality evidence. Only 4 recommendations were viewed as supported by moderate-quality evidence. Nonetheless, the panel came to a unanimous consensus on almost all of its recommendations. J Pain 2009; 10(2): 131-146.

Report of the AMA Council on Medical Education (2007)

Type: Document
Downloadable: Yes
Comments: 0
Substance use disorders constitute one of the most significant public health issues in the United States, and, in addition, there is solid evidence of an unmet need for care among those with these disorders. Although physicians are well placed to address this unmet need, there is also evidence that they frequently do not appropriately screen, diagnose, provide treatment interventions, or make referrals to specialists for those with these disorders.

Providing Competency-Based Family Medicine Residency Training in Substance Abuse in the New Millennium: A Model Curriculum (2010)

Type: Document
Downloadable: Yes
Comments: 0
Published on line at Biomedical Central Section on Medical Education, this core curriculum (commissioned by the Betty Ford Institute and MERF) is focused on screening, brief intervention and referral to treatment. It can be adapted by residency programs to meet their individual needs. Includes links to two additional files: specific modules with curriculum objectives associated with ACGME competencies and strategies for overcoming substance abuse training barriers.

ONDCP Third Leadership Conference on Medical Education in Substance Abuse (2008)

Type: Document
Downloadable: Yes
Comments: 0
This is an early working draft (incomplete in some areas) of the report of the third ONDCP conference held in January 2008. That meting was designed to share information about what had been accomplished since the first and second national leadership conferences and to focus on SBIRT (Screening, Brief Intervention, Referral to Treatment) and getting screening and brief intervention incorporated broadly into clinical practice.

ONDCP Second Leadership Conference on Medical Education in Substance Abuse (2006)

Type: Document
Downloadable: Yes
Comments: 0
The report from the second national leadership conference (2006) convened by the White House Office of National Drug Control Policy (ONDCP). It contains sections called "Goals and Strategies" for these areas: undergraduate, graduate and continuing medical education; licensing, accreditation and certification standards; and for payers.

ONDCP Leadership Conference on Medical Education in Substance Abuse: Working Groups Reports (2004)

Type: Document
Downloadable: Yes
Comments: 0
This is the report from the first national leadership conference convened by the White House Office of National Drug Control Policy (ONDCP) in 2004. It includes findings, recommendations and action plans about undergraduate, graduate and continuing medical education. These leadership conferences were repeated in 2006 and 2008.

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.

Lewis: A Review of Medical Education in Alcohol and Other Drug Abuse (1987)

Type: Document
Downloadable: Yes
Comments: 0
A review of medical education in alcohol and other drug abuse by David C. Lewis, MD, Robert G. Niven, MD, Dorynne Czechowicz, MD and Jeanne G. Trumble, MSW. JAMA 1987; 257(21):2945-8.

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
Comments: 0
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
Comments: 0
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
Comments: 0
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
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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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