Medical education on addictions has improved in the 25 years since the founding of the Association for Medical Education and Research in Substance Abuse, but it's still relatively rare for medical students to get comprehensive training on identifying and treating addictive disorders.

Over the years, AMERSA has advocated for improved physician training, and agencies like the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have provided funding for medical-school curriculum development and faculty education. Results of these efforts have included the development of guidelines for teaching about addiction in the fields of internal medicine, pediatrics, psychiatry, family medicine, emergency medicine, and obstetrics/gynecology, and a significant expansion of elective courses on addictions offered at major medical schools.

"But few require substance abuse in their [core] curriculum," noted Bud Isaacson, M.D., vice chairman of the Department of General Internal Medicine at the Cleveland Clinic, who spoke at the recent annual meeting of the American Society of Addiction Medicine in Los Angeles, Calif.

In a survey of medical-school directors published in the November 2000 edition of the Journal of Studies on Alcohol, Isaacson found that while 95 percent of schools for psychiatry required addiction classroom training, just 75 percent of schools for family physicians did so. And even fewer required residents to do a rotation at an addiction-treatment facility.

In spite of the pervasive presence of addiction problems in emergency rooms and fetal alcohol syndrome's status as the nation's leading cause of preventable birth defects, Isaacson's survey found that these and other areas of medicine gave especially short shrift to addiction training. Only 55 percent of curricula for emergency medicine included any course hours for addictive disorders; for internal medicine, 51 percent; for osteopathy, 41 percent; for OB/GYN, 39 percent; and for pediatrics, 31.8 percent.

Even course requirements were no guarantee of an immersive experience: Isaacson pointed out that programs for emergency physicians and OB/GYNs included an average of only 3 hours of addiction training, and even psychiatry schools required only 8 hours of training on addictions. "The number of hours was really quite small," Isaacson noted.

Given such limitations, it's not surprising that students rarely learned more than simple screening techniques and information about detoxification, and heard little about treatment follow-up or brief interventions. Such programs stand in sharp contrast to models like the Brody School of Medicine at East Carolina University in Greenville, N.C., where students not only receive extensive classroom training, but must attend local A.A. meetings, which counts as 15 percent of their grade. Graduates have shown a "dramatic improvement" in their assessment skills, confidence in making referrals to treatment and self-help groups, and overcoming preconceptions of addiction as a moral weakness or issue of willpower, said Jerome Schulz, M.D., a clinical professor at the school.

Medical-school directors said that lack of time, faculty experience, institutional support, and training sites were to blame for the dearth of addiction training. "Overall, psychiatry and family medicine are the most involved, but we have a long way to go," said Isaacson.

To address the problem, Isaacson and other advocates for medical training look to the Health Resources and Services Administration's Project Mainstream, intended to bring addiction training into the mainstream of medicine. Physicians also need to put pressure on residency review committees to enforce training requirements for addiction, said Isaacson.

Few Medical Students Learn About Addiction. Feature article by Bob Curley for Join Together Online (www.jointogether.org), June 1, 2001.