ATTC Messenger February 2017 Scant Opportunities to Learn about Substance Use in Pre-Service Educational Programs
Scant Opportunities to Learn about Substance Use in
Pre-Service Educational Programs
From the ATTC White Paper: Preparing Students to Work in Integrated Health Care Systems
Prepared by the ATTC Pre-service Education Workgroup:
Eric Goplerud, Ph.D.
Holly Hagle, Ph.D.
Tracy McPherson, Ph.D.
Most physicians, nurses, social workers, psychologists, and other health professionals receive sparse formal education or supervised pre-professional clinical work related to substance use disorders (SUDs) (Solberg et al., 2008; Lock, 2009; Gomel, Wutzke, Hardcastle, Lapsley, & Reznik, 1998; Osborne & Benner, 2012; Finnell, 2012). For example, the average medical school requires few hours to be devoted to the study of addiction, and the majority of that training addresses the treatment of intoxication and dependence, not prevention or risky substance use (Bradley et al., 2006). Medical schools rarely include stand-alone courses in addiction medicine (Bradley et al., 2007) and barely incorporate SUDs into other coursework. A survey of residency training program directors in seven medical specialties found that 56% reported having required curriculum content in preventing and treating addiction; however, the median number hours for this content ranged from just 3 (emergency medicine and obstetrics/gynecology) to 12 (family medicine).
Medical and Nursing Students Unprepared to Treat Patients with SUD
Medical students do not feel prepared to care for patients with problematic substance use. In a 2012 study, internal medicine students at a large teaching hospital were surveyed on their perceived level of preparation to diagnose and treat addiction. Most survey respondents ranked their overall instruction in addiction as poor and reported feeling unprepared to treat or diagnose addiction (Wakeman et al., 2013). A follow-up study using the same survey instrument showed that the students felt better prepared to diagnose and treat SUDs but still in need of more SUD instruction (Wakeman et al., 2014).
Even in the behavioral health field, SUDs are not always included in academic programming. For example, social workers, who play a critical role in providing behavioral health services in integrated settings, are not adequately prepared to treat SUDs (Funk et al., 2005; Quinn, 2010). A 2014 study demonstrated that only one of 58 masters of social work (MSW) programs reviewed required at least one course in SUDs (Russett & Williams, 2014); only 6.5% of Council on Social Work Education (CSWE)-accredited MSW programs have an SUD concentration track, and only four schools have a required course in SUDs for all students (Aalto, Pekuri, & Seppa, 2003).
In 2016, the American Board of Medical Specialties recognized addiction medicine as a new specialty (American Board of Medical Specialties, 2016). This development may increase the opportunities in some medical schools for learning about SUDs or incorporating rotations in addiction medicine, which, in turn, may increase the number of physicians able to care for people with SUDs. Such a transformation is sorely needed. In 2012, the American Medical Association (AMA) estimated that of the 985,375 active physicians, only 582 self-identified as addiction specialists (American Medical Association, 2012).
Nursing programs also lag in preparing graduates to screen or treat patients with risky, harmful, or severe substance use. A survey of baccalaureate nursing programs in 2013 found that little progress had been made in the 24 years since an earlier survey. The average number of substance use-related content hours nursing students received was 11, with most of the content related to the treatment of alcohol dependence (Tabak, Khoong, Chambers & Brownson, 2012; Babor & Higgins-Biddle, 2009; Savage, Dyehouse, & Marcus, 2014). Finnell (2012) suggested that current nursing curricula provide little education and clinical practice time devoted to providing care for patients with high-risk or dependent substance use, resulting in nurses entering the workforce unable to competently detect hazardous substance use among their patients and intervene accordingly.
Research has shown that if nurses deliver screening, brief interventions, and referral to treatment (SBIRT), patients will accept it. For example, a cross-sectional survey of patients at a large university-affiliated medical center showed high acceptance for nurse-delivered SBIRT, emphasizing the need for appropriate SBIRT training for nurses (Broyles, Rosenberger, Hanusa, Kraemer, & Gordon, 2012).
Behavioral Health Preservice Education: SUDs Not Always Covered. Even in the behavioral health field, SUDs are not always included in academic programming. For example, social workers, who play a critical role in providing behavioral health services in integrated care settings, are not adequately prepared to treat SUDs (Funk et al., 2005; Quinn, 2010). A 2014 study demonstrated that only one of 58 masters of social work (MSW) programs reviewed required at least one course in SUDs (Russett & Williams, 2014); only 6.5% of Council on Social Work Education (CSWE)-accredited MSW programs have an SUD concentration track, and only four schools have a required course in SUDs for all students (Aalto, Pekuri, & Seppa, 2003). Among bachelors’ social work programs in the US, only 25% offer one or more courses in SUDs (Glasgow et al., 2012). This lack of training related to SUDs in social work education negatively impacts clinicians’ attitudes toward clients with problematic substance use as well as their opinions about offering screening and treatment (Williams et al., 2011, Anderson et al., 2004).
Psychologists also do not necessarily receive adequate preparation in SUDs in preservice academic programs. The Association for Medical Education and Research in Substance Abuse (AMERSA) notes that “routine training in the recognition, diagnosis, assessment, and treatment of SUD has been surprisingly slow to emerge within the discipline of psychology” (AMERSA, 2002; Winerman, 2013). Furthermore, Burrow-Sanchez, Call, Adolphson, & Hawken (2009) found that psychologists working in education settings, who are among the most likely personnel to deliver mental health and substance use services, need and want more training in working with students who use substances at risky, harmful, or severe levels.
In addition to the scant opportunities to learn about substance use in multiple pre-service educational programs, there is insufficient training capacity for the current professional workforce for effective integration (Hall et al. 2015).
Click here to download the complete ATTC White Paper, Preparing Students to Work in Integrated Health Care Systems.