SECTION I
GUIDELINES FOR POSTGRADUATE MEDICAL TRAINING PROGRAMS
GOALParticipants will learn about the major components of a core curriculum for postgraduate medical training in the substance abuse treatment system.
OBJECTIVE
Upon completion of this section, participants will understand what specific knowledge and skills are required for the treatment of substance abuse.
Guidelines for Postgraduate Medical Training Programs
A. General Information
This curriculum is designed to provide training for high quality clinical care and conduct investigations into etiology and treatment of addictive illness. Trainees receive experience in a number of substance abuse treatment programs that expose the trainee to the most current and effective methods for the conceptualization, screening, and assessment and treatment of substance use disorders.
B. Educational Program
The training should be structured to provide a clinical core experience individualized to the specialty area of the trainee as follows:
1. Evaluation and consultation
a) patients with primary alcohol and/or drug abuse and dependency
b) hospitalized medical and surgical patients with drug and/or alcohol abuse and dependency, and comorbid psychopathology
c) psychiatric patients -- inpatient and outpatient -- with chemical dependency
d) patients with chronic pain disorders
e) medical professionals with chemical dependency
f) optional: patients with other addictive disorders (smoking, gambling, eating)
g) families of above patients2. Laboratory assessments
a) biochemical indicators of chronic alcohol/drug use
b) toxicology of recent use
c) questionnaire assessments, such as the MAST and the Addiction Severity Index3. Exposure to the evaluation and treatment of abuse of each of these agents:
a) alcohol
b) opiates
c) cocaine and stimulants
d) marijuana and hallucinogens
e) benzodiazepines
f) others, including sedative-hypnotics and nicotine4. Pharmacology of the aforementioned drugs
5.Types of treatment
a) detoxification (inpatient and outpatient)
b) medical complications of chemical dependency (including AIDS)
c) rehabilitation models based on 12-step programs, and their application in inpatient and outpatient settings
d) individual therapy or counseling -- inpatient and outpatient: cognitive and behavioral
e) group therapy -- inpatient and outpatient
f) adolescent alcohol and drug abuse programs
g) family treatment
h) organization and procedures of methadone maintenance treatment process
i) organization and procedures of therapeutic community
j) pharmacotherapy for addictive disease, using agents such as disulfiram, naltrexone.
k) long term ambulatory rehabilitation
l) optional: other therapies, e.g., acupuncture, hypnosis, cognitive therapy
m) optional: organization and procedures of Employee Assistance Programs6.Research techniques and current knowledge in epidemiology, genetics, pharmacology, social theories, psychology, toxicology, treatment outcome:
a) knowledge of current literature
b) exposure to ongoing research in the training center
c) conducting an independent research project
Specific Knowledge and Skills The field of substance abuse requires knowledge of pharmacology, psychiatry, general medicine, and psychology, as well as an understanding of the interaction of these disciplines. In order to insure that the trainee is well-versed in these areas, training programs must include both hands-on experience in clinical situations as well as classroom and seminar sessions. Areas of emphasis must be tailored to the practice requisite to the given specialty of the trainee, which will be different for psychiatry, internal medicine, family practice, etc. Opportunities to acquire skill in the following areas must, however, be included, and should be individualized relative to the medical specialty background of the trainee:
1. Recognition of the signs and symptoms of the use of all of the major categories of drugs, including sedatives (alcohol, benzodiazepines, barbiturates), stimulants (cocaine, amphetamine), opiates, and hallucinogens.2. Recognition of the signs of abuse and dependence on these categories of drugs, and knowledge of the types of treatment required for each.
3. Recognition of the signs of withdrawal from these major categories of drugs and knowledge and experience with the range of options for treatment of the withdrawal syndrome and its complications.
4. Recognition of the signs and symptoms of overdose and medical and psychiatric sequelae of these major categories of drugs and the ability to provide proper treatment of overdose.
5. Hands-on management of detoxification and acute hospital treatment of the chronic use of the major categories of drugs.
6. Recognition of the signs and symptoms of the social and psychological problems accompanying the chronic use and abuse of the major categories of drugs.
7. Recognition of the signs and symptoms of the psychiatric disorders which often accompanying the chronic use of each of the major categories of drugs.
8. Use of psychoactive medications in the treatment of psychiatric disorders often accompanying the use of the major categories of drugs.
9. Familiarity with the major medical journals and professional-scientific organizations dealing with research on the understanding and treatment of substance abuse.
10. The ability to critically analyze research reports such as acquired in journal clubs and seminars.
