In the United States, the leading cause of preventable illness and death is substance abuse, most notably tobacco and alcohol. Yet most medical professionals are not sufficiently trained to diagnose or treat addiction.
The CASAColumbia report states that physicians routinely screen for a wide range of health problems such as high blood pressure or high cholesterol, but hardly ever screen for substance abuse or signs of addiction. They end up treating a long list of conditions, including accidents, unintended pregnancies, heart disease, cancer and many other health problems without examining the underlying source of the problem.
This makes it difficult for primary care physicians to treat conditions that can’t be dealt with properly while their root cause – substance use and abuse – goes untreated. For example, dealing with chronic breathing conditions brought on by years of smoking tobacco is challenging while a patient continues to smoke, due to an addiction to nicotine.
To exacerbate the problem, many current addiction treatment providers are not even medical professionals and don’t possess the knowledge, skills or credentials necessary to provide the full range of screening, intervention, treatment and disease management tools available.
A Holistic Approach
At UTHSC, the formal curriculum centers around the biological, psychosocial and pharmacological components of dependence and addiction. Future physicians must fully grasp the complexity of this condition and comprehend that physical, psychological and social interventions are all necessary to treat this disorder.
The COM’s curriculum takes a broad-based approach to how dependence and addiction manifest themselves.
Along with the most common substances of use and abuse, namely alcohol and tobacco, the curriculum also addresses illicit drugs, prescription medications, eating and sexual addiction. While psychologically and socially these addiction conditions may have many commonalities, it is important for future clinicians to understand the unique biological and physiological impacts on the body and the brain through which these conditions impact the person.
The College of Medicine’s curriculum takes a multifaceted approach to training. For example, when confronting tobacco dependence and addiction, the students learn about the pharmacological approaches to smoking cessation and nicotine replacement. They observe and learn management of patients in withdrawal.
But medical students will need to approach dependence and addiction from the psychological and social perspectives as well. For instance, they are trained in Motivational Interviewing, an approach that helps clinicians focus on how ready individual patients are to make a change in their behavior. At the same time, medical students are introduced to environmental, social and community forces that may contribute to dependency and addictive behaviors.
From Hospital to Home
With regard to treatment, dependency and addiction disorders have seen a significant change in the past 30 years. Now, patients are only hospitalized for inpatient treatment in the most challenging of clinical situations. In most cases, psychiatrists were involved in the care of these patients. Now, the overwhelming majority of patients are cared for in the outpatient setting.
Increasingly, primary care physicians, and especially those in family medicine, are taking responsibility for the care, management and treatment of addiction, even in serious cases of opiate addiction. As another sign of change, one of the most common medications for opiate addiction, Suboxone, is commonly distributed and monitored by family medicine physicians.
Licensed physicians may now enroll in substance abuse fellowships in primary care disciplines of family medicine and internal medicine.
It has become clear that a team effort will be necessary to deal with the problem of addiction and dependence. Treatment, screening and detection that have traditionally been delegated to psychiatry will need to be required of all physicians and specialties. At UTHSC, the goal is to have all medical school graduates able to detect and screen for substance use and abuse, dependency and addiction in their patients. Each of these graduates should be able to direct these patients to interventions most useful to their own situations, whether implemented by themselves or another health care provider.