Addiction medicine

About: Addiction medicine is a research topic. Over the lifetime, 1070 publications have been published within this topic receiving 23685 citations.

The rise of super (?sub)-specialties courses in psychiatry: Is India ready for it !

Abstract: Byline: N. Manjunatha, Murali. Thyloth, T. Sathyanarayana Rao The field of psychiatry is still growing; [sup][1] however, the phenomenal growth occurred in many areas in the field of Indian psychiatry in last decade. One of them is the increase in postgraduate seats (Diploma in Psychological Medicine (DPM)/Doctor of Medicine (MD)/Diplomate of National Board (DNB) of psychiatry to address the shortage of psychiatrists in our country. In curious latest development two medical institutes in our country started two super-specialties psychiatry courses (after branching out from department of psychiatry) in the academic year of 2011-2012 such as Doctor of Medicine (DM) (Geriatric Mental Health) at 'King George Medical University', Lucknow (http://www.kgmu.org/dept_geriatric.php) and DM (Child and Adolescent Psychiatry) at 'National Institute of Mental Health and Neurosciences' (NIMHANS), Bangalore (http://www.nimhans.kar.nic.in/cap/default.htm) for candidates of MD/DNB psychiatry. Other awaiting super-specialty psychiatry course is DM (Addiction Medicine) at 'National Drug Dependence Treatment Centre' of 'All India Institute of Medical Sciences', New Delhi and 'Centre for Addiction Medicine', NIMHANS, Bangalore. Debate *In an outlook it is a welcome step, however, authors consider this rise of super-specialties in still growing field of Indian psychiatry is a debatable issue. When our country is already facing 77% average national deficit of psychiatrists, [sup][2] will not this step lead further shortage of general psychiatrists in India? India is currently producing 357 MD (Psychiatry) and 129 Diploma in Psychological Medicine (DPM) per year in various medical college/institutes of our country. [sup][3] Along with these reasons and the migration of qualified psychiatrists to developed countries, will this step be a pragmatic one for MD psychiatry candidates to enter DM in these super-specialties? *Then, what is the need of having super-specialty psychiatric courses? Is there a demand for clinical service, if so, having separate clinic/unit in the psychiatry department (one of the requirement of Medical Council of India (MCI) to start MD psychiatry course) shall be sufficient. Is there a demand in research point of view, if so, developing a separate 3 years course is not justified? If the development for teaching purpose due to lack of expertise, having separate clinic/unit within department of psychiatry would suffice. Considering all above points, Indian academic psychiatry is not ready for premature branching out as 3 years DM course. It may be pragmatic to wait till required number of psychiatrists of India is available for clinical service. *Another important aspect of this development is the employability after their training. Authors tend to believe as not so lucrative for these super-specialties as there are already inadequate practicing general psychiatrists and inadequate teaching psychiatric faculties in medical colleges. *In view of public mental health, when India is struggling to provide primary care psychiatry and facing difficulty in the implementation of 'National Mental Health Program', can we afford to have these super-specialties in psychiatry which further reduces the human resources? Progress in Indian Medical Education with Respect to Super-Specialties Authors feel that the developing new courses with new name are becoming fashionable in the field of Indian education. Medical education of our country is not the exception for this and is already developed new courses in last few decades such as DNB, DM, Magister Chirurgiae (MCh), etc., Irony in this development is having same name (i. …

Training in Substance-Related and Addictive Disorders, Part 1: Overview of Clinical Practice and General Recommendations.

Abstract: Substance-related and addictive disorders include the substance use disorders (SUDs) and the behavioural addiction of gambling disorder.1 Together, they represent some of the most prevalent mental disorders, where it is estimated that 11 to 14 per cent of North Americans will meet lifetime criteria for an SUD2–6 and a further 0.4 to 1.1 per cent will meet criteria for gambling disorder.7 The peak age of onset for SUD is in young adulthood (ages 18 to 20), apart from cannabis use disorder, which typically has its peak age of onset in later adolescence (ages 16 to 18), and comorbid mental disorders often being established early, then extending into adulthood.8–11 In addition to contributing to a wide range of social problems, including abuse, neglect, crime, unemployment, suicide, accidents, and family dysfunction, substance-related and addictive disorders are a major contributor to potentially preventable medical illnesses and premature death, where the estimated cost to Canadian society is $40 billion, annually.12,13 Psychiatric comorbidity in people with substance-related and addictive disorders are all too common, where between one-quarter and one-half of all patients seeking psychiatric treatment meet criteria for a lifetime SUD,14–17 and for those patients seeking addiction treatment, 40 to 60 per cent are identified to have an independent (nonsubstance-induced) mood disorder.15 In the Canadian health care system, mental health and addiction treatment services have been traditionally compartmentalized and have functioned independently with different philosophies. While we have known for some time that people suffering from a serious and persistent mental disorder with a co-occurring addiction tend to respond less well to traditional abstinence-focused addiction services,18 current fragmented services have impeded the development of a specialized capacity to effectively treat this population. These patients can do well with what has been called integrated treatment, where the treatment of the mental disorder and the addiction illness is provided by the same team of professionals. In fact, more than 50 controlled studies have established the importance of integrating the treatment of patients with co-occurring disorders, which inherently solve the typical problems encountered in the separate systems of care for these individuals.19 For these reasons, Canadian clinical guidelines recommend that all people seeking help from mental health treatment services be screened for co-occurring SUDs.20 Health Canada Best Practices20 further recommend an integrated treatment approach at the program level for people suffering from serious and persistent mental disorders with co-occurring addiction. In 1997, a first position paper was published by the Canadian Psychiatric Association (CPA) in the form of Curriculum Guidelines for Residency Training of Psychiatrists in Substance-Related Disorders.21 Since then, the field of addiction psychiatry has continued to advance, with the emergence of new scientific data regarding neurobiology and psychosocial interventions. Importantly, clinical guidelines have been published for the treatment of SUDs by the American Psychiatric Association (APA)22 and the World Federation of Societies of Biological Psychiatry.23,24 Health Canada also published Best Practices recommendations on concurrent mental and SUDs.20 In addition, in 2007, the Royal College of Physicians and Surgeons of Canada (RCPSC) released the new Specialty Training Requirements (STR) in Psychiatry,25 outlining more specific expectations in addiction training for psychiatry residents. The Objectives of Training (OTR)–STR, as they apply to training in substance-related and addictive disorders, include the following: Supervised experience in the treatment of patients with substance-related and addictive disorders in various settings. A learning portfolio or log should be maintained and reviewed by the program director. This experience must be undertaken as a discrete rotation of no less than one month or incorporated as a longitudinal experience (at any time during postgraduate year [PGY] 2 to 5) of no less than the equivalent of one month. This must be documented and evaluated separately from other rotations. Availability of a selective rotation in substance-related and addictive disorders of no less than three months, but preferably six months, during senior psychiatric residency training (PGY 4 to 5) to develop advanced knowledge (definition in Table 1) in addiction psychiatry. Table 1 RCPSC knowledge and skills definitions81

Integrating DATA 2000 waiver training into undergraduate medical education: The time is now.

Abstract: Background: Medications for opioid use disorder (MOUD) significantly reduce morbidity and mortality from opioid use disorder (OUD). To prescribe MOUD, physicians must obtain a DEA waiver through requirements outlined in the Drug Addiction Treatment Act of 2000 (DATA 2000). We developed an Addiction Medicine curriculum that features DATA 2000 waiver training at the Robert Larner, MD College of Medicine (LCOM). Methods: All third-year medical students completed a virtual DATA 2000 waiver training at the commencement of clinical clerkships. We conducted a curriculum needs assessment followed by pre- and post-training surveys to evaluate MOUD pharmacology knowledge and best prescribing practices. Results: Of LCOM students surveyed, 77.6% reported interest in being waivered to prescribed MOUD for OUD treatment. Third-year medical students demonstrated increases in both MOUD Pharmacology Knowledge from 64.2% to 84.8% (chi-squared = 40.8; p < .001) and MOUD Best Prescribing Practices from 55.9% to 75.2% (chi-squared = 29.9; p < .001). Discussion: Surveys showed the majority of students felt waiver training was relevant to their future practice. An online DATA 2000 waiver training format effectively improved student knowledge of MOUD. Conclusion: This curriculum exposed medical students to DATA 2000 waiver training, MOUD pharmacology and best practices, and increased the number of future physicians eligible to treat OUD using MOUD.

Educating treatment professionals about addiction science research: demographics of knowledge and belief changes.

Abstract: Communication of accurate, objective, and timely scientific information to treatment professionals is important--especially in the "drug abuse" and addiction field where misinformation and a lack of exposure to new information are common. The purpose of this study was to assess knowledge and belief changes that accompanied educational workshops (3 or 6 hr-long) on addiction science targeted to treatment professionals (N=1403) given in the United States and Puerto Rico between July 2000 and August 2001. Each workshop covered three main concepts: (1) terms and definitions; (2) basic neurochemistry of addiction; and (3) how new neurobiological knowledge will affect the treatment of addictions in the future. Analysis of variance was used to compare mean pretest to posttest change scores among levels of four independent variables: gender, age, occupation/position, and race/ethnicity. Workshop participants achieved a significant improvement in knowledge about addiction with younger groups achieving greater gains. Participants' beliefs shifted in the desired direction. Significant differences in belief shifts occurred among occupational and gender groups, but not among race/ethnicity or age groups. There was also a consistent change in the policy belief subscale that related to how strongly the audience members believed research on addiction was important. We conclude that addiction science education provided to treatment professionals can increase their knowledge and change their beliefs about the causes of addictions. In addition, the workshop participants form a base of constituents who are likely to support greater addiction research funding.