These factors, however, are not sufficient to
justify the lack of medical attention to a disease
affecting 16 percent of the population.
Physicians. Poor training in the care of patients
with addiction relates to low confidence among
physicians in their ability or competence to treat
such patients, negative attitudes toward patients
with addiction, pessimism about the
effectiveness of treatment and low rates of
implementation of evidence-based practices
related to screening, brief interventions and
treatment.^185
Only a small proportion of primary care
physicians feel “very prepared” to detect
particular types of risky use (alcohol--19.9
percent; illicit drugs--16.9 percent; prescription
drugs--30.2 percent), which is in stark contrast
to the much higher percentages of physicians
who report feeling “very prepared” to identify
hypertension (82.8 percent), diabetes (82.3
percent) and depression (44.1 percent).^188 A
state-based 2006 survey of primary care
physicians found that the vast majority (88
percent) screen for diabetes in adults with risk
factors such as obesity, hypertension and a
family history of diabetes.^189
A 2004 survey showed that less than one third of
certain medical professionals--registered nurses,
dentists, psychiatrists and emergency medicine
physicians--had received training in smoking
cessation.^190 Another national study found that
only half of psychiatry residency programs offer
training in tobacco cessation,^191 even though a
state-based survey found that 94 percent of
psychiatry residents would be interested in
receiving available training.^192 A study of
fourth-year medical students in New York City
found that the majority (85 percent) did not
know of local smoking cessation programs to
which to refer patients.^193 And a national survey
of directors and assistant directors of U.S.
medical school obstetrics/gynecology training
programs found that only nine percent reported
offering students at least 15 minutes of time
dedicated to improving students’ tobacco
cessation skills and only one-third (32.9 percent)
reported that their programs taught students both
how to intervene with patients who smoke and
how to refer them for follow-up.^194Medical curricula, by providing insufficient
information about recent advances in the
neurological science of addiction, perpetuate
misconceptions about the disease of addiction
and inhibit the acceptance of biological models
to explain the disease.^195Inadequate training with regard to tobacco,
alcohol and other drug use also derives from
limited exposure to role models in the field who
have knowledge about these issues.^196
Curriculum time and the number of faculty with
expertise in addiction education pale in
comparison to curriculum time and the number
of faculty with expertise in education for health
conditions with similar prevalence rates as
addiction, such as cancer and heart disease.^197More than 20 years ago, the subspecialty of
addiction psychiatry officially was
established,^199 yet there often are more addictionPhysicians can be the first line of defense
against risky substance use and addiction, but
they need the right tools and resources.^186--Nora D. Volkow, MD
Director
National Institute on Drug AbuseMost doctors do not look at addiction as part of
their job. They may assess, but they don’t
intervene.^187--Brian Hurley
Chair
Physicians-in-training Committee
American Society of Addiction MedicineAs medical students, many of us are perplexed by
the lack of a formal standard of care regarding
addiction. The sad thing is, many of my fellow
students and I feel that too many of our attending
physicians have not demonstrated to us that they
believe that addiction can and should be
addressed and that attitude affects patient care
for the worse.^198--Kimberly Fitzgerald
Fourth-year medical student