psychiatry residency positions available than
there is demand for them. Although a survey of
psychiatry residents found that most had positive
attitudes towards addiction psychiatry, few
residents believed that addiction psychiatrists
were well paid and less than half (45 percent)
believed a career in addiction psychiatry would
be satisfying.^200
The lack of physician training in addiction and
its treatment has very real effects on patient
care. For example, overwhelming evidence has
proven that smoking cessation interventions are
clinically effective and cost effective and that a
patient’s chances of quitting smoking are nearly
doubled if a health professional advises him or
her to quit.^201 Yet many medical schools do not
require clinical training in smoking cessation.^202
Other Health Professionals. Doctoral-level
clinical psychologists are highly trained in
psychosocial therapies, many of which can be
applied effectively to addressing addiction in the
significant proportion of their patient population
that has co-occurring addiction and mental
health disorders.^204 Yet because few
psychologists receive adequate training in
screening and intervention for risky substance
users and in diagnosing, treating or referring
patients with addiction, some fail to identify
risky use or addiction or lack confidence in their
ability to provide psychosocial therapies.^205 For
example, one study found that 17.1 percent of
clinical psychologists reported that a barrier to
providing smoking cessation counseling was
their “lack of training in tobacco cessation
skills.” Other reported barriers also were related
to a lack of knowledge about the disease: that
smoking was “not the client’s presenting
problem” (57.1 percent); that smoking cessation
is not “a priority for my patients” (28.7 percent);
“it may interfere with therapy goals” (21.2
percent); and “smoking patients are not
interested in smoking cessation counseling”
(19.8 percent).^206Dental professionals also receive inadequate
training in caring for patients with risky
substance use and addiction,^207 despite
significant evidence of the important role they
can play in screening, intervention and referral
to treatment.^208 There are no national standards
for tobacco cessation education in U.S. dental
schools and the ability to provide tobacco
cessation services is not considered a clinical
competency.^209 Only about half of dental
schools and dental hygienist programs* have
tobacco cessation clinical activities integrated in
their student clinics.^210 This is despite the fact
that dental professionals are highly receptive to
receiving substance-related training^211 and that
appropriate training early in a clinician’s career
increases the likelihood that such interventions
will be adopted and implemented in practice.^212Nurses constitute the largest group of health
care professionals^213 with extensive patient
contact; therefore, they are ideally situated to
perform patient education, screening and brief
intervention services.^214 Yet, nurses are not
adequately prepared to perform these services,
particularly tobacco cessation for which
research indicates they can be particularly
effective.^215 Barriers to the implementation of
smoking interventions include a reported lack of
motivation, self- efficacy, institutional support,
time and training.^216 Nursing school curricula
have little tobacco control content; there is a
lack of tested curricula, nurse educators are not* Forty-seven percent of dental schools and 55
percent of dental hygienist programs.There are trained clinicians who do not fully
understand the nature of addiction.I am amazed at how many if not most medical
professionals have no understanding and little
education on the subject.My relapse was in part due to ignorance in the
medical profession and lack of medical
addiction understanding during a life-
threatening illness....I escaped the clutches of doctors and
psychiatrists with their prescription pads and
rotten advice due to lack of understanding, due
to lack of education.^203--Respondents to CASA Columbia’s
Survey of Individuals in Long-Term Recovery