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“Medical school doesn’t teach us a great deal about how to identify addiction and what we, as doctors, can do about it.”

Christine Rauscher, MD

Why Pre-service Education?

In any given year, over 8% of Americans aged 12 and older have a diagnosable substance use disorder (SUD). If you are a doctor, a social worker, a nurse, a school counselor, or in any other field that helps people, that means that you will encounter clients whose lives are negatively affected by their substance use.

For people in those professions, knowledge about risky substance use and SUDs can improve their effectiveness in their jobs. Certainly, knowledge-building happens during continuing education, in such forms as in-person trainings, online courses, and webinars. But many people begin their professional lives with little or no training on evidence-based practices to prevent or treat substance use disorders.

That’s where pre-service education comes into play—before people begin their jobs. Ensuring that folks who provide healthcare have the tools they need to speak with people about substance use should begin before they encounter real-life situations.

To address this topic, a workgroup of ATTC members (that’s Addiction Technology Transfer Center) have collaborated on a White Paper about the current state and future of pre-service education about substance use. Its authors are Dr. Eric Goplerud, Dr. Tracy McPherson, and IRETA’s own Dr. Holly Hagle.

Non-Specialists Need Knowledge

The White Paper focuses on the pre-service education needs of health professionals who do not specialize in addiction, a broadly defined and diverse group. Specialists work in addiction treatment programs or sometimes doctors’ offices, helping their patients seek recovery or reduce harm. But before referral to specialists, a non-specialist needs to detect and discuss at-risk substance use in the first place. It’s not necessarily a social worker’s job to treat her client’s SUD, but she needs to know what services to connect her client to and how to respond productively if he relapses.

However, right now, health professionals don’t have much background in substance use. Sixty-two percent of medical students feel unprepared to treat SUDs.  A 2013 survey showed that the average number of substance use-related content hours nursing students received was 11, with most of the content related to the treatment of alcohol dependence.

Even in behavioral health, students don’t learn much about substance use. A 2014 study showed that only one of 58 masters of social work (MSW) programs required at least one course in SUDs.

What Do Non-Specialists Need to Know?

It’s easy to say that professionals should know more, that they should be empowered to do more. To actually implement better pre-service education, concrete goals help focus the approach.

After reviewing documents by AMERSA, UNODC, SAMHSA-HRSA CIHS, and AHRQ, the ATTC workgroup created recommendations for integrating substance use and its related health issues into educational curricula. Their recommendations are that health and behavioral health education include:

  1. Screening, Brief Intervention, and Referral to Treatment (SBIRT), including instruction and practice
  2. Infusion of substance use-related competencies by AMERSA, UNODC, SAMHSA-HRSA CIHS, and AHRQ into educational curricula.
  3. Infusion of TAP 21: Addiction Counseling Competencies into curricula, although its specialized nature means it doesn’t always need to be included in its entirety
  4. Discussion of and practice using Health Information Technology to treat patients with SUDs
  5. Participation in interprofessional collaborative practice teams

Is This Possible?

Making additions to pre-existing degree or certificate programs is challenging. You need experts who can share accurate information, time in information-packed courses, funding for creating needed content, and administrators who agree to prioritize inclusion of substance use-related topics. While these and other barriers have kept addiction and substance use out of many educational programs, the last few years have seen a marked increase in schools that encourage or mandate pre-service education. The White Paper offered plenty of examples.

Examples of Pre-service Education

In March 2016, more than 60 medical schools announced that students would be required to take some form of prescriber education. NIDA has helped four Massachusetts medical schools add curricula on the biology of addiction, SUD treatment strategies, and effective patient interactions. The University of Pittsburgh School of Nursing (with assistance from IRETA) has designed and integrated SBIRT training into their undergraduate nursing curriculum. Finally, Substance Abuse Research Education and Training in the Department of Population Health at the New York University School of Medicine educates students from diverse disciplines about addiction.

For the many students who still don’t have access to addiction coursework, or whose curiosity was whetted by an introduction, a couple of summer programs exist that supplement their medical schools’ content. Namely, IRETA offers the Scaife Medical Student fellowship in Pennsylvania, and the Hazelden Betty Ford Foundation hosts opportunities in Minnesota and California. These short, intensive programs reach fewer students, but offer a depth of knowledge that students can share afterward with their colleagues.

The Addiction Technology Transfer Center Network works intensively in pre-service education, offering direct delivery of educational content, comprehensive support, and curriculum infusion. To explore the regional, national, and special focus area centers’ diverse programs, you can visit the ATTC homepage. IRETA serves as the National SBIRT ATTC, advancing knowledge of SBIRT practices and providing training and technical assistance for groups that wish to use SBIRT, a recommended part of pre-service education.

Some ATTC offerings are stand-alone courses, either designed to be taken in tandem with degree programs or as entire programs themselves. Programs cover a multitude of topics related to substance use. Just as a sample, some address include expanding care through telehealth, cultural competency for diverse populations, and trainings on substance use and co-occurring mental health disorders.

The Future of Pre-service Education

As awareness of SUD as a prevalent disease grows, greater attention to it in behavioral and physical health fields should continue to grow. While there are great strides still to come in pre-service education for people training to become health professionals, right now we have a lot of good information about what that material ought to look like, both theoretically and in the form of concrete examples.