Substance use disorders are mental health conditions that center on a pattern of substance addiction or a disruptive pattern of nonaddicted substance abuse. In many cases, the doctors who must diagnose and treat these disorders do not have any specialist training in dealing with abuse- or addiction-related issues. In a study published in late 2013 in the journal Substance Abuse, researchers from five U.S. institutions sought to determine how prepared these nonspecialist physicians feel to adequately address substance use disorders in their patients.
Substance Use Disorder Basics
The widely recognized definition for substance use disorders comes from the American Psychiatric Association. All people affected by one of these disorders have as many as 11 or as few as two symptoms that indicate the presence of serious problems related to either a drug or alcohol addiction or life-impairing drug or alcohol use not associated with an addiction. These symptoms include such things as persistent cravings for alcohol or drugs, repeated use of drugs or alcohol in unsafe situations, lack of an ability to effectively set boundaries on alcohol or drug intake, shirking of responsibilities or obligations in favor of drug or alcohol use and devotion of substantial amounts of time and resources to obtaining a substance, using a substance or recuperating from the effects of a substance.
The treatments used to address the effects of a substance use disorder vary according to several factors, including the substance involved, the severity of the disorder in an affected individual and the resources available to an affected individual. Treatment settings also vary to a large degree. Some people receive treatment for drug or alcohol abuse or addiction in specialized programs designed to address these issues; as a rule, the staff members of these programs have or develop extensive familiarity with substance use disorders.
Many other people receive treatment (or receive an initial diagnosis of their condition) in settings such as hospitals, clinics or emergency rooms that do not specialize in treating people affected by substance abuse or addiction. The doctors working at these facilities see a range of patients throughout the day and may have nothing more than generalized training in diagnosing or treating substance use disorders. In many cases, the doctors working in nonspecialist facilities are residents; this term is used to describe licensed MDs who have yet to complete their advanced, post-graduate medical education.
How Prepared Are Nonspecialists?
In the study, researchers from the Colorado School of Public Health, the Mongan Institute for Health Policy and three Harvard University-affiliated institutions asked a group of 184 residents working at the well-respected Massachusetts General Hospital to describe their self-perceived level of preparedness for dealing with patients affected by a substance use disorder. The researchers also asked the participating doctors to assess the quality of their addiction-related training and their level of knowledge on addiction-related issues.
After reviewing the results of their survey, the researchers found that 26 percent of all patients seen by the participating residents were likely candidates for a substance use disorder diagnosis. Fully one-quarter (25 percent) of the residents said they lacked the preparedness to accurately diagnose their substance-affected patients, and only 13 percent of all the participating physicians felt confident in their ability to make an accurate diagnosis. When questioned on their level of preparedness for treating people affected by a substance use disorder, the majority of the respondents (62 percent) said they did not feel ready to offer such treatment to their patients.
Some of the residents participating in the study received their addiction-related training in an inpatient program for substance use disorders, while others received their training in an outpatient program. Nearly three-quarters (72 percent) of the doctors trained in an outpatient setting said that the quality of instruction they received was either fair or poor. The majority (56 percent) of the doctors trained in an inpatient setting also described the quality of their instruction in the same terms. As part of the survey, the researchers asked all of the doctors to answer six key questions related to the treatment of substance use disorders. None of the doctors answered all of these questions accurately.
The study’s authorsemphasized the apparent lack of preparedness and thorough training among a group of doctors responsible for diagnosing and treating a substantial number of the people affected by a substance use disorder. To address this situation, they recommend the introduction of comprehensive substance abuse- and addiction-related training for all residents, including those who go on to specialize in other areas of medicine.
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