effectively identify, intervene with, and refer patients with substance-use problems and illnesses (Haack and Adger, 2002). Transmission of this set of knowledge, attitudes, and competencies to the workforce was initiated by the Multi-Agency INitiative on Substance abuse TRaining and Education for AMerica (Project MAINSTREAM), which provided trainers to train interdisciplinary faculty (Samet et al., 2006). The students trained by these faculty enter the workforce with the knowledge and skills needed to provide care for individuals and communities dealing with substance-use problems and illnesses.

Annapolis Coalition on Behavioral Health Workforce Education The Annapolis Coalition on Behavioral Health Workforce Education (Annapolis Coalition) grew out of a 2001 conference convened by the American College of Mental Health Administration and the Academic Behavioral Health Consortium, with funding from SAMHSA and the Agency for Healthcare Research and Quality (AHRQ). The Annapolis Coalition distilled recommendations from a substantial number of peer-reviewed publications addressing the need for training reform in the M/SU treatment field and subjected those recommendations to further vetting by experts in the field by preparing and distributing for comment of a series of review papers (Daniels and Walter, 2002; Hoge et al., 2002), as well as discussing the recommendations at a national summit of experts on workforce development (Hoge and Morris, 2002). The result was a series of 10 recommended best practices for improving the quality and relevance of workforce education (Hoge et al., 2005a).

Paucity of Content on Substance-Use Care

Despite the frequency of co-occurrence of general medical, mental, and substance-use problems and illnesses, many providers in each of these areas receive little or no education in the others and their effects on the presenting condition. According to the congressionally mandated study of the prevention and treatment of co-occurring substance-use and mental conditions (SAMHSA, undated:15), “Perhaps one of the most significant program-level barriers, noted by consumers and family members as well as by providers…is the lack of staff trained in treating co-occurring disorders.” The limited content of substance-use education in most health professions is evidence of this.

Physician education Medical students can be educated about substance-use problems and illnesses in a variety of settings. During the first 2 years of medical school, however, the subject is often integrated into standard coursework; and separate courses on addiction medicine are rarely taught.

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