During the final 2 years of medical school, students also may have some experience with substance-use health care during required or elective clinical rotations in internal medicine, family medicine, neurology, or psychiatry. Overall, however, dedicated training in substance-use problems and illnesses is rarely offered in medical schools. A 1998–1999 survey of the Liaison Committee on Medical Education found that of the 125 accredited U.S. medical schools, 95 percent provided training in substance-use health care as part of a larger required course, 8 percent had a separate required course, and 36 percent offered an elective course (Haack and Adger, 2002). This current level of exposure of medical students to substance-use health care issues has not given recent medical school graduates the confidence to screen, assess, or provide needed interventions for these patients (Miller et al., 2001; Saitz et al., 2002; Vastag, 2003).

With respect to residency training, a 1997 national survey of residency program directors found that the percentage of programs with required training in care for substance-use problems and illnesses ranged from 32 percent in pediatrics to 95 percent in psychiatry, with an average of 56 percent across all emergency medicine, family medicine, internal medicine, obstetrics/gynecology, osteopathic medicine, pediatrics, and psychiatry residency programs. However, the survey found that even when there was required curriculum content in substance-use health care, the median number of curriculum hours dedicated to the subject varied greatly, ranging from 3 (emergency medicine and obstetrics/gynecology) to 12 (family medicine). Psychiatry residency programs reported an average of 8 hours devoted to substance-use health care in their curriculums (Isaacson et al., 2000). Even in preventive medicine residency training, most of the alcohol-, tobacco-, and other drug-use training focuses solely on tobacco (Abrams Weintraub et al., 2003).


Psychologist education Psychologists typically receive very little training in or preparation for dealing with substance-use problems and illnesses. Results of a 1994 survey indicated that although 91 percent of psychologists encountered substance-use problems or illnesses in their daily work, 74 percent had received no formal undergraduate or graduate coursework in the subject, and slightly more than half (54 percent) had received no training in substance-use conditions during their internships. Although few had received such training as part of their formal education, 86 percent subsequently acquired training in substance-use conditions through workshops, supervision, and other sources (Aanavai et al., 1999).


Social work education The Interdisciplinary Project to Improve Health Professional Education in Substance Abuse found that most schools of social work failed to provide students with a basic knowledge of alcohol-



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