The American Journal on Addictions, 24: 191–192, 2015 Copyright © American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online DOI: 10.1111/ajad.12211
Needs Assessment Survey of Addictions Training in General Psychiatry Residency Dana Billups, MD,1 Daryl Shorter, MD1,2 1
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas Michael E. DeBakey VA Medical Center, Houston, Texas
2
According to the 2013 National Survey on Drug Use and Health (NSDUH), of the estimated 22.7 million Americans aged 12 or older who needed treatment for an illicit drug or alcohol use problem, only 2.5 million received treatment at a specialty facility.1 Despite the widespread prevalence of substance use disorders (SUD) and identified need for more addictions professionals,2 entrance of physicians into specialty training for Addiction Psychiatry continues to lag behind estimates of need. Additionally, although access to addiction treatment services has traditionally been limited, with passage of the Affordable Care Act (ACA) there is further anticipated burden upon the limited number of addictions treatment providers currently available. According to the annual resident census by the American Psychiatric Association (APA), in conjunction with the Accreditation Council for Graduate Medical Education (ACGME), the number of addiction psychiatry fellowship trainees nationally has remained primarily stable, decreasing from 67 (in academic year 2010–11) to 62 (2011–12), and later rising to 73 (2012–13), representing approximately 1% of the total number of psychiatry trainees.3 Though this more recent increase in the number of trainees appears promising, the continued addition of qualified addictions providers into the workforce is of paramount importance. According to a 2009 national survey of General Psychiatry residents, trainees generally had a positive impression of addiction psychiatrists, but expressed less favorable attitudes toward the actual practice of addictions treatment.4 Additionally, research studies suggest four primary challenges that general psychiatry trainees report in relation to Addiction Psychiatry education. Defined broadly, these challenges are (1) limited comfort in treating patients with SUD after completion of training,5 (2) lack of familiarity with addictions treatment options (e.g., pharmacotherapy, psychotherapy, Received September 29, 2014; revised January 16, 2015; accepted February 7, 2015. Address correspondence to Shorter, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. E-mail: [email protected]
community resources),6 (3) negative attitudes about the population and treatment outcomes,7 and (4) limited interest in the field of addictions as a career.4 In order to further understand the impact of these challenges and assess progress made in resident training as well as methods for raising interest in addictions, we embarked upon a detailed needs assessment survey of the General Psychiatry residents of a major medical school in Texas. This effort was undertaken to concretely identify elements within the training that were identified by residents to either enhance or decrease interest in Addiction Psychiatry. To our knowledge, these findings reflect the first published results of this kind. Consistent with previously reported findings, we found that 44% (7/16) agreed or strongly agreed with the statement, “I enjoy working with addiction patients.” However, only 25% (4/ 16) of residents reported interest in going obtaining specialty training. Of those expressing interest in fellowship, 75% (3/4) reported comfort with prescribing medications and treating substance use disorders in the outpatient setting, while only 29% (4/14) of those uninterested in fellowship reported feeling comfortable. This finding suggests that (a) despite not feeling comfortable with prescribing, these trainees are not attracted to fellowship training in order to improve those skills, and (b) the possibility that not feeling comfortable with the treatment decreases the desire to do further addictions training. Additionally, while 94% (15/16) reported comfort with modalities to be employed early in addictions treatment, such as screening, brief intervention, and referral to treatment (SBIRT), only 25% of respondents reported feeling comfortable with utilizing ongoing, or prolonged, treatment interventions, such as addictions-focused cognitive-behavioral therapy. In conclusion, this survey suggests two specific areas of focus that might serve to improve resident knowledge and comfort in addictions treatment. Outpatient clinical training rotations should focus on (1) careful instruction in the use of pharmacotherapy in outpatient treatment of substance use disorders, and (2) introduction and close, dedicated supervision of psychotherapeutic modalities, such as cognitive behavioral therapy (CBT), aimed at reduction of substance misuse. Additional study of specific educational interventions is warranted. 191
ACKNOWLEDGMENTS D Shorter received support from VA CSR&D I01BX007080. This material is the result of work supported with resources and the use of facilities at the Michael E. DeBakey VA Medical Center. Declaration of Interest The authors report no conflict of interest. REFERENCES 1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (September 4, 2014). The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Rockville, MD.
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2. McLellan AT, Carise D, Kleber HD. Can the national addiction treatment infrastructure support the public’s demand for quality care? J Subst Abuse Treat. 2003;25:117–121. 3. American Psychiatric Association. Resident Census: Characteristics and distribution of psychiatry residents in the U.S. Arlington, VA. 2013. 4. Renner JA Jr, Karam-Hage M, Levinson M, Craig T, Eld B. What do psychiatric residents think of addiction psychiatry as a career? Acad Psych. 2009;33:139–142. 5. Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: Obstacles and strategies for change. J Addict Dis. 2008;27:77–97. 6. Thomas CP, Reif S, Haq S, Wallack SS, Hoyt A, Ritter GA. Use of buprenorphine for addiction treatment: Perspectives of addiction specialists and general psychiatrists. Psych Serv. 2008;59:909–916. 7. Lindberg M, Vergara C, Wild-Wesley R, Gruman C. Physicians-in-training attitudes toward caring for and working with patients with alcohol and drug abuse diagnoses. South Med J. 2006;99:28–35.
Addictions Needs Assessment
April 2015
Copyright of American Journal on Addictions is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
Needs Assessment Survey of Addictions Training in General Psychiatry Residency Dana Billups, MD,1 Daryl Shorter, MD1,2 1
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas Michael E. DeBakey VA Medical Center, Houston, Texas
2
According to the 2013 National Survey on Drug Use and Health (NSDUH), of the estimated 22.7 million Americans aged 12 or older who needed treatment for an illicit drug or alcohol use problem, only 2.5 million received treatment at a specialty facility.1 Despite the widespread prevalence of substance use disorders (SUD) and identified need for more addictions professionals,2 entrance of physicians into specialty training for Addiction Psychiatry continues to lag behind estimates of need. Additionally, although access to addiction treatment services has traditionally been limited, with passage of the Affordable Care Act (ACA) there is further anticipated burden upon the limited number of addictions treatment providers currently available. According to the annual resident census by the American Psychiatric Association (APA), in conjunction with the Accreditation Council for Graduate Medical Education (ACGME), the number of addiction psychiatry fellowship trainees nationally has remained primarily stable, decreasing from 67 (in academic year 2010–11) to 62 (2011–12), and later rising to 73 (2012–13), representing approximately 1% of the total number of psychiatry trainees.3 Though this more recent increase in the number of trainees appears promising, the continued addition of qualified addictions providers into the workforce is of paramount importance. According to a 2009 national survey of General Psychiatry residents, trainees generally had a positive impression of addiction psychiatrists, but expressed less favorable attitudes toward the actual practice of addictions treatment.4 Additionally, research studies suggest four primary challenges that general psychiatry trainees report in relation to Addiction Psychiatry education. Defined broadly, these challenges are (1) limited comfort in treating patients with SUD after completion of training,5 (2) lack of familiarity with addictions treatment options (e.g., pharmacotherapy, psychotherapy, Received September 29, 2014; revised January 16, 2015; accepted February 7, 2015. Address correspondence to Shorter, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas. E-mail: [email protected]
community resources),6 (3) negative attitudes about the population and treatment outcomes,7 and (4) limited interest in the field of addictions as a career.4 In order to further understand the impact of these challenges and assess progress made in resident training as well as methods for raising interest in addictions, we embarked upon a detailed needs assessment survey of the General Psychiatry residents of a major medical school in Texas. This effort was undertaken to concretely identify elements within the training that were identified by residents to either enhance or decrease interest in Addiction Psychiatry. To our knowledge, these findings reflect the first published results of this kind. Consistent with previously reported findings, we found that 44% (7/16) agreed or strongly agreed with the statement, “I enjoy working with addiction patients.” However, only 25% (4/ 16) of residents reported interest in going obtaining specialty training. Of those expressing interest in fellowship, 75% (3/4) reported comfort with prescribing medications and treating substance use disorders in the outpatient setting, while only 29% (4/14) of those uninterested in fellowship reported feeling comfortable. This finding suggests that (a) despite not feeling comfortable with prescribing, these trainees are not attracted to fellowship training in order to improve those skills, and (b) the possibility that not feeling comfortable with the treatment decreases the desire to do further addictions training. Additionally, while 94% (15/16) reported comfort with modalities to be employed early in addictions treatment, such as screening, brief intervention, and referral to treatment (SBIRT), only 25% of respondents reported feeling comfortable with utilizing ongoing, or prolonged, treatment interventions, such as addictions-focused cognitive-behavioral therapy. In conclusion, this survey suggests two specific areas of focus that might serve to improve resident knowledge and comfort in addictions treatment. Outpatient clinical training rotations should focus on (1) careful instruction in the use of pharmacotherapy in outpatient treatment of substance use disorders, and (2) introduction and close, dedicated supervision of psychotherapeutic modalities, such as cognitive behavioral therapy (CBT), aimed at reduction of substance misuse. Additional study of specific educational interventions is warranted. 191
ACKNOWLEDGMENTS D Shorter received support from VA CSR&D I01BX007080. This material is the result of work supported with resources and the use of facilities at the Michael E. DeBakey VA Medical Center. Declaration of Interest The authors report no conflict of interest. REFERENCES 1. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (September 4, 2014). The NSDUH Report: Substance Use and Mental Health Estimates from the 2013 National Survey on Drug Use and Health: Overview of Findings. Rockville, MD.
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2. McLellan AT, Carise D, Kleber HD. Can the national addiction treatment infrastructure support the public’s demand for quality care? J Subst Abuse Treat. 2003;25:117–121. 3. American Psychiatric Association. Resident Census: Characteristics and distribution of psychiatry residents in the U.S. Arlington, VA. 2013. 4. Renner JA Jr, Karam-Hage M, Levinson M, Craig T, Eld B. What do psychiatric residents think of addiction psychiatry as a career? Acad Psych. 2009;33:139–142. 5. Yoast RA, Wilford BB, Hayashi SW. Encouraging physicians to screen for and intervene in substance use disorders: Obstacles and strategies for change. J Addict Dis. 2008;27:77–97. 6. Thomas CP, Reif S, Haq S, Wallack SS, Hoyt A, Ritter GA. Use of buprenorphine for addiction treatment: Perspectives of addiction specialists and general psychiatrists. Psych Serv. 2008;59:909–916. 7. Lindberg M, Vergara C, Wild-Wesley R, Gruman C. Physicians-in-training attitudes toward caring for and working with patients with alcohol and drug abuse diagnoses. South Med J. 2006;99:28–35.
Addictions Needs Assessment
April 2015
Copyright of American Journal on Addictions is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
