Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination.

PURPOSE: To determine knowledge of a national sample of medical students about substance withdrawal, screening and early intervention, medical and psychiatric complications of addiction, and treatment options.

METHODS: Based on learning objectives developed by medical faculty, twenty-two questions on addictions were included in the 1998 Canadian licensing examination.

RESULTS: The exam was written by 858 medical students. The average score on the addiction questions was 64%.

• Students showed strong knowledge of the clinical features of medical complications.

Specific knowledge gaps were identified for

• withdrawal treatment protocols,
• low-risk drinking guidelines,
• taking an alcohol history,
• substance-induced psychiatric disorders, and
• Alcoholics Anonymous.

CONCLUSION: Medical students are knowledge-deficient around key learning objectives in addictions. The deficiencies were in areas of basic knowledge that could be learnt with little difficulty.

Research report; Kahan M, Midmer D, Wilson L, Borsoi D. Medical students’ knowledge about alcohol and drug problems: results of the medical council of Canada examination. Subst Abus. 2006 Dec;27(4):1-7.

Brief-TSF includes training, as well as other matters, in taking an alcohol inventory and knowledge of Alcoholics Anonymous.

Are Brief Alcohol Interventions Likely to be Effective in Routine Primary Care Practice?

A number of meta-analyses have demonstrated the modest efficacy of brief interventions (BI) for nondependent unhealthy alcohol use in primary care settings.

Whether this level of efficacy can be expected when BIs are delivered outside of research studies in not known.

This systematic review identified 22 randomized trials including over 5800 patients. Investigators classified the trials on a spectrum from tightly controlled (efficacy design) to real world (effectiveness design) studies.

The scale considered whether patients presented to health care with a range of conditions, whether practices delivered a full range of medical services, whether practitioners routinely worked in the service rather than being funded by the trial, and whether the intervention could be delivered within standard visit times.

• Participants who received BI drank approximately 3 standard drinks per week less than those who did not.
• Longer duration of intervention was not significantly associated with a larger effect.
• The effect of BI on drinking was similar in studies regardless of whether they were tightly controlled or had more real world characteristics.

Comments by Michael Levy, PhD

This meta-analytic study showed the benefit of BI in reducing alcohol consumption in both controlled and real world primary care settings.

It seems logical to assume similar results could be achieved in community treatment programs.

Since BI in the studies reviewed was designed to achieve a reduction in alcohol consumption, treatment programs could consider implementing BI for patients who are not interested in achieving abstinence but who want to reduce their intake.

Reference: Kaner EF, Dickinson HO, Beyer F, et al. The effectiveness of brief alcohol intervention in primary care settings: a systematic review. Drug Alcohol Rev. 2009;28(3):301–323.

From; Join Together Online

Query Patients About Past Drug Problems to Prevent Prescription Misuse, Docs Told

Diversion and misuse of prescription drugs is a growing problem, but one that physicians can help prevent by asking patients about their addiction history before prescribing drugs with high abuse potential, experts say.

AMANews reported March 17 that doctors who want to prescribe adequate medication to treat pain can take a number of precautions to avoid running afoul of law enforcement or unwittingly contributing to an addiction problem. “Because so many patient problems have fallen at the feet of primary care, we need to look at ways primary care can be part of the solution and not part of the problem,” said Michael M. Miller, M.D., president of the American Society of Addiction Medicine.

Miller advises doctors to start by asking about the patient’s past history with alcohol and other drug addiction as well as past problems controlling prescription medication use. Prescribing only as much medication as the patient will reasonably need also can prevent diversion or misuse, such as kids or others taking unused pills from a parent’s medicine cabinet.

“We hate to see somebody in pain run out of medicine, so sometimes we may be a little too generous,” said Kyle Kampman, M.D., medical director of the Charles O’Brien Center for Addiction Treatment at the University of Pennsylvania. “Patients tell me they worked as a maid at the height of their addiction and they would go through people’s medicine cabinets. I had a patient who was a roofer tell me, ‘If you ever let a roofer in your house and in the bathroom, chances are they are looking through your medicine cabinet.’”

Patients returning early to seek a refill of their prescription also should raise a red flag with physicians. “It’s a joke among addiction providers that sinks and toilets seem to be magnets for people’s medications,” said Kampman. “That’s an excuse you often hear: ‘I dumped my medicine down the sink or down the toilet.’ So that should ring alarm bells.”

If a problem is suspected, doctors should question patients directly, said Kampman. Some will admit an addiction problem and can be referred to treatment, while others may need stronger medications for their pain and should be referred to a pain specialist.

Doctors also should be careful to adhere to rules requiring them to conduct a physician exam before prescribing medication, and inform patients that sharing prescription drugs with others is illegal and that leftover medicine should be destroyed.

Finally, doctors can now check prescription-drug databases to find out if patients are “doctor shopping” — visiting multiple physicians for prescriptions to feed their addiction or illicit sales. “It takes about 30 seconds to check to see if patients are filling other prescriptions,” said family physician Terry Haffner, M.D., of Kokomo, Ind., where such a tracking system is now in place.  

From Join Together Online

Alcohol hospital admissions hide individual tragedies, say doctors (issued Tuesday 22 Jul 2008)

The new government figures released today (Tuesday 22 July 2008) revealing that 811,000 people in England were admitted to hospital with alcohol misuse problems in 2006 hide the individual tragedies that hospital frontline staff see day in day out, said the British Medical Association.

The BMA’s Head of Science and Ethics, Dr Vivienne Nathanson, added:

“While this figure is rightly very frightening and shocking, it also hides the hundreds and thousands of individual tragedies that doctors witness every day. Alcohol misuse is related to over 60 medical conditions including heart and liver disease, diabetes, strokes and mental health problems – it costs the NHS millions of pounds every year and is linked to accidents and street violence.

The truth is there is nothing glamorous about drinking too much alcohol – it wrecks health, lives and families.

“The BMA will be responding in full to the government’s consultation on alcohol and we will certainly be backing tough action like introducing mandatory regulation and labelling and restricting ‘happy hours’ and irresponsible drinks promotions . There can be no more softly, softly approach. The access and affordability of alcohol must be tackled head on.”

Full story at; British Medical Association, The professional association for doctors

See also;

• If you have healthcare training this manual may help.
• Science of Addiction
• Early or Adaptive Stage of Alcoholism
• Types of Dysfunctional Families

Understanding and Counseling Persons With Alcohol, Drug, and Behaviorial Addictions by Howard Clinebell Read more about this title…