Current Psychiatry Reports

, Volume 7, Issue 5, pp 352–359 | Cite as

Training psychiatrists to diagnose and treat substance abuse disorders

  • John A. RennerJr
  • Janice Quinones
  • Amanda Wilson


Addiction training in psychiatric residency programs needs expansion. Epidemiology research has shown that patients with substance use disorders and co-occurring mental health disorders are the norm in nearly all clinical settings. Unfortunately, traditional training approaches built around brief rotations on detoxification or intensive substance abuse rehabilitation units do not adequately train psychiatrists in long-term management skills, and may reinforce misperceptions that these patients do not respond to treatment. An enhanced addiction curriculum coupled with an extended outpatient clinic rotation is an ideal model for teaching the skills needed to successfully care for these patients. Training must include an adequate knowledge base, an opportunity to cultivate positive attitudes toward these patients, and recognition that psychiatrists must take responsibility for treating the addiction problem and any co-occurring psychiatric disorders. The program developed at Boston University Medical Center successfully integrates expanded addiction psychiatry training into the general psychiatry residency.


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References and Recommended Reading

  1. 1.
    Musto DF: The American Disease: Origins of Narcotic Control. New York: Oxford University Press; 1999.Google Scholar
  2. 2.
    Grant BF, Harford TC: Comorbidity between DSM-IV alcohol use disorders and major depression Results of a national survey. Drug Alcohol Depend 1995, 39:197–206.PubMedCrossRefGoogle Scholar
  3. 3.
    Kessler RC, Nelson CB, McGonagle KA, et al.: The epidemiology of co-occurring addictive and mental disorders Implications for prevention and service utilization. Am J Orthopsychiatry 1996, 66:17–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Kessler RC, Crum RM, Warner LA, et al.: Lifetime co-occurrence of DSM III-R alcohol abuse and dependence with other psychiatric disorders in the National Comorbidity Survey. Arch Gen Psychiatry 1997, 54:313–321.PubMedGoogle Scholar
  5. 5.
    Kessler RC: The epidemiology of dual diagnosis. Biol Psychiatry 2004, 56:730–737.PubMedCrossRefGoogle Scholar
  6. 6.
    Regier DA, Farmer ME, Rae DS, et al.: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990, 264:2511–2518.PubMedCrossRefGoogle Scholar
  7. 7.
    Warner LA, Kessler RC, Hughes M, et al.: Prevalence and correlates of drug use and dependence in the United States Results from the National Comorbidity Survey. Arch Gen Psychiatry 1995, 52:219–229.PubMedGoogle Scholar
  8. 8.
    Weaver T, Madden P, Charles V, et al.: Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry 2003, 183:304–313.PubMedCrossRefGoogle Scholar
  9. 9.
    Merikangis KR, Mehta RL, Molnar BE, et al.: Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology. Addict Behav 1998, 23:893–907.CrossRefGoogle Scholar
  10. 10.
    Center for Substance Abuse Treatment: Substance Abuse Treatment for Persons With Co-Occurring Disorders. Treatment Improvement Protocol (TIP) Series 42. DHHS Publication No. (SMA) 05-3922. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2005.Google Scholar
  11. 11.
    Drake RE: Psychosocial approaches to dual diagnosis. Schizophr Bull 2000, 26:105–118.PubMedGoogle Scholar
  12. 12.
    Willenbring ML, Olsen DH, Bielinski JB: A randomized trial of integrated outpatient treatment for mentally ill alcoholic men. Arch Intern Med 1999, 159:1946–1952.PubMedCrossRefGoogle Scholar
  13. 13.
    American Academy of Addiction Psychiatry: Co-occurring psychiatric and substance use disorder treatment policy, 2002. http:// Accessed June 17, 2005. This policy statement from the primary professional organization for addiction psychiatrists clearly articulates the importance of effective treatment for patients with co-occurring psychiatric and substance use disorders.Google Scholar
  14. 14.
    McLellan AT, Meyers K: Contemporary addiction treatment: a review of systems problems for adults and adolescents. Biol Psychiatry 2004, 56:764–770.PubMedCrossRefGoogle Scholar
  15. 15.
    Galanter M, Kaufman E, Taintor Z, et al.: The current status of psychiatric education in alcoholism and drug abuse. Am J Psychiatry 1989, 146:35–39.PubMedGoogle Scholar
  16. 16.
    Fisher JC, Mason RL, Keeley KA, Fisher JV: Physicians and alcoholics. The effect of medical training on attitudes toward alcoholics. J Stud Alcohol 1975, 36:949–955.PubMedGoogle Scholar
  17. 17.
    Geller G, Levine DM, Mamon JA, et al.: Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA 1989, 261:3115–3120.PubMedCrossRefGoogle Scholar
  18. 18.
    Brewster JM, Single E, Ashley MJ, et al.: Preventing alcohol problems: survey of Canadian medical schools. Can Med Assoc J 1990, 143:1076–1078.Google Scholar
  19. 19.
    Ewan CE, Whaite A: Training health professionals in substance abuse: a review. Int J Addictions 1982, 17:1211–1229.Google Scholar
  20. 20.
    Chappel JN: Training of residents and medical students in the diagnosis and treatment of dual diagnosis patients. J Psychoactive Drugs 1993, 23:293–300.Google Scholar
  21. 21.
    American Psychiatric Association: Position statement on the need for improved training for treatment of patients with combined substance use and other psychiatric disorders. Am J Psychiatry 1994, 151:795–796.Google Scholar
  22. 22.
    American Psychiatric Association: Position statement on training needs in addiction psychiatry. Am J Psychiatry 1996, 153:852–853.Google Scholar
  23. 23.
    Isaacson JH, Fleming M, Kraus M, et al.: A national survey of training in substance use disorders in residency training programs. J Stud Alcohol 2000, 61:912–915.PubMedGoogle Scholar
  24. 24.
    Fleming M, Manwell LB, Kraus M, et al.: Who teaches residents about the prevention and treatment of substance use disorders? J Family Practice 1999, 48:725–729.Google Scholar
  25. 25.
    American Council for Graduate Medical Education: Program requirements for residency training in psychiatry, 2001. Accessed June 17, 2005.Google Scholar
  26. 26.
    Renner J: How to train residents to identify and treat dual-diagnosis patients. Biol Psychiatry 2004, 56:810–816.PubMedGoogle Scholar
  27. 27.
    Galanter M, Brook D: Network therapy for addiction: bringing family and peer support into office practice. Int J Group Psychother 2001, 51:101–122.PubMedCrossRefGoogle Scholar
  28. 28.
    Denning P: Practicing Harm Reduction Psychotherapy: An Alternative Approach to Addictions. New York: The Guilford Press; 2002. This is an excellent model for treating patients with dual diagnoses.Google Scholar
  29. 29.
    Miller WR, Rollnick S: Motivational Interviewing: Preparing People for Change, Second Edition. New York: The Guilford Press; 2002. This technique is widely recognized as one of the most effective approaches for engaging resistant patients in addiction treatment.Google Scholar
  30. 30.
    Najavits LM: Seeking Safety: A Treatment Manual for PTSD and Substance Abuse. New York: The Guilford Press; 2001. This approach is one of the most effective evidenced-based models for treating substance abuse patients with a wide range of co-occurring psychiatric disorders.Google Scholar
  31. 31.
    Weiss RD, Najavits LM: Overview of treatment modalities for dual diagnosis patients: pharmacotherapy, psychotherapy, and 12-step programs. In Dual Diagnosis and Treatment: Substance Abuse and Comorbid Medical and Psychiatric Disorders. Edited by Krantzler HR, Rounsaville BJ. New York: Marcel Dekker, Inc.; 1998:87–105. This is an excellent standard reference for this topic.Google Scholar
  32. 32.
    Mueser KT, Drake RE, Noordsy DL: Integrated mental health and substance abuse treatment for severe psychiatric disorders. J Psychiatric Practice 1998, 4(3):129–139.Google Scholar
  33. 33.
    National Institute on Drug Abuse: Principles of Drug Addiction Treatment, A Research-Based Guide. NIH 1999, No 99-4180. This is an excellent standard reference for this topic.Google Scholar
  34. 34.
    Roche AM, Parle MD, Campbell J, Saunders JB: Substance abuse disorders: psychiatric trainees’ knowledge, diagnostic skills and attitudes. Aust N Z J Psychiatry 1995, 29:645–652.PubMedGoogle Scholar
  35. 35.
    Willenbring ML, Kiviahan D, Grillo M: Evidence-based clinical practice guidelines in substance-use disorders: A survey of VA substance abuse treatment program leaders. A report from the substance abuse module, quality enhancement research initiative (QUERI). Washington, DC, Department of Veterans Affairs. 2001. This is an excellent standard reference for evidenced-based treatment.Google Scholar
  36. 36.
    Veterans Administration-Department of Defense: VA-DOD Substance use disorders guidelines, 2001. http// Accessed June 17, 2005. This comprehensive algorithm for addiction treatment includes the management of patients with co-occurring psychiatric disorders.Google Scholar
  37. 37.
    American Society of Addiction Medicine: Public Policy of ASAM: Dual Diagnosis, Co-Occurring Addictive and Psychiatric Disorders, 2001. dual%20diagnosis.htm. Accessed June 17, 2005.Google Scholar
  38. 38.
    Klamen DL: Education and training in addictive diseases. Psychiatr Clin North Am 1999, 22:471–480.PubMedCrossRefGoogle Scholar
  39. 39.
    Sattar SP, Madison J, Markert RJ, Bhatia et al.: Addiction Training Scale (ATS): Pilot study of a self-report evaluation tool for psychiatry residents. Acad Psychiatry 2004, 28:204–208.PubMedCrossRefGoogle Scholar
  40. 40.
    Dove HW: Postgraduate education and training in addiction disorders. Defining core competencies. Psychiatr Clin North Am 1999, 22:481–488, xi.PubMedCrossRefGoogle Scholar
  41. 41.
    Karam-Hage M, Nerenberg L, Brower KJ: Modifying residents’ professional attitudes about substance abuse treatment and training. Am J Addictions 2001, 10:40–47.CrossRefGoogle Scholar
  42. 42.
    Bigby J, Barnes HN: Evaluation of a faculty development program in substance abuse education. J Gen Intern Med 1993, 8:301–305.PubMedCrossRefGoogle Scholar
  43. 43.
    Mayfield D, McLeod G, Hall P: The CAGE questionnaire: validation of a new alcoholism instrument. Am J Psychiatry 1974, 131:1121–1123.PubMedGoogle Scholar
  44. 44.
    Saunders JB, Aasland OG, Babor TF, et al.: Development of the Alcohol Use Disorders Screening Test (AUDIT). WHO collaborative project on early detection of persons with harmful alcohol consumption, II. Addiction 1993, 88:791–804.PubMedCrossRefGoogle Scholar
  45. 45.
    Selzer ML: The Michigan alcoholism screening test: the quest for a new diagnostic instrument. Am J Psychiatry 1971, 127:1653–1658.PubMedGoogle Scholar
  46. 46.
    Chase C: American Society of Addiction Medicine: ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition, Revised. Chevy Chase, MD: American Society of Addiction Medicine; 2001.Google Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • John A. RennerJr
    • 1
  • Janice Quinones
  • Amanda Wilson
  1. 1.VA Outpatient ClinicBostonUSA

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