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Letters to the Editor  |   July 2006
Addressing Substance Abuse in Medical School Curricula
Author Affiliations
  • WALTER C. PROZIALECK, PHD
    Department of Pharmacology Midwestern University/Chicago College of Osteopathic Medicine Downers Grove, Ill
    Professor and Chairman
Article Information
Addiction Medicine / Medical Education / Curriculum
Letters to the Editor   |   July 2006
Addressing Substance Abuse in Medical School Curricula
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 425-426. doi:10.7556/jaoa.2006.106.7.425
The Journal of the American Osteopathic Association, July 2006, Vol. 106, 425-426. doi:10.7556/jaoa.2006.106.7.425
To the Editor: In their excellent review in the supplement to the June 2005 issue of the JAOA, Wyatt et al1 highlight the importance of the problem of substance abuse disorders to the osteopathic medical profession. They also emphasized the need for improvement in the education of osteopathic medical students and physicians in this area. 
As a pharmacologist and medical educator, I have long thought that this was an issue that needed to be addressed more completely in medical curricula. To provide an opportunity for students at the Midwestern University/Chicago College of Osteopathic Medicine to obtain more in-depth training in this area, I have developed an interdisciplinary elective course, “Aspects of Drug Abuse,” that is offered to osteopathic medical, pharmacy, and physicians assistant students on our Downers Grove, Ill, campus. The students have received this course extremely well. Therefore, I offer a general description of the course for readers who are dealing with the issue of substance abuse education. 
A 20-hour elective course was designed to provide students with an in-depth understanding of the pharmacology of the common drugs of abuse, including alcohol, cocaine, hallucinogens, inhalants, marijuana, nicotine, opioids, phencyclidine, sedatives, stimulants, and tobacco. Particular emphasis is given to basic pharmacokinetic and pharmacodynamic mechanisms as they relate to the effects of the drugs and to the development of drug tolerance and dependence. Current theories regarding the physiologic basis of drug-seeking behavior and the development of drug dependence are presented. Various social, legal, and ethical aspects of substance abuse problems are considered. Students receive instruction in the diagnosis and treatment of overdose for each of the major classes of drugs of abuse. They also receive instruction in current medical approaches for recognizing and treating drug-dependent patients, including drug testing procedures, intervention techniques, detoxification procedures, maintenance procedures, and procedures for weaning the patient from drugs. In addition, topics discussed include nonmedical approaches for the treatment of drug-dependent individuals, particularly support groups such as Alcoholics Anonymous, as well as the problem of drug abuse among healthcare professionals. 
This course is interdisciplinary and is usually presented by a team of instructors with expertise in a wide variety of areas, including pharmacology, public health, emergency medicine, forensic toxicology, and substance abuse counseling. Faculty use a variety of methods of instruction, including lectures, group discussions, assigned readings, and patient-oriented problem-solving exercises. Because it is an elective course, the instructors try to maintain a relaxed atmosphere and present the material in a manner that makes learning fun. 
Until 2 years ago, all students in the course were required to attend an open meeting of Alcoholics Anonymous, or a similar organization, as observers. Although the students almost universally thought that this was an excellent learning experience, the requirement was eventually dropped because of the large class size and potential confidentiality issues. 
During the past 2 years, the students have been required to review an interactive computer program called “Understanding the Alcoholic” that was developed by Richard M. Eisenberg, PhD, at the University of Minnesota Duluth. This program features video clips of patient scenarios and includes information on the ways in which healthcare professionals can recognize patients with alcohol-related problems and provide appropriate intervention and treatment. 
The students' feedback on this program has been extremely positive. 
The final noteworthy component of the course is that it includes presentations by patients from a nearby substance abuse treatment center that specializes in the treatment of healthcare professionals with substance abuse disorders. Each year, several patients who are nearing the completion of their treatment program have agreed to speak to the class. Besides telling their personal stories, they have often provided excellent insights into the problem of substance abuse among healthcare professionals. 
During the past 5 years, a total of 1172 students, including 386 osteopathic medical students, have completed the course. Student evaluations of the course have been overwhelmingly positive, with more than 99% of the students answering “yes” to the question, “Has this course enhanced your understanding of the problem of drug abuse?” 
If any readers are contemplating the development of a similar course or educational program at their college, I would be glad to provide additional information and share any experience or any resources that I can provide. Moreover, I am most interested in learning how other colleges of osteopathic medicine have addressed this issue in their curricula. 
Wyatt SA, Vilensky W, Maulandro JJ, Dekker MA. Medical education in substance abuse: from student to practicing osteopathic physician. J Am Osteopathic Assoc. 2005;105(6 suppl 3):S18–S25. Available at: http://www.jaoa.org/cgi/content/full/105/6_suppl_3/S18. Accessed June 27, 2006.