“The most troubling finding is 94% of primary care physicians failed to include substance abuse among the five diagnoses they offered when presented with early symptoms of alcohol abuse in an adult patient.” This quote is taken from the CASA National Survey of Primary Care Physicians and Patients on Substance Abuse.
Unfortunately, little attention is normally given medical students in their preparatory studies about the disease of addiction. As a result, physicians often feel inadequate in talking to their addicted patients about their addiction. 1 Furthermore, the majority of physicians do not understand that addiction is a brain disease.
“Historically, we have attributed addictive illness, including alcoholism, to willful misconduct, character flaws, weak will, moral turpitude, or just bad people. Science does not support these outdated stereotypes. In 1956, the American Medical Association declared alcoholism an illness. Hampered by prejudice, misinformation, and an outdated sense of hopelessness at our supposed inability to effect meaningful intervention, the medical community has been slow to respond. Even today, most medical students and residents complete training without benefit of a rudimentary working knowledge of addictive illness; an illness they will see in their office almost daily for the rest of their careers. Addiction is a disease of the patient’s reward system, which alters behavioral drives that are under limited conscious control. Decision making is damaged such that abstinence is no longer simply a matter of choice. Gastfriend dubs addictive illness ‘a brain disease that subverts self-preservation’”. 2
With this in mind, the Betty Ford Institute created a Summer Institute for Medical Students (SIMS) program. The program has been operating for 26 years and gives medical students an in-depth experience with the dynamics of the disease of addiction. During their week-long session, students learn about the disease by spending time as participant observers with the patients and family members on campus. This is supplemented with education provided by Betty Ford physicians and treatment experts who give participants a comprehensive perspective on addiction treatment and recovery. In 2010, the program was attended by 149 medical students from 67 medical schools. One of the aims of the program is to prevent harm being done to addicted patients by physicians who have not been trained adequately to recognize addictive disease. The Betty Ford Institute surveyed program participants before and after the program. When asked if the student felt comfortable assessing a patient for addiction before the program, only 20% responded affirmatively. After the program, 75% provided a positive response. 3
If you are a program director or a department head involved in resident training, you may wish to consider this excellent program for your students. Scholarships are available through the Betty Ford Center Foundation. Contact www.bettyfordcenterfoundation.org to apply.
1 SIMS survey results taken from the Betty Ford Center Foundation Annual Report, 2010
2 Gary D. Carr, “Alcoholism: A Modern Look at an Ancient Illness”, Prim Care Clin Office Pract 38 (2011) 9-21.
3 SIMS survey results taken from the Betty Ford Center Foundation Annual Report, 2010