OST 517 - BEHAVIORAL SYSTEMS:
SUBSTANCE ABUSE

SPRING TERM 1997

Room E-105 Fee Hall

RATIONALE
 
Substance abuse and addiction pose major social, economic and medical problems for the United States. They cost the nation almost $14 billion in health care, most of which covers hospital treatment for the acute and chronic complications of undiagnosed and untreated substance abuse. Less than one third of these costs are attributed to the screening, assessment, diagnoses and treatment of alcoholics and other substance abusers and addicts.
 
Substance abuse problems are commonly encountered in clinical practice, and medical research supports the clinical effectiveness and cost benefits of substance abuse treatment. However, numerous studies have indicated that physicians are able to diagnose only a small percentage of patients who are dependent on alcohol or drugs. Opportunities for effective prevention efforts are lost as a result of this same phenomenon.
Physicians regularly miss the diagnosis of underlying substance abuse in patients because their training had not demanded that they develop the requisite attitudes, knowledge, and clinical skills. These deficiencies in the education of physicians have been compounded by the social and professional stigmas linked to substance abusing patients; inadequate reimbursements provided to the physicians for the care of these patients, and the lingering belief that substance abuse is not an intermittent relapsing chronic disease, but rather reflects a flaw in personal character.
 
In order to correct this situation, a group of true experts in the field of substance abuse and health care met in Phoenix, Arizona in October of 1994 to discuss what should be done. The 45 participants included state legislators, managers of employee assistance programs, federal health officials, experts in substance abuse, and representatives of the residency review committees and certifying boards in the primary care specialties. This group recommended that the specialties of Family Practice, Internal Medicine, Pediatrics, and Obstetrics-Gynecology promptly respond to the need to improve the quality of care provided by the physicians trained in these specialties to patients with alcohol and other drug problems.
 
Further they recommended that these primary care specialties should require all residents to be trained to develop and to demonstrate those skills necessary to prevent, screen, and diagnose alcohol and other drug problems; to refer these patients for additional care when necessary; and to deliver follow-up care for these patients and their families.
 
They also suggested that the certifying boards and residency review committees of these specialties expeditiously take specific actions to strengthen their requirements so that the performance of residents in managing substance abuse patients is measurably improved.
 
In Osteopathic Medicine the council of Postdoctoral Training is currently reviewing the primary care residencies to evaluate the training residents receive in the area of substance abuse. The goal is to develop minimum training requirements. Osteopathic Medicine has made progress in developing a certificate of additional qualification (CAQ) in addiction medicine. Five certifying boards are currently developing standards.
 
(The above paragraphs are adapted with permission from the printed proceedings of a conference called TRAINING ABOUT ALCOHOL AND SUBSTANCE ABUSE FOR ALL PRIMARY CARE PHYSICIANS published by the Josiah Macy, Jr. Foundation in New York City)
 
PURPOSE
 
This course is designed to enable future physicians to base their clinical decisions relative to their patientís use and/or abuse of mood altering substances on adequate scientific knowledge and to develop the attitudes and skills that will facilitate effective interventions for patients with current or potential substance abuse problems.
 
 
PROCESS
 
We will depend heavily on the computer and the internet system (WEB) to provide the cognitive material. You will be on your own to read this material. Two hours of "lecture time" will be devoted to answering any questions you may have about the material you are reading.
You can find assistance in the use of the computer in the Kobiljak Center. You are free to access the WEB page and all the material needed for this course from any computer in the world that has internet access.
 
A broader perspective on the topic will be achieved through exposure to physicians and patients who have experienced this issue first hand and who will share their observations and feelings regarding the care of patients with substance abuse problems.
 
You will be asked to be present for a training session on interviewing with an emphasis on brief intervention for patients with potential substance abuse problems. Further, you will be given a chance to practice this skill in a small group of your peers who will provide feedback on your performance.
 
 
OBJECTIVES
 
Students will be able to:

1. Describe a method of searching for substance abuse related information on the WEB.
2. Describe the characteristics and current patterns of use of alcohol, tobacco, marijuana, cocaine, heroin, and other mood    altering substances in our society.
3. Describe a well researched method of screening patients for alcohol use and abuse and be able to generalize the approach for use with tobacco and other drug use.
4. Describe a well researched method for assessing the level of severity of substance abuse problems.
5. Describe methods for providing office based treatment including techniques for brief intervention.
6. Describe basic pharmacological treatments for nicotine, alcohol, and other drugs
7. Describe methods for making viable referrals for specialized treatment and/or other community services for substance use disorders.
8. Describe what care is needed for family members affected by a relativeís substance use disorder and how to make a viable referral for them.
9. Describe methods for recognizing and assisting colleagues who may have an alcohol or drug problem.
10. Describe their own attitudes and values regarding substance use disorders.

READING ASSIGNMENTS
 
Please go to http://www.kcc.com.msu.edu/index.html on a computer that is linked to the internet. Click on "instructional courseware" then click on OST 517. There you will find the objectives and the reading assignments for this course. If you are not familiar with how to access an address on the World Wide Web, check with the staff in the Kobiljak center for assistance. If you do not have a personal computer to work on, please feel free to use one of the computers in the Kobiljak center or any other computer that you might get access to that has an internet connection.
 

Schedule for Ost 517 - Substance Abuse Component

 
January 28, 1998
 
8:00am: Introduction and review of course outline and grading system
8:20am: Introduction to screening, assessment and brief interventions
 
8:50am: Break
 
9:00am: How to provide a brief intervention
 
January 29, 1998
 
10:00am: Question and Answer session on anything related to substance abuse or this course.
 
10:30am: Discussion Session I: Visit with an alcoholic
 
February 4, 1998
 
8:00am Group I: Training session on Brief Intervention
 
February 5, 1998
 
10:00am: Question and Answer session on anything related to substance abuse or this course.
 
10:30am: Discussion Session II: Visit with a recovering drug addict.
 
 
February 11, 1998
 
8:00am Group II: Training session on Brief Intervention
 
February 12, 1998
 
10:00am: Question and Answer session on anything related to substance abuse or this course.
 
10:30am: Discussion Session III: Discussion with a treating physician on the seemingly paradoxical approach of using drugs in the treatment of substance abuse.
 
February 18, 1998
 
8:00am Group III: Training session on Brief Intervention
 
February 19, 1998
 
10:00am: Question and Answer session on anything related to substance abuse or this course.
 
10:30am: Discussion Session IV: Visit with a group of physicians who specialize in the treatment of substance abuse.
 
February 25, 1998
 
8:00am Group IV: Training session on Brief Intervention
 
February 26, 1998
 
10:00am Final Exam
 
Final Exam:
The final will be made up of questions that will be taken from the course objectives and their associated readings listed on the WEB. Study questions will be posted under each objective to assist in your preparation for the final.

Grading System:
In order to pass this segment of OST 517 you need to earn at least 80 points. This may be done with any combination of the following:
 

Item	Maximum Possible Points
Brief Intervention Training Session	25
*Student Survey	5
Discussion I	5
Discussion II	5
Discussion III	5
Discussion IV	5
Final Exam	50
Total Possible	100
NEEDED TO PASS	80
**Extra Credit - attend an open AA meeting	5

 
**Extra Credit - attend an open AA meeting after the beginning of this course.
*Student Surveys must be turned into Mary Schneider prior to your assigned training session.
 
* *Forms for recording attendance at AA meetings will be available in class.

NB: Points will be deducted for late arrival at discussion or training sessions

REMEDIATION:
 
In the event that you do not earn enough points to pass this module, you will be required to make up the points needed through appropriate academic activities. It should be noted that the make up activities will be significantly more time demanding than the original requirement in class. For example, if you must make up the training session, you will need to submit a written report on the history and efficacy of brief interventions and present your findings orally to Dr. Hagan. In addition you will be required to demonstrate your ability to do a brief intervention by role-playing with Dr. Hagan. This is designed to encourage you to participate fully in the learning activities of the class with your peers. There is much to be gained through this type of interaction. Students who are unable to achieve a total of 80 points through available make up exercises will have to take the course again next year.
 
EXCUSED ABSENCES: 
 
At times it is necessary for a student to be excused from a final due to extraordinary circumstances. If this happens to you, a date will be set for a make-up version of the exam and you will be required to take the final at that time. If you are again unable to take the final, you may not be able to pass the course this year. Other missed exercises will have to be made up through study, papers, interviews or oral exams with Dr. Hagan.