Evaluating alcoholism and drug abuse knowledge in medical education: a collaborative project.

A series of six modular examinations, each representing a substance abuse problem, were developed by a National Institute on Drug Abuse task force working with consultants from the National Board of Medical Examiners (NBME). Each examination contained a patient management problem and multiple-choice questions. The examinations were administered to 629 third- and fourth-year U.S. medical students, and the results indicated that students performed less well in this area than on the traditional content of the NBME examinations. Students performed better on items related to pharmacologic effects of drugs of abuse, Alcoholics Anonymous, and the treatment of delirium tremens. Students did less well on items related to metabolic and biochemical areas; emergency room treatment of drug-overdosed, comatose patients; and legal issues in substance abuse. As a result of these data, a syllabus explaining each item in the available modules was developed, score-reporting to participating schools was modified, and the modules were shortened. Implications for medical education in substance abuse are discussed.

New perspectives on the similarities and differences of alcoholism and drug abuse.

This article reviews the similarities and differences of alcoholism and drug abuse from a biopsychosocial perspective. Special emphasis is given to newer developments. In biology, the role of endorphins and isoquinolines is considered against the more traditionally recognized clinical differences between alcohol and drug disorders. Consideration is given to psychological themes such as the utility of the addictive personality concept, the impact of more sophisticated prevention strategies, and the combined treatment of alcoholics and drug abusers. Reports from social fields include a cross-cultural view of chemical dependence and an appraisal of legal and political trends which influence chemical use and the civil rights of chemical users. Recent developments in the biologic, psychologic and social sciences have solidified the impression that the chemical dependencies, for all their differences, share a number of important characteristics. The etiology of alcoholism and drug abuse has been attributed to biopsychosocial causes, currently a widely accepted hypothesis. From one perspective, this theory could be seen as a grab bag approach, since no specific universal cause has been discovered while many have been postulated. From another aspect, the hypothesis is a rational synthesis of present knowledge which finds no one etiological factor to be either preeminent or ubiquitous. This article presents in succession an overview of the biology, psychology and sociology of chemical dependence with emphasis on integrating newer developments with familiar knowledge.

Clinical fellowships in substance abuse: a new curriculum strategy.

Recognizing the effectiveness of substance abuse treatment is made easier when there is a steady supply of newly trained medical professionals who are competent in this specialty. University-based substance abuse treatment facilities have a clear obligation to educate such professionals. This article shows how three different medical colleges were able to establish new clinical fellowships in substance abuse so that teaching activities could be fostered at preexisting treatment sites. Fellowship activities varied from one place to the next, but at all three schools important momentum was generated on behalf of substance abuse education. These experiences provide models for those academicians and administrators who face the task of integrating educational and serivce delivery missions in the substance abuse field.

Alcoholism, life events, and psychiatric impairmant.

A sample of 122 DPs was compared to a "normative" sample of CSRs. The presentation of psychiatric disorder scores and numbers and kind of stressful life events was detailed. Results of this comparative analysis suggest that research that focuses on high psychiatric disorder-controlling for life events is in order. Furthermore, therapeutic intervention must obviously take into account the iterative nature of alcohol and stressful life events. Also, these findings suggest and support the role of life stress in the possible formation of alcoholism.

Physicians and alcoholics. The effect of medical training on attitudes toward alcoholics.

The over-all ratings assigned by first- and second-year medical students and housestaff (residents and interns) to alcoholics on a 16-adjectivee bipolar semantic differential measure differed significantly. Mean ratings by the housestaff were lowest and the ratings by the second-year students were lower than those of the first-year students on 5 of the 6 adjective pairs on which the groups differed significantly.

Physicians and alcoholics. Factors affecting attitudes of family-practice residents toward alcoholics.

Family-practice residents rated alcoholics as weaker, sicker and more hopeless and aimless than average persons on an adjective semantic differential, and diabetics as sicker than average persons. The implications for the diagnosis and treatment of alcoholism are discussed.