Approximately 1 in 10 Canadians describe symptoms consistent with alcohol or illicit drug dependence. Yet, the undergraduate medical education system devotes a total of 12 hours of curricular time to addiction medicine, not a proportionate response to the severity of the problem.
Addictions place a serious burden on the healthcare system, costing Canadians an estimated $39.8 billion in 2002. Despite years of rigorous training, why is it that less than 20% of primary care physicians feel confident identifying a patient with alcohol/drug dependence?
The medical education system does not dedicate sufficient time to addiction medicine: not enough time is spent in class, students are not introduced to effective screening tools, and they are not exposed to addiction patients during their undergraduate career.
Exposure to addiction medicine during undergraduate education is enormously important, because it means all students will be taught before they split into their residencies. Addictions are a reality in every part of the health care system: ER doctors encounter patients who are intoxicated or in withdrawal in the Emergency Department, surgeons encounter addictions when they must manage a post-op patient’s withdrawal, and since so few hospitals have in-patient addictions services, internal medicine and psychiatry often find themselves managing complicated medical detoxifications or maintenance therapies.
Incorporating addiction medicine into the curriculum is difficult as there are many hurdles that need to be overcome. The belief that addictions are a choice and not a disease has resulted in a “bad rep” for suffering patients, despite research that suggests otherwise. The stereotype that an individual with an addiction is a challenging patient with a poor social and medical prognosis is the foundation of what is being taught, resulting in physicians expressing negative views regarding these patients.
In addition, many physicians do not feel competent treating these patients and do not find the work rewarding. Consequently, patients are not screened for addictions, leaving them to suffer alone.
A vicious circle of ignorance and incompetence is created as these physicians teach medical students and mould the students’ views to mirror their own. This is reflected in numerous studies that show students express increasingly negative feelings regarding addiction patients as they progress through medical school.
Finding a solution to this problem is critical as the incidence of mental illnesses is increasing in Canada. Teaching students about effective screening tools and referrals to appropriate services can improve identification and quality of care. It is necessary to not only dedicate an appropriate amount of time, but also to use different forms of teaching methods (small-group discussions, role-play and traditional didactic lectures) to ensure that the allocated time is used in the best possible way and with the greatest impact.
Giving students the opportunity to become familiarized with addiction patients under physician guidance can provide them with an example to follow in their own practice. Gaining exposure by attending Alcoholics Anonymous meetings can allow students to see the non-medical implications of this disease. Furthermore, creating standards regarding addiction medicine curricula can help create congruency across the undergraduate medical education system. Also, remembering that education is not solely about the student but the teacher as well requires the development of programs to teach faculty members about addiction medicine in order to help them revise their negatives attitudes.
Undoubtedly, overcoming the stigma associated with addictions is an uphill battle. However, change must begin immediately to ensure that future generations will receive the full benefits of our Canadian healthcare system. A stronger education system will lead to a culture shift, allowing addiction patients to receive the best possible care, so they do not suffer alone.