Ask Dr. Bill

Dear Dr. Bill,
I would like to respond to AGS directly (Ref:'Ask Dr. Bill' 7/18/01... AGS wrote, "Frankly, I tend to agree with MD-Teaneck who hates to treat addicts..that they are 'tough to deal with in the first place and no treatment is really effective.' I'm an internist who won't deal at all with addicts. I have plenty of other really sick patients to care for..........")

You say you hate to treat addicts, finding them "tough to deal with" and treatment not really effective. I guess if I were a doctor with your philosophy, I might similarly deny treatment to the heart patient who refuses to improve his/her diet and exercise routine, or to the patient who suffers from high blood pressure or lung cancer yet refuses to quit smoking. They are, after all, addicts too, and they are refusing to do the simple things that might drastically improve their health.

Many of our illnesses today could be construed as self-inflicted. Optimally, we all ought to have the self-control to eat properly, exercise regularly and lead healthier lives. Yet we don't, and we are entitled to treatment nonetheless. It seems to me that a doctor can treat illnesses and can attempt to educate, but it is dangerous for him/her to judge.

RWH-Teaneck

Dear RWH,
I intended to lay off this subject for a while but your letter again brought to mind the incongruity of our nation spending billions on a so-called "drug war" against suppliers while doing little to reduce demand, most of which, as the tobacco industry learned long ago, is rooted in early experimentation with drugs and alcohol by the very young. I have yet to meet anyone, let alone a teenager, who wanted to become addicted, but nearly 10% of these early "recreational" users do. Who should be at the fore-front in addressing the issue of prevention and treatment. I think it should be our nation's physicians but,they simply are not. Medical education on addictions has improved over the past 25 years, but it's still rare for medical students to get comprehensive training on identification and management of addicted patients.

The National Institutes on Drug Abuse(NIDA) and on Alcohol Abuse and Alcoholism (NIAAA) have provided funding for medical school curriculum development and faculty education, including guidelines for teaching about addiction in the fields of internal medicine, pediatrics, psychiatry, family medicine, emergency medicine, and obstetrics/gynecology and a significant expansion of elective courses on addictions offered at major medical schools, but few require substance abuse in their core curricula.

A recent Journal of Studies on Alcohol survey of medical schools reports that, while 95% of psychiatry programs required classroom training on addictive disorders, only 75% for family physicians did so. Even fewer required that residents complete a rotation at an addiction treatment facility.

In spite of the many addiction problems seen in emergency departments and the fact that fetal alcohol syndrome is the leading cause of preventable birth defects,the survey found that emergency medicine and OBGyn gave especially short shrift to addiction training. Only 55% of emergency medicine curricula included any course hours for addictive disorders; for internal medicine, 51%; for osteopathy, 41%; for OB/Gyn, 39%; and for pediatrics, ONLY 32%! These curricula were no guarantee of an in-depth learning experience. Programs for emergency physicians and OB/Gyns included an average of only 3 hours of addiction training, and even psychiatry programs required only 8 hours of training on addictions. The reason so many doctors don't want to treat addicts, is that most don't know how!