A "Middle Way": Introducing a Flexible Year-Long Program to Prepare for Certification in Addiction Medicine.

Abstract

Substance use is endemic in the USA. In 2012, an estimated 22 million Americans, or 8.5 % of the population, met criteria for a substance use disorder in the past year [1]. In 2011, there were 2.5 million emergency department visits that involved drug misuse or abuse, a 52 % increase since 2004. Half of these visits involved the nonmedical use of pharmaceuticals, which is an increase of 132 % since 2004 [2]. Yet despite the tremendous need for treatment, only 11 % of addicted individuals received specialized substance abuse treatment in 2012 [1]. So, how can this enormous treatment deficit be addressed? Given the high prevalence of substance use disorders in a variety of clinical settings (ranging from 8 to 29% in inpatient settings and up to 20 % in primary care) [3, 4], it would make sense to identify individuals with substance use disorders in these settings and then connect them to treatment. Screening and brief intervention have been shown to be effective in primary care and an increasing number of settings, and models of integration into routine practice have been described [5]. Successful referral to substance abuse treatment from a primary care setting has even been shown to improve depression [6]. However, many surveys have found that physicians do not feel prepared to diagnose or treat addiction, and residents do not feel that they have received sufficient training in addictive disorders during residency [7]. In addition to proposals for curriculum design in residencies and medical schools, online-based programs have been implemented to teach skills to physicians, residents, and medical students, with varied success [8]. Psychiatry residents can subspecialize in addiction psychiatry by training in an Accreditation Council on Graduate Medical Education (ACGME)-certified addiction psychiatry fellowship program. In addition, physicians from psychiatry and other specialties can become certified by the American Board of Addiction Medicine (ABAM). There are two pathways: (1) a 1-year fellowship training similar to addiction psychiatry programs but administered by the American Board of Addiction Medicine Foundation or (2) to qualify to take the ABAM exam after completing 50 h of addiction-related continuing medical education (CME) courses and practicing in the field of addiction medicine for 1 year. The first pathway requires an additional year of training, which can be difficult for many physicians with large amounts of medical education debt. The second pathway does not provide much structure, making it difficult to physicians to stay motivated. To encourage physicians to complete the second pathway, we developed the Rutgers New Jersey Medical School Executive Fellowship in Addiction Medicine (Exec-FAM). In addition to providing structure for ABAM exam requirements, we hope this fellowship will increase a practitioner’s confidence and accuracy in assessing and diagnosing addictive disorders, and raise her or his comfort level in providing evidence-based treatment for addicted patients.