Music Therapy, Spiritual Health Needs, and Substance Use Disorders

Social connectedness and related relational constructs can facilitate recovery in adults with substance use disorder (SUD). To date, there is a lack of research differentiating music therapy interventions as measured by the group relationship among peers within an inpatient detoxification setting for adults with SUD. The purpose of this study was to compare three commonly used group music therapy interventions in adults with SUD by measuring the group relationship Participants (N = 103) were adults with SUD hospitalized on an inpatient detoxification unit. The researcher cluster-randomized participants to one of three single-session group music therapy conditions: lyric analysis (LA), recreational music therapy (RMT), or songwriting (SW). Participants completed pre- and posttest measures of the group relationship. All conditions had favorable mean group relationship changes from pre- to posttest. There were significant between-group differences in the positive bonding relationship and positive working relationship subscales between the SW and RMT conditions. There was a significant between-group difference in the negative relationship scale between the RMT and both the LA and SW conditions. Despite the temporal limitations of single-session therapy common on detoxification units, this study has clinical implications because of the relevance of social connectedness and group relationships among adults with SUD. As the SW condition outperformed the RMT condition in all three group relationship subscales and has support regarding other SUD-related constructs, SW may constitute an ideal intervention in adult detoxification settings. Implications, limitations, and suggestions for future research are provided.

Substance use disorder (SUD) is the continued use of one or more psychoactive substances, including alcohol, despite negative effects on health, functioning, and social relations. Problematic drug use has increased by 10% globally since 2013, and harmful use of alcohol is associated with 5.3% of all deaths. Direct effects of music therapy (MT) on problematic substance use are not known, but it may be helpful in alleviating associated psychological symptoms and decreasing substance craving. To compare the effect of music therapy (MT) in addition to standard care versus standard care alone, or to standard care plus an active control intervention, on psychological symptoms, substance craving, motivation for treatment, and motivation to stay clean/sober. We searched the following databases (from inception to 1 February 2021): the Cochrane Drugs and Alcohol Specialised Register; CENTRAL; MEDLINE (PubMed); eight other databases, and two trials registries. We handsearched reference lists of all retrieved studies and relevant systematic reviews. We included randomised controlled trials comparing MT plus standard care to standard care alone, or MT plus standard care to active intervention plus standard care for people with SUD. We used standard Cochrane methodology. We included 21 trials involving 1984 people. We found moderate-certainty evidence of a medium effect favouring MT plus standard care over standard care alone for substance craving (standardised mean difference (SMD) -0.66, 95% confidence interval (CI) -1.23 to -0.10; 3 studies, 254 participants), with significant subgroup differences indicating greater reduction in craving for MT intervention lasting one to three months; and small-to-medium effect favouring MT for motivation for treatment/change (SMD 0.41, 95% CI 0.21 to 0.61; 5 studies, 408 participants). We found no clear evidence of a beneficial effect on depression (SMD -0.33, 95% CI -0.72 to 0.07; 3 studies, 100 participants), or motivation to stay sober/clean (SMD 0.22, 95% CI -0.02 to 0.47; 3 studies, 269 participants), though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result. There was no evidence of beneficial effect on anxiety (mean difference (MD) -0.17, 95% CI -4.39 to 4.05; 1 study, 60 participants), though we are uncertain about the result. There was no meaningful effect for retention in treatment for participants receiving MT plus standard care as compared to standard care alone (risk ratio (RR) 0.99, 95% 0.93 to 1.05; 6 studies, 199 participants). There was a moderate effect on motivation for treatment/change when comparing MT plus standard care to another active intervention plus standard care (SMD 0.46, 95% CI -0.00 to 0.93; 5 studies, 411 participants), and certainty in the result was moderate. We found no clear evidence of an effect of MT on motivation to stay sober/clean when compared to active intervention, though effect sizes ranged from large favourable effect to no effect, and we are uncertain about the result (MD 0.34, 95% CI -0.11 to 0.78; 3 studies, 258 participants). There was no clear evidence of effect on substance craving (SMD -0.04, 95% CI -0.56 to 0.48; 3 studies, 232 participants), depression (MD -1.49, 95% CI -4.98 to 2.00; 1 study, 110 participants), or substance use (RR 1.05, 95% CI 0.85 to 1.29; 1 study, 140 participants) at one-month follow-up when comparing MT plus standard care to active intervention plus standard care. There were no data on adverse effects. Unclear risk of selection bias applied to most studies due to incomplete description of processes of randomisation and allocation concealment. All studies were at unclear risk of detection bias due to lack of blinding of outcome assessors for subjective outcomes (mostly self-report). We judged that bias arising from such lack of blinding would not differ between groups. Similarly, it is not possible to blind participants and providers to MT. We consider knowledge of receiving this type of therapy as part of the therapeutic effect itself, and thus all studies were at low risk of performance bias for subjective outcomes. We downgraded all outcomes one level for imprecision due to optimal information size not being met, and two levels for outcomes with very low sample size. AUTHORS' CONCLUSIONS: Results from this review suggest that MT as 'add on' treatment to standard care can lead to moderate reductions in substance craving and can increase motivation for treatment/change for people with SUDs receiving treatment in detoxification and short-term rehabilitation settings. Greater reduction in craving is associated with MT lasting longer than a single session. We have moderate-to-low confidence in our findings as the included studies were downgraded in certainty due to imprecision, and most included studies were conducted by the same researcher in the same detoxification unit, which considerably impacts the transferability of findings.

People with substance use disorder may be especially susceptible to COVID-19, and compromised lung function from COVID-19 could also put at risk those who have opioid use disorder and methamphetamine use disorder. This commentary describes the risks of the collision of the COVID-19 and addiction epidemics.

ABSTRACTBackground: Lyric analysis is a commonly utilized music therapy intervention for clients in substance abuse rehabilitation wherein participants interpret song lyrics related to their clinical objectives. For these patients, working alliance and trust in the therapist represent consequential factors that may influence outcomes. However, there is a lack of randomized controlled music therapy studies investigating working alliance and trust in the therapist within lyric analysis interventions for patients with addictions. Objective: The purpose of this study was to quantitatively differentiate live versus recorded and educational versus recreational music therapy interventions via measures of working alliance and trust with patients on a detoxification unit. Method: Participants (N = 130) were cluster randomized in a single-session posttest-only design to one of four conditions: Live educational music therapy, recorded educational music therapy, education without music, or recreational music therapy. Dependent measures included working alliance and trust in the therapist. Educational music therapy interventions were scripted lyric analyses. Results: There was no statistically significant between-group difference in any of the measures. Although not significant, a greater number of patients and research participants attended live educational music therapy sessions. Conclusions: Between-group descriptive data were consistently similar but attendance trends may have implications for engaging patients and billing. Implications for clinical practice, limitations of the study, and suggestions for future research are provided.

While there is broad recognition of the high societal costs of substance use disorders (SUD), treatment rates are low. We examined whether, in the United States, participants with substance or alcohol use disorder would report a greater willingness to enter SUD treatment located in a primary care setting (primary care) or more commonly found specialty care setting in the United States (usual care). Randomized survey-embedded experiment. US web-based research panel in which participants were randomized to read one-paragraph vignettes describing treatment in usual care (specialty drug or alcohol treatment center), primary care or collaborative care within a primary care setting. A total of 42451 panelists aged 18+ were screened for substance or alcohol use disorder using validated diagnostic criteria. Participants included 344 with a substance use disorder and 634 with an alcohol use disorder not in treatment with no prior treatment history. Willingness to enter treatment across vignettes by condition. Among participants with a substance use disorder, 24.6% of those randomized to usual care reported being willing to enter drug treatment compared with 37.2% for primary care [12.6 percentage point difference; 95% confidence interval (CI)=0.8, 24.4) and 34.0% for collaborative care (9.4 percentage point difference; 95% CI=-2.0, 20.8). Among participants with an alcohol use disorder, 17.6% of those randomized to usual care reported being willing to enter alcohol treatment compared with 20.3% for primary care (2.6 percentage point difference; 95% CI=-4.9, 10.1) and 20.8% for collaborative care (3.1 percentage point difference; 95% CI=-4.3, 10.6). The most common reason for not being willing to enter drug (63%) and alcohol (78%) treatment was the belief that treatment was not needed. In the United States, people diagnosed with substance or alcohol use disorders appear to be more willing to enter treatment in a primary care setting than in a specialty drug treatment center. Expanding availability of primary care-based substance use disorder treatment could increase treatment rates in the United States.

Creativity and partnership

Goodman, K. D. (201 1 ). therapy and training: From theory to practice. Springfield, IL: Charles C. Thomas. 324 pages. ISBN 978-0-398-08609-1. $69.95Goodman's text represents an ambitious undertaking and will serve as a timely, valuable resource for music therapy educators. With recent advances in science, research, and data collection techniques that have transformed clinical practice, the time is right to examine educational practices in music therapy, thus ensuring the best possible preparation of future generations of clinicians. Goodman's approach consists of examining what students learn in the classroom (i.e., theory, skills, etc.) and considering ways to help students transfer that information to the clinical setting. Overall, she provides a broad overview of music therapy and training, with an impressive amount of detail in certain areas.In the first chapter, Music Therapy Education and Training in the United States, Goodman offers a comprehensive historical review of and in music therapy, including university programs, curricula, and professional organizations as well as guidelines for university program approval and a detailed discussion of levels of professional practice. This information will serve as a helpful guide for the newly-hired assistant professor or a rich resource for anyone wishing to pursue research on music therapy education. The details included here would also play a vital role in the establishment of a new music therapy program at a university or even as part of accreditation reviews (i.e., the Joint Commission on Accreditation of Healthcare Organizations) when questions arise as to the of clinicians. The content reflects a depth of knowledge that can only be gleaned from years of teaching experience and first-hand knowledge of music therapy governing bodies (i.e., American Therapy Association [AMTA], National Association for Schools of [NASM]), as well as the peculiarities of academia.The chapter provides a clear presentation of factual information with little analysis or interpretation. Questions that appear to remain unanswered in this chapter include: which universities offer both undergraduate and graduate music therapy education? What are the philosophical positions of these programs? Additionally, the chapter does not explore the status of the educational competencies for the doctoral degree and gives no information on the Registered Therapist credential.Chapter 2, Competency-Based Education and Training, details the development of professional music therapy competencies and offers considerations for how to address the competencies in education. Goodman clarifies the difference between education (i.e., the initial introduction of skills and knowledge in the classroom) and training (i.e., application of skills and knowledge in the clinical realm) and places a strong emphasis on the value of the competencies and their relevance to clinical practice, specifically for music foundations, clinical foundations, and music therapy. Furthermore, Goodman draws in and reflects upon research that has been done on the competencies; an effort that very much strengthens and deepens the material. Once again, this chapter would be of significant benefit to any educator looking to establish a music therapy program or revise a curriculum.Chapter 3, Preprofessional Clinical Training, presents an overview of practicum and internship, with discussion of appropriate degrees of structure, support, and supervision in both areas. Goodman explores additional competencies such as client assessment, treatment planning, therapy implementation, therapy evaluation, documentation, termination/ discharge planning, professional ethics, interdisciplinary collaboration, supervision, and administration. She integrates findings of previous research on the identified competencies when this information is available. …

ABSTRACT: Historical research contributes a perspective on the evolution of the music therapy profession and creates an opportunity for reflection. The development of music therapy practice and formal education in Iowa have a rich and interesting history dating before the formation of the National Association for Music Therapy (NAMT) in 1950. As part of the Iowa Lecture Series at the 2006 AMTA Mid-western Regional Conference, this paper reflects on the origins and development of music therapy practice and education in the state of Iowa. Historical research contributes a perspective on the evolution of the profession and creates reflection. Reflection provides an understanding of past decisions, directions, trends, and theories. Reflection also informs the future (K. Gfeller, personal communication, May 9, 2006). Historical research puts together the stories of individuals, places, cultures, and time. These stories on their own may only be interesting to those involved, but by placing the smaller stories into the context of the profession, a foundation of understanding is built. With a strong foundation, current and future generations of music therapists have a connection with their past that engages them in meaning for the future. Presented as part of the Iowa Lecture Series at the 2006 AMTA Midwestern Regional Conference, this paper reflects on the origins and development of music therapy practice and education in the state of Iowa and thereby contributes to the past, present, and future narrative of the music therapy profession. The development of music therapy practice and formal education in Iowa have a rich and interesting history dating before the formation of the National Association for Music Therapy (NAMT) in 1950. The first substantial accounts of music therapy clinical work occurred in 1949 at the Cherokee State Hospital, a state facility that provided treatment for individuals with mental illness (Gingrich, 1949). Later, the growth of clinical music therapy programs at the Knoxville Iowa Veterans Hospital and at the University of Iowa hospital provided substantial evidence that music therapy practice existed in some of the most prominent health care facilities in the state. The first attempt to educate musicians to work as therapists began in 1949 at the Cherokee State Hospital. This short-lived program offered musically gifted employees of the Iowa state hospital system a chance to learn music therapy techniques to use with clients who had mental illness (Gingrich, 1949). In 1976, The University of Iowa created a music therapy training program whose evolution provides a historical reflection of music therapy education in the United States. The Early Years In the late 1940s a typical psychiatric facility would have been overcrowded, housing in excess of 1000 clients, and would have provided limited treatment to their patients. The four largest mental hospitals in Iowa at this time were no exception; they were overcrowded and only offered treatment to select clients. Located in Cherokee, Mount Pleasant, Clarinda, and Independence, these facilities were constructed using the Kirkbride model, a style of construction intended specifically for psychiatric facilities (http://www.kirkbridebuildings.com/about/index.html). Named after Thomas Storey Kirkbride, a 19th century mental health reformer, these structures were massive multiple story buildings designed to house hundreds (and later thousands) of patients in an efficient manner, by segregating patients according to gender, race, diagnosis, and severity of disorder. Originally, treatment was the goal for all clients, but as the 20th century drew near and funding became scarce, these enormous hospitals largely provided custodial care. Even by the mid-twentieth-century, therapy was in most instances limited to patients with the best prognosis for recovery. Music Therapy Training at Mount Pleasant State Hospital The September 1949 issue of the Hospital Music Newsletter contained a brief description of a unique music therapy aide training program offered at Mount Pleasant State Hospital (Gingrich, 1949). …

Achieving competence has been an ongoing focus of research in music therapy as it relates to supervision in music therapy education and training (Bruscia, 1986; Bruscia, et al., 1981; Crowe & Rio, 2004; Dileo, 2001; Farnan, 2001; Forinash, 2001; Croene, 2004; Jackson, 2008; Knight, 2008; Madsen & Kaiser, 1999; McClain, 2001; Murphy & Wheeler, 2005; Tanguay, 2008; Wheeler, 2002). Forinash (2001) edited the first 'Music Therapy Supervision' book to help clinicians and scholars gain knowledge in various aspects of supervision in relation to meeting the appropriate competence requirements in music therapy practice. McClain (2001) noted that competency is viewed as a continuum of development, while Farnan (2001) suggested a timeline for the attainment of competencies. In 2007, the American Music Therapy Association appointed a task force to develop competencies for the advanced level of music therapy practice, which resulted in four domains: (a) professional growth, (b) musical development, (c) personal growth and development, and (d) integrative clinical experience (AMTA, 2007).Developing competencies at the pre-professional level, which is defined in this study as the period prior to the completion of internship, differs from that at the professional level. The focus of competence development at this preprofessional level includes developing academic and clinical competencies while identifying one's personal strengths and limitations early in training (Alley, 1978; Braswell, et al., 1980; Brookins, 1984; Decuir & Jacobs, 1990; Forinash, 2001; Furman, et al., 1992; Greenfield, 1978; Taylor, 1987). Research has recognized the importance of understanding various aspects of the student's clinical training, including technical, behavioral, ethical, multicultural, and emotional areas (Alley, 1980; Darrow, et al., 2001; Dileo, 2001; Estrella, 2001; Grant & McCarty, 1990; Madsen & Kaiser, 1999; Maranto, 1987). For example, Grant and McCarty (1990) analyzed personal and professional changes in the emotions of music therapy interns, while Madsen and Kaiser (1999) surveyed music therapy/music education majors regarding their pre-internship fears and found that students felt the most fear in the areas of general preparation/being prepared, followed by failure/not cut out for therapy, and supervisor/placement. Knight (2008) conducted a comparative analysis of questionnaires between music therapy internship supervisors and pre-internship students, in which music therapy interns reported less need for assistance compared to supervisors in the areas of Communicating with facility staff and Maintaining client confidence. Findings from these studies imply that students need specific guidance in their professional and personal development. Due to the unique and wide range of studies that music therapy education involves, it is imperative for educators and supervisors to understand the personal and professional development of student music therapists to help them meet the required competencies in both aspects of the profession.While traditional music therapy research has focused on different areas of competence, there is growing recognition of the need for more research in relation to student development (Luce, 2008; Milgram-Luterman, 1997) and students' perspectives of competence development (Wheeler, 2002) to understand students' process of their development from both students' and supervisors' perspectives and provide more effective supervision. Milgram-Luterman (1997) presented a developmental theory of music therapy undergraduate education as a reflective practice and suggested that there are five developmental phases that undergraduate music therapy students go through: novice, immersion through observation, experience, reflection, and integration phase. The five developmental phases share common characteristics of counselors as suggested by Hogan (1964) and Stoltenberg (1981). Stoltenberg presented a counselor complexity model in which the counselor characteristics were categorized according to four levels of suggested development: Dependent level, Dependency-autonomy conflict, conditional dependency, and master counselor. …

The existing literature indicates that motivation is an important predictor of treatment outcome for people with substance use disorders (SUD). Although researchers have found that music therapy can positively impact motivation for people with SUD, the music therapy and SUD literature base lack a theoretical understanding of motivation. Vroom’s expectancy theory of motivation (ETM) is an established theoretical framework positing that motivation depends on three relationships: expectancy, instrumentality, and valence. These relationships consist of four variables: effort, performance, reward, and preference. Based on these four variables, motivation depends on the expectation that an increase in effort will lead to improved performance, thus leading to a reward aligned with an individual’s preferences. The purpose of this paper is to apply Vroom’s ETM to music therapy and SUD clinical practice and research. We reviewed the existing literature addressing Vroom’s ETM within SUD treatment and created a model to depict how to apply Vroom’s ETM to music therapy clinical practice for people with SUD. Application of Vroom’s ETM may help music therapists understand and augment motivation for people with SUD, potentially leading to relapse prevention and recovery. Implications for clinical practice, limitations, and suggestions for future research are provided.

<h3>Context:</h3> Multimodal approaches are essential to improve substance use disorder (SUD) management in the primary care setting. Music therapy (MT) is an effective treatment for SUD that is primarily available in inpatient treatment centers. There are few studies on MT in the outpatient primary care setting. <h3>Objective:</h3> To evaluate the feasibility and acceptability of remote group MT to treat SUD in a Federally Qualified Health Center (FQHC). <h3>Secondary aim:</h3> change in craving and frequency of use of substances, depression and anxiety. <h3>Study Design and Analysis:</h3> Single group intervention with pre-post evaluation using mixed methods. Frequencies graphed with SAS software, three researchers independently analyzed the qualitative data using grounded theory methodology. <h3>Setting:</h3> FQHC network. Population studied: Adults seen at our FQHCs with moderate to severe SUD. <h3>Intervention:</h3> Eight weekly, remote group MT sessions conducted by a licensed music therapist using a medical musical psychotherapy approach. <h3>Outcome Measures:</h3> Feasibility was measured by the time to implement the program, rate of enrollment, session attendance, and reasons for non-attendance/dropout. PHQ9, GAD7, substance use and craving were measured before and after the intervention. Individual qualitative interviews eliciting participant perceptions were conducted. <h3>Results:</h3> It took 3.5 months to onboard the music therapist and 3 months to recruit participants. Of the six enrolled, three participated in five or more sessions, and every session was attended by one to five individuals. Anxiety and depression scores trended down, as did the number of days of substance use, although there was no change in craving. Participants reported that group MT was “soothing” and “calming,” gave them tools to treat cravings and stress, and created a sense of community. They reported they were distracted from substance use during the sessions and afterwards, improving their cravings at that moment. They all stated they would seek out MT again. <h3>Conclusions:</h3> Our results suggest that remote group MT is feasible and acceptable to our FQHC patients with SUD. We saw an improvement in participants’ mood and substance use, and in their ability to manage stress. We wish to build on the results of this pilot study to enhance our understanding of the effects of MT in the outpatient setting, and broaden our patients’ access to MT for SUD in our FQHC.

The epidemic within the pandemic: Behavioral health and substance use in the face of COVID-19

Music therapy (MT) and music-based interventions (MBIs) are increasingly used for the treatment of substance use disorders (SUD). Previous reviews on the efficacy of MT emphasized the dearth of research evidence for this topic, although various positive effects were identified. Therefore, we conducted a systematic search on published articles examining effects of music, MT and MBIs and found 34 quantitative and six qualitative studies. There was a clear increase in the number of randomized controlled trials (RCTs) during the past few years. We had planned for a meta-analysis, but due to the diversity of the quantitative studies, effect sizes were not computed. Beneficial effects of MT/ MBI on emotional and motivational outcomes, participation, locus of control, and perceived helpfulness were reported, but results were inconsistent across studies. Furthermore, many RCTs focused on effects of single sessions. No published longitudinal trials could be found. The analysis of the qualitative studies revealed four themes: emotional expression, group interaction, development of skills, and improvement of quality of life. Considering these issues for quantitative research, there is a need to examine social and health variables in future studies. In conclusion, due to the heterogeneity of the studies, the efficacy of MT/ MBI in SUD treatment still remains unclear.

Background Craving and withdrawal can contribute to the development and maintenance of substance use disorder (SUD), relapse, and overdose. Although music therapy can positively impact craving and withdrawal in adults with SUD on a detoxification unit, there is a lack of randomized research comparing different music therapy interventions as well as studies measuring within-session changes in these critical constructs. Objective The purpose of this effectiveness study was to compare motivational-educational songwriting (MESW) and recreational music therapy (RMT) via measures of craving and withdrawal in adults with SUD on a detoxification unit using a two-group pre- and posttest design. Method Participants (N = 134) were cluster-randomized to a single group MESW or RMT condition. Established craving and withdrawal psychometric instruments were used as pre- and posttests to determine potential within- and between-group differences. Results There were significant within-group differences in craving subscales of urges and coping as well as withdrawal, all p < .001. Within-group effect sizes ranged from .244 to .456 with favorable changes from pre- to posttest. There was no between-group difference among the MESW and RMT conditions, all p > .05. Conclusions Although the specific music therapy intervention did not impact craving or withdrawal, a single MESW or RMT session can have an immediate and significant positive impact on craving and withdrawal in adults with SUD on a detoxification unit. As the MESW condition also addressed motivational and educational aspects of recovery, perhaps MESW interventions are ideal in detoxification settings.

Back to table of contents Previous article Next article Education & TrainingFull AccessResource Document Calls for Improved Residency Training on SUDsMark MoranMark MoranSearch for more papers by this authorPublished Online:26 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.23AbstractTrainees need to see patients in a wide variety of settings, over time, with supervisory training that focuses on a patient’s addiction.When trainees are exposed to patients who recover from a substance use disorder, it is humanizing, destigmatizing, and unforgettable, said Shelly F. Greenfield, M.D., M.P.H., a member of APA’s Council on Addiction Psychiatry, at the virtual meeting of the American Association of Directors of Psychiatric Residency Training (AADPRT).“When trainees have that opportunity to work with a patient with a substance use disorder over time and see the patient get better in a real-world setting, it is incredibly gratifying,” says Shelly F. Greenfield, M.D., M.P.H.Residents and fellows need more of those experiences. Greenfield cited data from surveys of program directors and from an October 2020 APA Resource Document on Education and Training for Substance Use Disorders (see section below) indicating that trainees generally do not receive sufficient training in the treatment of substance use disorders (SUDs), including faculty supervision focused specifically on treatment of SUD patients over time. Additionally, too few residents receive training in prescribing buprenorphine and other medications approved for treating SUDs.“When trainees graduate as early career psychiatrists—no matter where they practice—they will see a very high proportion of patients with an SUD either alone or co-occurring with another psychiatric disorder,” Greenfield said. “Yet they have very little training in their four years overall. There have been some positive changes in addiction training in residency, but most studies and the APA resource document demonstrate that training for diagnosing and treating patients with substance use disorders is inadequate for graduating residents in 2021.”She noted that the requirement of the Accreditation Council for Graduate Medical Education for just four weeks of dedicated training in addiction has not been changed since 2001. A 2012 survey of 104 program directors supported by the APA Council on Addiction Psychiatry found that only 19% of program directors reported that trainees were paired with supervisors for addiction, and 68% said patients with SUDs were sent elsewhere for treatment. Most did not provide opportunity for long-term treatment for patients with SUDs.In comments to Psychiatric News after the meeting, Greenfield emphasized four areas in which training in addiction falls short:Lack of supervision that is specifically focused on treatment of patients with SUD. Greenfield cited a 2018 survey of 84 program directors by the Addiction Task Force of AADPRT that found that in many programs addiction training takes place only on general psychiatry units in which co-occurring disorders are evaluated and treated, but the extent to which addiction-trained supervisors are available or addiction is the focus of the training is unclear. In that survey, 41.6% of program directors indicated there was a limited number of faculty with expertise in co-occurring conditions to provide trainee supervision.Greenfield said one approach for programs that lack faculty expertise in addiction is collaboration with other programs, an opportunity made possible by the widespread use of video technology in medicine and psychiatry during the pandemic.Failure to see patients over time. Trainees need to see the progress and recovery of patients with SUD over time. “Longitudinal experience with patients having SUD usually happens in outpatient settings where the trainee can treat patients with SUD, receive supervision, and be able to follow them beyond just a four-week experience on an inpatient unit,” Greenfield said.Lack of training in using buprenorphine and other medications approved for addiction and SUD. “If residents have eight-hour waiver training in buprenorphine, they learn a lot about the medication and about opioid use disorder,” Greenfield said. “Data show that if you get just eight hours of training in residency, you are much more likely to prescribe this medication in your practice after residency. And yet we don’t have a requirement to complete that training.”The tendency of residents to see patients with SUD only in the emergency department. “If you mostly expose trainees to patients who present to the emergency department with SUD, this can contribute to stigma and therapeutic nihilism—the belief that this condition never gets better,” Greenfield told Psychiatric News. “Most patients with SUDs are never seen in emergency departments.”Psychiatrists should learn how to care for patients presenting in the emergency department with acute withdrawal or intoxication, she said, but most will graduate to practice in other settings—outpatient practices, community health settings, inpatient services, and residential and partial hospital settings. “Psychiatrists will routinely encounter patients in these settings who have substance use disorders including those with co-occurring psychiatric disorders, and it is imperative that they feel competent in providing that care.”In addition to the APA resource document, Greenfield cited a number of resources for trainees and training programs. They include the Opioid Response Network and the Providers Clinical Support System, of which APA is a partner. This program offers training and mentoring in evidence-based prevention and treatment of opioid use disorders and treatment of chronic pain.When trainees are expose to patients who recover from an SUD, it can be an experience the trainee will never forget.“We have an apprentice system of learning in graduate medical education—as a resident you have a supervisor, but you are treating the patient yourself,” she said. “What we know is that when trainees have that opportunity to work with a patient with a substance use disorder over time and see the patient get better in a real-world setting—it’s incredibly gratifying.” ■The APA Resource Document on Education and Training for Substance Use Disorders is posted here.APA Resource Document Offers Recommendations for Medical Students, Residents, and Lifelong Learners“Medical schools, physician training (residency) programs, and continuing education programs for physicians in practice provide limited training in the treatment of SUDs,” according to the APA Resource Document on Education and Training in Substance Use Disorders. “The scope of training on SUDs is disproportionate to the population health need to address these problems, and many with SUDs go undiagnosed and untreated.”The resource document is a product of APA’s Council on Addiction Psychiatry, the Council on Medical Education and Lifelong Learning, and the Council on Healthcare Systems and Financing. The document offers recommendations for medical schools, residencies, and continuing medical education for physicians in practice, as well as strategies for change.Recommendations for medical student rotations and residency programs include the following:Addiction and co-occurring disorders should be incorporated into all aspects of psychiatry residency training since patients with SUD are seen at all levels of care.Supervision and discussion of SUD cases should occur at inpatient and outpatient levels of care and should include an addiction psychiatrist.Programs should ensure they have access to resources to help them incorporate enhanced training in SUD with the goal of bolstering resident competencies in assessing and treating patients for these conditions.All psychiatry residents should complete the buprenorphine waiver training or its equivalent.Residents should be trained to treat patients with alcohol use disorder, stimulant use disorder, opioid use disorder, sedative/hypnotic use disorder, cannabis use disorder, tobacco use disorder, and other substances.Training experience should include various levels of patient acuity and corresponding care including outpatient and residential treatment.Residents should receive training in the use of FDA-approved medications for opioid, alcohol, and tobacco use disorder (and others as developed and approved by the FDA).Training on SUD treatments should include knowledge of the range of evidence-based behavioral therapies and competency to practice at least one. This might include, but is not limited to, the ability to integrate motivational interviewing concepts and techniques into patient assessments and sessions. ISSUES NewArchived