DOCUMENT RESUME ED 331 380 HE 024 447 TITLE ...DOCUMENT RESUME ED 331 380 HE 024 447 TITLE Resource...

DOCUMENT RESUME

ED 331 380 HE 024 447

TITLE Resource Manual for Alcohol and Other Drug AbuseEducation in Family Medicine Medical School andResidency Programs. Final Report.

INSTITUTION Society for Teachers of Family Medicine, Kansas City,MO.

SPONS AGENCY National Inst. on Alcohol Abuse and Alcoholism(DHHS), Rockville, Md.; Nationa) Inst. on Drug Abuse(DHHS/PHS), Rockville, Md.

PUB DATE 87

CONTRACT ADM-281-85-0012NOTE 46p.; For related documents, see HE 024 448-45.PUB TYPE Guides - Classroom Use - Teaching %ides (For

Teacher) (052)

EDRS PRICE MF01/PCO2 Plus Postage.DESCRIPTORS *Alcohol Abuse; *Curriculum Design; Curriculum

Evaluation; *Drug Abuse! *Family Practice (Medicine);Graduat't Medical Education; Higher EducatIon;*Medica.. Education; Medical Students

ABSTRACTThis manual of resources for alcohol and other drug

abuse education in medical schools and residency programs establishesbasic learning goals, and objectives for teaching drug abuse unitsthat reflect the philosophy of family medicine. The manual wasdeveloped using data and curriculum material collected through adetailed curriculum survey of the members of the Society of Teachersof Family Medicine. After a first chapter outlining the minimumknowledge and skill goals for all practicing physicians, a secondchapter delineates knos..ledge and skill objectives for alcohol ardother drug abuse teaching particular to family medicine. The th:rdchapter suggests a model for integrating the objectives of knowledge,skill and attitude into an over all curriculum. Chapter 4, LearningExperiences and Strategies, includes an analysis of the data gatheredby the curriculum survey. A fifth chapter on evaluation principlesand methods includes an example of an evaluation asqessment tool. Thelast chapter, Curriculum Examples, describes a few tual programs indepth and includes a contact person, telephone number and address foreach. An extensive final section, titled Learning Materials, containsa bibliography of approximately 125 items, a list of 32 audiovisualmaterials, and a list of 10 resource institutions providingeducational materials. (J13)

******************** ***** ******** ***** *********************************Reproductions supplied by EDRS are the best that can be made

from the origina-- document.****** ***** ********************************************** ***** *********

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Resource Manual forAlcohol and Other Drug Abuse Education in

Family Medicine Medical School andResidency Programs

Society of Teachers of Family Medicine

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health Service

Alcohol, Drug Abuse, and Mental Health Administration PhiD8

PROJECT COMMITTEE

Project Director

Peter G. Coggan, MDDepartment of family MedicineUniversity of California at IrvineOrange, CA

Assistant Project Director

Ardis K. Davis, MSWSociety of Teachers of Family MedicineSeattle, WA

Project Administrator

Roger A. Sherwood, CAESociety of Teachers of Family MedicineKansas City, MO

Advisory Committee Members

David Reed BeattyAmerican Medical Student Association RepresentativePhiladelphia, PA

Antonnette V. Graham, RN, MSWDepartment of Family MedicineFamily Practice Residency ProgramCase Western Reserve UniversityCleve laturi, OH

Rebecca Henry, PhDOffice of Medical Education Research and DevelopmentMichigan State UniversityEast Lansing, MI

C. Earl Hill, MDResidency Training ProgramDepartment of Family MedicineUniversity of MarylandBaltimore, MD

Al Mooney, MDWillingway HospitalStatesboro, GA

Resource Manual forAlcohol and Other Drug Abuse Education in

Family Medicine Medical School andResidency Programs

Society of Teachers of Family Medicine

Final ReportPrepared under contract no. ADM 281-85-0012

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESPublic Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Alcohol Abuse and Alcoholism5600 Fishers Lane

Rockville, Maryland 20857

1 his curriculum development project was supported by the NationalInstitute on Alcohol Abuse and Alcoholism (NIAAA) and the NationalInstitute on Drug Abuse (NIDA) under contract no. ADM 281-85-0012and carried out under the direction of Frances Cotter, M.P.H.,NIAAA, and Dorynne Czechowicz, M.D., NIDA. All materialappearing herein may be reproduced or copied without permissionfrom the author or the Institute. Citation of the source is appreciated.

The opinions expressed herein are the views of theauthors and do not necessarily reflect the officialpositions of the National Institute on Alcohol Abuseand Alcoholism and tha National Institute on Drug Abuseor any other part of the U.S. Department of Health andHuman Services

CONTENTS

page

Preface

Introduction 1

Minimum Knowledge and Skill Goalsfor Practicing Physicians 3

Family Medicine Knowledge and Skill Objectivesfor Alcohol and Other Drug Abuse Teaching 5

Learning Objectives by Educational Level 12

Learning Experiences and Strategies 16

Evaluation 18

Curriculum Examples 21

Learning Materials 27

iii

PREFACE

In 1985, the Society of Teachers of Family Medicine, in commonwith sister organizations representing primary care internal medi-cine, pediatrics, and psychiatry, was awarded a contract to determinethe extent and quality of teaching in alcohol and other drug abusewithin the specialty. Consensus statements on educational goalsreached at interdisciplinary meetings were refined and modified asthe project progressed.

This manual begins with a list of broad goals, endorsed by thefour specialties contributing to this project, that summarizes theminimum knowledge and skills desirable for practicing primary carephysicians. A list of educational objectives follows that was devel-oped by the Society of Teachers of Family Medicine Advisory Com-mittee and is recommended as a curriculum planning tool for depart-ments of family medicine.

Through a detailed survey of its membership, a substantial set ofdata and curriculum materials were collected. This manual includesrecommended learning experiences and strategies, strategies forevaluation, examples of curricula, and a discussion of common dif-ficulties, problems, and weaknesses with some recommendations fromthe Society of Teachers of Family Medicine Advisory Committee.The appendices contain information on educational material re-sources and bibliographies on educational strategies for alcohol andother drug abuse teaching for medical education.

Any manual of this nature has its limitations. Medical schoolsand residency programs differ greatly in their structure, philosophy,and the ease with which new curriculum units can be introduced orexisting units redesigned. Faculty and student attitudes toward thesubject of alcohol and other drug abuse, resistance to multidisci-plinary teaching, lack of curriculum time, or simply a lack of facultyexpertise may appear to block curriculum development in this area.The effort required to introduce this new material will be consider-able, but we hope that family medicine faculty will rise to thechallenge and will find this document helpful in integrating this topicinto their existing teaching and in working with colleagues in otherclinical departments to improve the medical school curriculum.

Aftl

INTRODUCTION

The Society of Teachers of Family Med-icine (STEM) Advisory Committee consid-ered numerous educational objectives in thefinal selection of appropriate educationalgoals and objectives in alcohol and otherdrug abuse for family medicine. This servesas the foundation on which other sections ofthis manual are built.

The task of establishing these learninggoals and objectives required our committeeto examine some overall, generic issues,which serve as the premises for our ra-tionale. We would like to begin this docu-ment with a statement of some of thesepremises.

Family Medicine Emphasis

An adequate understanding of alcoholand other drug abuse necessitates inputfrom virtually all specialties of mt 'icine inaddition to nonmedical specialties. There-fore, it is incumbent upon each specialty todelineate the unique scope of its own cur-riculum in alcohol and other drug abuse,which should offer a specialty-specificperspective while at the same time aug-menting the total medical school curri-culum. The common ground should be taughtin a complementary, reinforcing fashionthrough a collaborative interspecialty effort.

To complement and augment the work ofother specialties, this report focuses onlearning goals and objectives that reflectthe philosophy of family medicine. Theemphasis is on issues related to the familyimpact of alcohol and other drug abuse aswell as the continuum of care extendingbeyond the physician's office. Because ourfocus is on that portion of an alcohol andother drug abuse curriculum that fits bestwithin family medicine's overall contribu-tion to medical education, we expect thatany gaps in the curriculum, for example, inthe basic sciences, would be filled by other

1

medical specialties or nonmedical disci-plines. Therefore, we see the learning goalsand objectives for family medicine as in-tegrated into a total curriculum for medicaleducation. ,

It is important to point out, however,that it is family medicine's overall goal toensure that all practicing family physicianshave at their disposal a cadre of sLills pro-viding them with the ability to diagnosealcohol and other drug abusing patients intheir practices and to manage those patientsas they would anyone else, i.e., treat themin a professional manner to the best of theirability.

Attitudes

One of the most potent blocks to theintroduction of alcohol and other drug abusecurriculum is the attitude of faculty,students, and residents, whether born ofanxiety from lack of knowledge or a mor-alistic or legalistic view. We feel thatcertain attitudes are fundamental tosuccessful teaching in alcohol and otherdrug abuse and should be integratedthroughhout every phase of a curriculum,including faculty development.

It is the opinion of the STFM AdvisoryCommittee, strongly supported by the lit-erature, that successful training in alcoholand other drug abuse must be built on apositive attitude toward the treatment ofpatients with this group of illnesses. There-fore, as a prerequisite to curriculum plan-ning and development, the issue of attitudesmust be addressed and should be included inteaching at all phases, especially early on.The attitudes necessary for clinical effect-iveness in the recognition and treatment ofalcohol and other drug abuse imply the ac-ceptance of certain professional obligations:

to become informed about the illness and

recognize its effect on the individual, lay resources for management of theillness.family, and community;

to recognize the illness; and

to manage the illness or referappropriately.

In addition, family physicians must havean attitude of willingness to recognize theirown strengths and limitations in managingthe illness. Adoption of this attitude pre-supposes recognition of the following pro-fessional obligations:

to be informed about other professionaland lay resources available to managethe illness; and

to cooperate with other professional and

2

Lastly, the family physician must havean attitude of awareness of the medicalprofession as a group at risk for alcohol andother drug abuse. Adoption of this attitudeimplies recognition of the following pro-fessional obligations:

to participate willfully in personal riEkassessment for potential alcohol orabuse problem;

to recognize alcohol or other drug abusein a colleague; and

to take appropriate action when alcoholor other drug abuse is recognized in acolleague.

MINIMUM KNOWLEDGE AND SKILL GOALSFOR PRACTICING PHYSICIANS

The purpose of this statement is tobroadly describe the minimum knowledgeand skills in alcohol and other drug abuse forpracticing physicians including generalinternists, psychiatrists, family physicians,and pediatricians. This body of knowledge isbeing presented because the practicingphysician is at the forefront of preventionand management of this important problem.

Physicians should accept alcohol andother drug abuse as medical disorders. Theyshould be informed about alcohol and otherdrug abuse disorders; recognize the effectson the patient, the family, and the com-munity; and be able to diagnose and treatthese disorders. Physicians should recognizetheir personal strengths and limitations inmanaging patients with alcohol and otherdrug abuse.

General Concepts

The practicing physician should under-stand the following general concepts ofalcohol and other drug abuse:

Common definitions

Diagnostic criteria

Epidemiology and natural history

Risk factors, including familial andsocial cultural factors as well as cur-rent genetic and biologic theories

The relationship of this group of dis-orders to the functioning of the family

Prevention

Practicing physicians should understandtheir role in the prevention of alcohol andother drug abuse problems through:

3

Patient educationRisk identificationPrescribing practices

Pathophysiology

The practicing physician should under-stand the following:

The pharmacology and behavioral ef-fects of commonly abused substances

The physiology of intoxication, de-pendence, tolerance, and withdrawal

Pathological effects of acute zndchronic drug and alcohol abuse onorgan systems

Evaluation of the Patient

The practicing physician should be awareof specific presenting complaints suggestiveof alcohol and other drug abuse. In addition,physicians should be able to screen effec-tively for the early and late manifestationsof alcohol and other drug abuse includingbehavioral manifestations. Once abuse issuspected in an individual patient, physi-cians should be able to confirm the diagnosisby obtaining a detailed alcohol and drug usehistory, identifying physical findings sug-gestive of substance abuse, and interpretingthe results of selected laboratory tests.

The practicing physician should be awarethat alcohol and other drug abuse disordersmay present as other medical or psychiatricdisorders or may be complicated by thepresence of psychiatric or medicalcomorbidity.

The practicing physician should be awarethat denial in the patient, family, and phy-sician delays recognition and treatment.

1 0

Management

Practicing physicians should be able todirectly manage or refer patients fortreatment of acute intoxication, overdose,and withdrawal. They should be able tomotivate the patient for further treatmentand select an appropriate management planfrom available treatment options, bearing inmind the patient's needs and communityresources. They should be knowledgeable ofthe various treatment alternatives and theexpected outcomes of treatment.

Physicians should recognize their ownresponsibility in the long-term managementand followup of patients with alcohol andother drug abuse.

The practicing physician should be fa-miliar with the philosophy and availabilityof self-help groups for the patient and fam-ily, such as Alcoholics Anonymous andAl-Anon.

Legal Aspects

The practicing physician should know thelegal aspects of informed consent, releaseof information, and obtaining blood, urine,

4

and breath tests in screening for alcohol andother drug use.

Health Professional Impairment

The practicing physician should be awareof health professionals as a group at risk foralcohol and drug problems and be aware ofthe resources available for impairedcolleagues.

Medical Students

Medical students should be aware of theprevalence of patients with alcohol andother drug abuse in all medical settings.Students should have the same fund ofknowledge in this area as practicing physi-cians. Students should also be capable ofscreening for alcohol and other drug abusein the course of performing a history andphysical examination and should be able totake a detailed alcohol or drug use historywhen appropriate. Students should be awareof different treatment modalities and ex-pected outcomes, but are not expected tohave the skills necessary to treat patientsfor their primary problems.

FAMILY MEDICINE KNOWLEDGE AND SKILL OBJECTIVESFOR ALCOHOL AND OTHER DRUG ABUSE TEACHING

Family medicine has a unique strategicadvantage in detection and management ofthe alcohol or other drug abusing patient. Ifalert and knowledgeable, family physiciansunderstand zhe newer genetic data aboutalcoholics and can use family-centeredtechniques such as genograms to furtherassess an at-risk population. In followingchildren, they can use early-interventionstrategies and patient education with apopulation where prevention is of utmostimportance. Additionally, although abusingpatients may be able to avoid visiting thefamily physician, the members of theirfamilies are likely to present with a myriadof complaints and signs of dysfunction. Thisallows the family physician to intervenewhether or not the index patient is helped.

Adequate preparation for the practice ofthe specialty of family medicine requiresthat the following objectives be met. All ofthem can be prefaced with the clause: "Theresident family physician, by completion oftraining, will know/be able to ." Wherepossible, they have been worded in such amanner as to lend themselves to testing.

General Knowledge

Knowledge Objectives

1. General statistics related to alcoholand other drug abuse in Americansociety, i.e., overall cost in dollars,human lives, family violence, physicaland mental abuse, child abuse, andprevalence of substance intake (bymajor types) in the general population

2. Natural history of alcoholism andother drug abuse, which can be con-ceptualized as a paradigm of achronic, progressive, relapsing familyillness

5

3. At least three common definitions andcriteria and three myths of alcoholismand other drug abuse and one defini-tion appropriate for family medicine

4. Differences in alcohol content, la-beling, advertising, and marketing fora minimum of three types of beverages

5. General facts about the history ofalcohol use and abuse and other druguse and abuse in a social context

Family Illness/Systems Issues


1. Family transmission patterns throughgenerations

2. Basic premises of family systemstheory

3. Differences between family dynamicsin healthy families and those with analcohol or other drug abusing member

4. Red flags for raising index of suspicionwithin a family

5. Progression and stages of family al-cohol and other drug abuse anddependence

6. Observable and documentable family-enabling types of behaviors

7. Treatment resources available forfamily members with and apart fromthe substance-abusing patient

8. Available resources in the communityspecializing in family support (e.g.,Al-Anon) and resources available tomake initial contacts

12

9. Frequency of increased occurrence inother members of a family with onealcohol or other drug-abusing member

10. At least two techniques ft.:- communi-cating with children

11. The power of family and social pres-sures to drink and the critical role ofthe family in relapse prevention

12. General family counseling principlesrelative to alcohol and other drugabuse and family therapy options

13. Characteristics of adult children ofalcoholics and the prevalence of re-lated problems

Skill Objectives

Motivate families for treatment andrecovery and initiate family counseling/therapy or referral for such families in atleast one situation even if the patient re-fuses treatment.

Epidemiology


1. Risk factors for alcohol and other drugabuse with specific attention tosubpopulations

2. Major genetic theories and evidence inrelation to alcoholism

Skill Objectives

Detect a minimum of 10 at-risk patientsby virtue of their sociocoltural backgroundinformation and implement a method forcontinued, periodic review of those patients'patterns of alcohol and/or other drug use.(This can then be documented as part ofrecertification.)

Prevention


1. Understanding the family physician's

6

unique advantage in prevention anddetection

2. At least two available patient educationtechniques

3. Two kinds of community public relationspreventive strategies

4. f Alcohol Syndrome criteria, statIs-tics, detection methods, resources avall-able, and implications for unborn andnewborn children and mothers

5. Understanding how advertising en-courages increased consumption and useby adolescents

Skill Objectives

1. Initiate a risk-reduction intervention(e.g., behavior modification, educationalinterventions) with et least five patientsin the family practice setting

2. Initiate counter-advertising strategieswithin the family practice ofrce

Pattophysiology


1 The meanings of intoxication, ttllerdnce,and dr.,,pendence as they apply to alcoholand other drug abuse

2. Absorption, metabolism, and distribu-tion of alcohol and other major drugs ofabuse

3 Major complications categorized by bodysystems

4. Alcohol or other drug abuse masquerad-ing as other medical symptoms

5. Complications borne out through un-expected data sources (e.g., radiologydata, emergency room data)

6. Recent biomedical developments inaddiction

Differential Diagnosis and Diagnosis


I. How to use and interpret the MichiganAlcoholism Screening Test (MAST),Short Michigan Alcoholism ScreeningTest (SMAST), and Cutting DownAnnoyance From Criticism guiltyFeelings Eye-openers (CAGE) screen-ing instruments

2. At least two alcohol detection anddrug monitoring techniques availablein the office setting

3. Indicators of dual diagnosis (psy,thi-atric and alcohol or other drug abuseproblem)

4. Cross-addiction potential: concomit-ant use of drugs masking or alteringsigns of abuse in a patient

Skill Objectives

Interpret CAGE and MAST data in re-lation to otner diagnostic factors from thehistory, physical exam, and laboratory in-vestigations in a minimum of two patientswho have aroused physician's suspicions.Document in patient record.

History Taking

Know lenge Objectives

1. What questions to ask in a routineexamination

2. What questions to ask if suspicion isaroused

3. Areas of a history likely to be high-yieldin terms of identifying an alcohol orother drug abuse problem

4. Clues to a problem found in the style ofa patient's or family member's responseto questioning

Skill Objectives

Follow up on all suspicions aroused in a

7

routine alcohol and other drug history withthorough and directed line of questioning.

Physical Examination


1. Common early, middle, and latemanifestations

2 The common lack of signs in the earlystages

3. Physical signs associated with abuse ofone drug masking abuse of another

Skill Objectives

Interpret physical exam findings inrelation to alcohol and other drug use andabuse in at least five patients who havearoused the physician's suspicions. Docu-ment relevant conclusions in patient record.

Laboratory Investigations


1. What supporting tests are available

2. Common early, middle, and latemanifestations

3. The common lack of physical signs inearly stages

4. Cross-addiction potential: concomitantuse of drugs masking or altering signs ofalcohol or other drug abuse

Skill Objectives

Interpret laboratory test findings inrelation to alcohol and/or other drug abusein a minimum of two patients who havearoused the physician's suspicions anddocument in the patient record.

Intervention


1. An actual "diagnosis" written in the

1 4

chart need not be made to warrant anintervention

2. Intervention is always important

3. At least two methods to attack thedenial and the different manifes-tations of denial

4. Ingredients of confrontation

S. Common reactions to confrontation

6. Intervention techniques available inthe community and office

7. At least two motivating and counsel-ing techniques

8. Awareness of "failure" versus"success" in the context of confrontingan alcohol or other drug abuser orfamily member

9. The continuum of confrontationinvolves a longitudinal process usingvarious strategies and opportunities

Skill Objectives

1. Participate in a minimum of oneconference to motivate a patient fortreatment and recovery

2. Participate in a negotiation sessionwith a patient and family fortreatment with attention to the"critical moment" of timing ininitiating this negotiation process

3. Initiate arrangements for or assist inconducting an intervention to directlyconfront the denying patient; docu-men4 in patient record

Acute Management


1. Indications for outpatient and in-patient detoxification

2. Complications of detoxification: es-sential elements and pitfalls

8

3. Natural course of withdrawal andstages

4. Differences in withdrawal patternseen in different drugs, e.g., sedativehypnotics, stimulants, alcohol

5. Sedative substitution in withdrawaland other techniques of withdrawal

6. Indications and techniques for non-medical detoxification

7. Resources available in the communityfor detoxification

8. Essential elements of making a con-tract with a patient

9. Characteristics of patient motivationas they impinge on success ofdetoxification

10. Incidental withdrawal signs and man-agement strategies

11. Monitoring and following detoxifica-ticn progress

Skill Objectives

1. Determine whirh patients to detoxifyin a group of five alcohol-abusingpatients

2. Determine where to detoxify thosepatients

3. Conduct detoxification of at least onepatient using a non-drug regimen andone patient with a drug regimen, withfull patient record documentation

4. Anticipate complications of detoxi-fication and refer patient if necessary

5. Make appropriate arrangements (referor followup) after detoxification for aminimum of two patients and document

Referral


1. Indications of when to refer and to

whom to refer

2. Steps necessary to follow up on apatient entering a formal treatmentprogram

1 Physician's responsibilities and levelof involvement in different types oftreatment programs

4. What other specialties can offer interms of referral, e.g., family thera-pist, nephrologist, gastroenterologist,alcohol/drug abuse counselor

5. Major patient selection characteristicsby programs

6. Program characteristics for patientselection

7. Financial requirements of patients fortreatment and common financial plansavailable

Skill Objectives

1. Evaluate at minimum two patients fora program/resource and the programs/resources for those patients

2. Participate in an aftercare planningconference with at least two patientsand their families; document in pa-tient record

Self-Help Groups


I. Principles and roles of AA, Al-Anon,Narcotics Anonymous (NA), and otherself-help groups in intervention andrecovery

2. General principles of AA

3. General progression of steps of AAand Al-Anon

4. Requirements for membership in AAand Al-Anon

9

5. General philosophy of AA, Al-Anon,NA, etc.

6. Availability of NA and othei self-helpwoups in the community

7. Availability of resources (c.g., AAmembers) in the community to assistpatients in making initial cont.nt withself-helo group

8. What educational and self-instruc-tional materials are available or howto access that information

Skill Objectives

1. Assist two patients in making initialcontact with AA or other self-helpgroup and document with attendanceslips

2. Attend at least three AA meetings andtwo Al-Anon meetings

Long-Term Management


I. At least three different treatmentphilosophies

2. Outpatient versus inpatient treatmentindications and differences betweenthe two kinds of treatment

3. Outcome data or results of at leastthree modalities with an assessment ofthat information for use in recom-mending programs

4. Managing relapse

5. Attention to prescription and over-the-counter drug use

6. Monitoring family adjustment andcoping

7. Encouraging continued involvement inAA and Al-Anon for family

8. Indications and contraindications foruse of disulfiram

CI

9. Health modification techniques

10. Smoking cessation and implications ofother addictive behaviors

11. Chronic pain management and iatro-genic and nonsanctioned drug use

12. Ways Employee Assistance Programscan be useful resources in long-termmanagement

Skill Objectives

I. Identify an alcohol abuser in thefamily practice setting and, afterassessing the situation, develop andcarry out a management plan withthat person and the family, with fulldocumentation in the patient record

2. Prevent, where possible,relapse

3. Conduct perioperativewith one patient

and manage

management

4. Treat intercurrent psychiatric andmedical illnesses or behavioral prob-lems within the context of alcoholismor other drug abuse history in onelongitudinal patient, with full patientrecord documentation

5. Prescribe and follow up the use ofdisulfiram in management

Use of Psychotropic Medications


I. Prevalence of hazardous drugs anddrugs/medicines containing alcohol

2. Indicators for when to use psycho-tropic medications in management

3. Contraindications for use of psycho-tropic medications in management

4. Addiction potential for patients beingmanaged for pain, anxiety, insomnia,and depression

10

Skill Objectives

1. Determine at least five situationswhere pharmacologic intervention maybe inappropriate for treatment ofintoxication or withdrawal

2. Prescribe all medications with fullknowledge of consequences for re-covering alcoholics or other drugabusing patient.

Therapeutic Relationship


1. One's own personal and professionallimitations in managing alcohol orother drug abuse

1 Alcohol and other drug abuse comprisea very common illness presenting infamily practice

3. The role alcohol and other drugs playin one's own life and in the lives offamilies in society in general

4. Characteristics of a physician's role inthe long-term management of alcoholand other drug abuse

Skill Objectives

I. Participate in a planning meeting withother health care professionals re-garding long-term goals for at leastone patient

2. Evaluate appropriate physician role inthe long-term management of at leastone patient and implement plans basedon that evaluation.

Leval Aspects


1. Legal issues involved in drug screening

7

2. Legal implications of a diagnosis in apatient's record and confidentialitylaws regarding alcohol and drug useand abuse

3. Use of prescriptions



1. Demographics of alcohol and drugabuse in physicians and other healthprofessional groups

2. High-risk specialties

3. Signs and symptoms to alert attentionto self or colleague

4. Special features of physician alcoholand other drug abuse versus otherprofessional groups

5. Contributory factors to physicianalcohol and other drug abuse

6. Outcome study results

7. Characteristics of resources availablewithin institution or community

8. State's Impaired Physician programs

Aid to Impaired Medical Students(AIMS) programs

10. Self-help groups for physicians withalcohol and drug problems, e.g.,International Doctors in AA

Skill Objectives

1. Initiate an appropriate interventionstep if an alcohol or other drug abuseproblem manifests in self or acolleague

2. Freely discuss drug and alcohol useand personal risk with colleagues

11 S

LEARNING OBJECTIVES BY EDUCATIONAL LEVEL

Model for Curriculum Integraticm

A model for integration of topics andknowledge, skill, and attitude objectivesinto an overall curriculum in family medi-cine across levels of education is shown infigure 1. The three dimensions can be seenas representing the following concepts:

Horizontal: Comprehensiveness of thecurriculum in terms of the number oftopics introduced at each of the foureducational levels. Of particular notehere is the pyramid structure, addingtopics with each level.

Vertical (across all four boxes): Thecontinuum of the curriculum over timeor over t le four levels of education.

Depth: I. The comprehensiveness (ordepth) of skill objectives. The Offer-ences in depth across levels reflects thedifferences in emphasis on skill develop-ment by level in the curriculum. Notethe relatively big jump in skill develop-ment between medical school and resi-dency and between CME and fellowshiplevels.

2. Attitudes. Attitudes as an integralpart of all curricula at all levels.

Topics

Twenty topics are listed below in orderof the priority for family medicine curric-ulum assigned them by the committee.

History TakingFamily Illness/Systems IssuesGeneral ConceptsDifferential Diagnosis and DiagnosisSelf-Help Groups (e.g., AA)Physician Impairment

12

PreventionAcute ManagementLong-Term ManagementPhysical ExaminationInterventionReferralTherapeutic RelationshipEpidemiologyMedical ComplicationsLaboratory InvestigationsPsychotropic MedicationsBasic SciencesLegal IssuesChronic Pain Management

Learning objectives over time reflect a"building block" structure, with all topicsincluded before the CME level as indicatedin the model. In general, as one might ex-pect, clinical emphasis and level of sophisti-cation increase over time.

It should be stressed that, although thetopics are given in order, the consensus ofthe committee is that all of these topics areimportant for a comprehensive curriculumin family medicine. The ordering assists inascertaining which we consider to be coretopics and, thus, important for early in-clusion in the overall curriculum (i.e.,medical student level).

Attitudes

Teaching directed at attitudes must bean integral part of any curriculum addres-sing alcohol and other drug abuse in familymedicine. The strong consensus of thecommittee is that attitude objectives mustbe included and integrated throughout allteaching A curriculum at all levels shouldstrive to ; chieve one overall set of attitudes.Thus, attitude objectives are visuallydepicted as a depth dimension across alllevels.

fi)

Model tor Integration of Substanos Abu,* CurriculumAcross Educational Lintels In Family tiodkine

Knowledge Broken Down by Topics

rnaght Os tessONss0 seed1C1g same/ fa* for simfaits rw prim Iffro ccriwy Croy specisly

13

Knowledge

Basically, one body of knowledge isnecessary to adequately diagnose andmanage alcohol and other drug abuse infamily medicine, but it cannot all be taughtat any one level. Therefore, for each levelof education (undergraduate, residency,CME/subspecialty, fellowship), the suggestedbody of knowledge is broken down by topicand ultimately builds on itself. The modelmight be represented by a pyramid-shapedcomprehensive knowledge base with in-creasing scope over the course of medicaleducation. This kind of framework impliesthat a learner at one level must haveacquired the body of knowledge of theprevious level in order to progress throughthe curriculum. Also inherent in thisapproach is the notion that the performanceof one skill (psychomotor task) at a par-ticular level requires varying bits ofknowledge from several topics that arecovered in the curriculum at that level, orthat were acquired at an earlier level.

Skills

Skills increase over time in a mannerconsistent with the abilities at each edu-cational level. Our basic structure assumesthat a resident will have acquired the coreknowledge of a graduating medical studentby the time of the first year of residency (orthe first year of the residency curriculumwould ensure that all residents reach thisgoal). This structure, however, does notimply that medical education can ade-quately address all the essential skills for allof the topics addressed in the 4-year medi-cal school curriculum. Core topics need tobe "revisited" in a more sophisticated fashionat residency/CME levels.

Skills for the adequate preparation forthe resident family physician (residentand/or CME level) are specified under theseven general goal headings. Less sophisti-cated skills for medical school education arenot included in that discussion.

Next, we demonstrate how skills for coretopics (i.e., medical school topics) might betaught to accommodate that level ofeducation.

14

Undergraduate Level Skills in Core Topics

By graduation, every edical studentshould be able to perform the followingtasks. They are worded so as to bemeasurable in behavioral terms.

Prevention

Give five family practice patients anoverview on alcohol and other drug use/abuse in our society.

Assess these same five patients' risk forbecoming an alcohol or other drug abuser.

Histoty Taking

Take an alcohol and other drug historyfrom every patient as part of initial workup.

Differential Dir.mosis and Diagnosis

Administer the CAGE and MAST to oneclassmate and have it administered to selfby classmate.

Use and explain the CAGE and MASTresults to a minimum of two patients seen inthe family practice setting.

Physical Examination

Conduct a routine physical exam on fivepatients in the family practice office withattention to physical signs (or the absencethereon that could suggest an alcohol orother drug abuse problem.

Self-Help Groups (AA and Others)

Evaluate AA as a resource by attendingat least one open meeting.

Review available patient educationmaterials put out by self-help groups in thecommunity.

Family Illness/Systems Issues

Interview at least two family memberswith attention to possible alcohol and/orother drug abuse situations through familyand social red flag data.


Recognize self and peers as belonging to

a profession at risk for alcohol and other mates of family's and self's pattern ofdrug abuse through discussion with class- alcohol and other drug use.

15

LEARNING EXPERIENCES AND STRATEGIES

Teaching Strategies

The curriculum survey conducted bySTFM gathered information on teachingstrategies used in family medicine alcoholand other drug abuse teaching units. Thesurvey looked at classroom teachingstrategies, opportunities for individuallearning, and clinical experiences at bothresidency and medical school levels. Withthe exception of research, which was givena very low priority at both educationallevels, most teaching involves a variety oftechniques, both didactic and experiential.The lecture still predominates as the mostcommon teaching strategy. Clinicalexperiences tend to be emphasized morefrequently in residency teaching, whereasstudents are exposed to more reading andfilms. The breakdown is shown in table 1.

Respondents to the survey were alsoasked to indicate who in their program wasresponsible for teaching the alcohol andother drug abuse units. In only 41 percent ofthe units was a family 'physician teachingthe material at all, and in 15 percent theonly teacher was a family physician. Many

other teachers were used, predominantlybehavioral scientists and alcohol and otherdrug abuse counselors.

Many respondents to the curriculumsurvey indicated plans to expand or refinecurrent curriculum in alcohol and other drugabuse. Particular concerns appeared to be adesire to improve community-based clinicalexperiences and to improve the relevance ofteaching to clinical practice.

Recommendations of the Committee

Desirable strategies to consider in thedevelopment or expansion of a familymedicine alcohol and other drug abuse cur-riculum include:

Involvement of community treatmentstaff in curriculum planning

Involving community treatment staff incurriculum planning provides expertise inareas related to (1) clinical management, (2)counseling, (3) literature and other educa-tional materials, (4) community resowces,

Table 1. Teaching strategies in family medicine in residency and medical school

Residency (n=202) Medical school (n=62)

Lecture 87.1% Lecture 79.0%Clinical Care 75.7% Readings 79.0%Films 69.3% Films 63.9%." 4. Meetings 67.3% Seminars 56.4%Seminars 63.9% Demonstrations 55.7%Demonstrations 61.9% AA Meetings 54.8%Readings 59.9% Self-Instruction 47.5%Conferences 56.4% Experiential 47.5%Experiential 54.5% Clinical Care 38.7%Se lf-Instruction 43.1% Conferences 36.0%Research 5.0% Research 6.5%

16

and (5) treatment philosophy. It also enlistscommunity support for finding and arrangingfor guest speakers and clinical training sitesand aid in community relationship problem-solving. Lastly, it establishes credibility ofthe teaching program within the treatmentcommunity.

Team teaching involving family physi-cians and nonphysicians

Team teaching helps to teach conceptsof team building and therapeutic effective-ness while simultaneously providing a familyphysician role model.

Use of experiential teaching strategies

A variety of strategies used in combina-tion is recommended, with ideal optionsincluding simulat ni patients, case presen-totions, demonstration interviews, andpatient panels.

Clinical application within the familypractice office setting

It is desirable to expose students toalcohol and other drug abusing patientswithin the family practice office setting andto incorporate teaching directly into clinicalwork. Some strategies to help with thisinclude (1) using the medical record byencouraging chart notation and recordingthe problem or diagnosis on the problem list,(2) using family genograms, and (3) usingscreening instruments routinely in the clinicsuch as MAST or the short version thereofSMAST or the CAGE instrument.

Clinical application within thecommunity

Clinical experience in a treatment pro-gram (or experiences in a variety of pro-grams) is essential. The typical short-term

17

block rotation might, in the committee'sopinion, be enhanced by (1) total immersionexperiences whereby a student or residentbecomes a "patient" in a program or parti-cipates in an intensive, exclusive 4-weekblock rotation and (2) the student or resi-dent follows a minimum of one family fromdiagnosis through recovery.

Other community experiences

Attendance preferably at a minimum oftwo AA meetings is strongly advised. Inaddition, contact with or an understandingof other community support groups such asAl-Anon, Al-Ateen, or NA is suggested.

Future Plans

Many respondents to the curriculumsurvey had a teaching program currently inplace but had no plans to expand or modifyit. Presumably, they had not identified anyproblems or deficiencies, or at least nonemajor enough to require changes. Whereplans were indicated, they were directedtoward the following:

1. Expand community-based clinicalexperiences

2. Obtain more curriculum time

3. Increase relevance of teaching toclinical practice

4. Continue to refine existing curriculum

5. Identify useful resources

6. Improve impaired physician teaching

7. Liaison with other departments

8. Faculty development

EVALUATION

The basic principles and methods forevaluating alcohol and other drug abusecurricula do not differ fundamentally fromevaluation in other areas of medical edu-cation. One possible exception is in attitudemeasurement and change. Because attitudeshave been emphasized as an important topicfor alcohol and other drug abuse teaching,they may warrant a more detailed evalu-ation than other areas of a medicalcurriculum.

for evaluation of the student, the teacher,and the program thus flow logically fromthe objectives and permit an easy assess-ment of needed changes.

Short-term evaluation is the type mostcommonly used in medical education. Itprovides immediate feedback to student andteacher but does not measure desired long-term behavioral changes. Ideally, theseshould be measured through evaluationsystems designed to assess changes in

Ongoing Processof Change

FEEDBACK

NEEDS10.11=8111114116,

EVALUATION

OBJECTIVES

METHODOLOGY

Figure 2 (taken from PredoctoralEducation in Family Medicine, Task Forceon Predoctoral Education, STFM 1981)illustrates the feedback loop in the evalu-ation process. At its best, evaluation is adynamic process providing information forthe learner and for the teacher. It stimu-lates improvement in both and promotesrevision in the learning experience. Respon-dents to the survey indicated that evalu-ation is a weakness in current alcohol andother drug abuse teaching.

Evaluation should be linked to the goalsand objectives. Well thought-out goals andobjectives are essential because they formthe basis for the evaluation system. Theyshould therefore be measurable. Criteria

18

performance over longer periods to demon-strate permanent changes in patterns ofmedical practice. Such comprehensivesystems are rarely used because of thedifficulty arxi expense involved.

Evaluation can target the learner, theprogram or teacher, and oneself. These arebriefly discussed below.

Evaluation of the learner is keyed tothe objectives of the learning unit. Knowl-edge and skills are assessed through directobservation of patient care, pre- and post-tests, multiple-choice questions, patientmanagement problems, oral examinations,live simulated patients, and computersimulations. Attitudes may be assessedthrough semantic differential and other

9 --:.

attitude instruments. There are also sum-mative and formative forms of evaluatingthe learner. Formative evaluatbn is de-signed to provide information and feedbackduring a learning experienca. This is done ina way that encourages the measurement ofbehavioral change, the provision of furtherfeedback, and ideally an improvement inperformance. Summative evaluation isterminal and therefore does not permit themeasurement of improvement during anexperience.

Evaluation of the program and teacheraddresses questions about program planningand administration. It also attempts toevaluate appropriateness of the learningmaterials/resources and learning experi-ences. Coupled with this are questionsconcerning clinical application of the teach-ing or of the setting where teaching occurs.Included here is evaluation of the evaluationsystem.

Evaluation of the teacher is more thanan evaluation of personality. It includesdescriptive and objective measures, such asthe student's ability to learn from theexperiences designed by the teacher, fromthe opportunities provided, and from thefeedback given by the teacher. Most in-stitutions have a predesigned form thatcovers all clerkships but, again ideally, ateacher evaluation form should measurewhether specified course goals are metthrough the efforts of the teacher.

Self-Evaluation may use contracts and

learning plans, which are becoming popularas a method of developing an experiencethat more closely fits the individual needsof the learner. They are usually orientedtoward achieving specific individualizedlearning objectives.

In summary, evaluation is a dynamic toolproviding opportunities for individual review,for looking at the connection betweenteaching and learning, and for promotingchange where necessary. For more indepthinformation on evaluation in family medi-cine, we refer you to the references below.

McGaghie, WC., and Frey, J.J., eds.Handbook for the Academic Physician.New York: Springer-Verlag, 1986.

Corley, J.B. Evaluating ResidencyTraining. Lexington, MA and Toronto;The Collamore Press, D.C. Heath andCompany, 1983.

Predoctoral Education in FamilyMedicine. Kansas City, MO: The TaskForce on Predoctoral Education of theSociety of Teachers of Family Medicine;1981.

Evaluation Assessment Tool

Table 2 may be useful both as a"diagnosis of evaluation" tool and as anevaluation assessment tool.

Table 2. Evaluation assessment tool(Drawn from Educational Goals and Objectives Chapter)

MAJOR GOALS AREAS ATTITUDES KNOWLEDGE SKILLS

I. GENERAL CONCEPTSDefinitionsCriteriaNatural HistoryEpidemiologyFamily

fl PREVENTION

PATHOPHYSIOLOGY

EVALUATION OF PATIENTDiagnosisHistory TakingPhysical ExamLab Investigations

V. MANAGEMENT OF PATIENTInterventionAcute ManagementReferralSelfHelp GroupsLongTerm ManagementPsychotropic Meds.Then Relationship

LEGAL ASPECTS

VIL HEALTH PROFESSIONALIMPAIRMENT

20

CURRICULUM EXAMPLES

From among the various curriculummaterials submitted with the survey data bymany programs, we selected a few foindepth description. They represent v niapproaches to the presentation of alt. :

and other drug abuse teaching in the medi-cal school and residency curricula. A contactperson, address, and telephone number arelisted for each.

The Advisory Committee decided tochoose curriculum units that demonstratevariPtions in the following characteristics:

Required versus elective or selectivr.:

Block (a separate unit that standsalone) versus integrated or longitudi-nal (the unit is meshed with anotherlarger course or the alcohol and other

drug abuse curriculum is built into thelarger curriculum's components

,a-house (teaching takes place at themedical school, hospital, or residencytraining program and is conducted forthe most part by university affiliatedfaculty) versus community-basedteaching (the learning experience islocated outside of the university/insti-tutional setting and is taught for themost part by community-based spe-cialists in alcohol and/or other drugabuse).

Medical School Example of Required/Integrated/In-house Curriculum Unit inIntroduction to Clinical Medicine Course(Year 1)

Curriculum Integration Strengths

A 2-hour unit integrated into a requiredcourse

Pre- and post-test evaluations ofparticipants

21

Evaluation of the unit

Learning Goal and Objective Areas

General ConceptsPreventionDiagnosis: History taking; laboratory

investigations; diagnosisthrough family members

InterventionFamilyAttitudes

Strategies

LectureHandouts and slidesSelf-made videotape of interview withalcoholic family

Contact Person:

Macaim Baird, M.D.Dept. Family MedicineUniversity of Oklahoma800 NE 15th St., Room 503Oklahoma City, OK 73190Phone: 405-271-8000

Medical School Example of Elective/Integrated/Community Curriculum Unit inIntroduction to Clinical Medicine Course(Year 1)


Elective chemical dependency experi-ence integrated into a larger requiredcourse

Provision of r!ommunity setting experi-ence to augment didactic learning inrelation to interview techniques anddifficult patient management situationswithin a larger course

9. N.)

Setting options (up to three) are avail-able for a large range of experienceswithin both alcohol and other chemicaldependency


AttitudesDiagnosis: Early warning signs, screen-

ing instruments, historytaking

Patient managementReferralSelf-help groupsTherapeutic relationsifp and tea mmanagement

Strategies

Multiple sessions per month are availablewith options for a 1- or 2-day experience

Visits to community treazment center

Direct participation in patieht interviewand group sessions

Discussion with professional staff at thetreatment center

Contact Person,:

Maureen Strohm, M.D.Department of Family MedicineUSC School of Medicine2025 Zonal Ave.Parkview Medical Building, B-207Los Angeles, CA 90033Phone: 213-224-7711

Medical School Example of Required/Integrated/In-1w= Community CurriculumUnit in a Family and Community MedicineClerkship(Year 3)


Combination of clerkship faculty par-ticipating in in-house teaching with visitsto community sites

Comprehensive evaluation of partici-pants and of the unit

22

Evaluation results suggest attitudechange as greatest area of studentimprovement

Lt. Trning Goal and Objective Areas

AttitudesPreventionDiagnosis: History takingLong-term managementReferralHealth professional impairment

Strategies

Module in clerkship in seven site. ,

Two seminars in which faculty presenttapes and lead discussions on drug andalcohol abuse (using the film "Alcoholismand the Physician Parts I-IV")

Use of outside speakers ai seminars

1-2 days in a treatment facility observ-ing intake interviews and group sessionswith the opportunity for more indepthinterviewing

Opportunity for discussions with treat-ment center staff

Attendance at an AA meeting

Contact Person:

Jack Rodnick, M.D.Marilyn Little, Ph.D.Department of Family MedicineUniversity of California400 Parnassus Ave. AC-9San Francisco, CA 94143Phone: 415-476-1482

Medical School Example of Selective/Integrated/In-house Community CurriculumUnit(Year 4)


One of six 1-week mini-modules in aBasic Science of Family Medicine FourthYear Selective

Combining in-house teaching/discussionwith a community experience (atten-dance at an AA meeting)

Evaluation of the unit and participant(the latter drawing on case managementproblems from real patients in theprimary care setting)

Small-scale course that allows formeeting individual needs and interestssuch as ongoing student support group


Physician impairmentAttitudesDiagnosisPathophysiologyInterventionFamilySelf-help groupsReferral

Strategies

Assessment of students' prior experienceon Day One to tailor learning experience

Written self-reflective assignments eval-uating student and unit

Seminars :ombining films, outside speak-ers, discussion groups, case presentations,and role playing

Contact Person:

Maureen Strohm, M.D.Dept. Family MedicineUSC School of Medicine2025 Zonal Ave.Parkview Medical Building, B-207LOF Angeles, CA 90033Phone: 213-224-7711

Medical School Example of Selective/Block/Community Curriculum Unit on AlcoholismRehabilitation(Year 4)


Direct interaction with both patients

23

and health care professionals, includingphysicians

Flexible and individually tailored tostudents' schedules and needs

Varied clinical experiences at a com-munity treatment center

Evaluation of unit and participant

Lemming Goals and Objective Areas

Diagnosis: History takingAcute managementInterventionReferralLong-term managementTherapeutic relationshipPathophysiologyFamilyAttitudes

Straregies

Two-week community experience withina 4-week clerkship

Three community settings available forexperiences in both chemical dependencyand alcoholism treatment

Clinical exposure in treatment centersincludes rounds, staff meetings, partici-pation/observation in/of group therapy,education classes

Attendance at AA and Al-Anon meetings

Readings

Provision of large selection of audio-visual materials in community treatmentsettings

Contact Person:

John Kish, Ph.D.School of NursingMedical College of OhioCS # 1008Toledo, OH 43699Phone: 419-381-5129

3 fi

Residency Example of Required/Integrated/In-House Curriculum


Needs assessment of faculty precededdevelopment of learning goals andcompetencies

Goals elaborated in behavioral terms

Strategies to meet goals developedafter goals and objectives weredeveloped

Evaluation testing instruments developed

Each unit integrated to meet needs ofdifferent levels of training


PreventionDiagnosis: History taking, interviewing,

physical examIntervention and confrontation

Acute and long-term management in-cluding resources

Family support and treatment

Attitudes and personal risk

Strategies

Content.Year 1: Attitudes, personal risk,diagnosis and resources

Years 2 and 3: In-depth diagnosticskills, acute and long-term treat-ment, family support and treatment

Process.Year 1: Orientation session: Alco-holism Teaching Seminar (Smallgroups; films)

Self-administered learning modules

Years 2 and 3: Two units in Behavior-al Medicine Block Rotation

Unit 1: Diagnosis, treatment,physician role

24

Unit 2: Family support andtreatmentUnit Activities:

Film series and small groupsFamily conference seriesVideo preceptingAA and Al-AnonDWI program site visitIndividual patient consults

Year 3: (Planned) Participation inlocal treatment center ranging fromintake evaluation and observationactivities to 1-month rotation

Contact Person:

James Finch, M.D.Duke-Watts Family Medicine Program407 Crutchfield St.Durham, NC 27704-2799Phone: 919-471-4421

Residency Example of Required/Integrated/In-house Curriculum


Curriculum integrated throughout all 3years to reinforce learning

Learning clinically focused in familypractice center

Evaluation includes clinical vignettes

Includes smoking cessation


AttitudesPreventionEarly diagnosisPatient managementFamilyImpaired physician

Strategies

Content:Year 1: Attitudes, early diagnosis,impaired physician

Years 2 and 3: lndepth diagnosis,treatment, referral, and family care

Process.Year 1: Lecture, seminars, AA meet-ings (films, book of readings)

Year 2: Family Psychosocial Center(4 hours per week for 3 months duringfamily medicine/psychiatry rotation)

Year 3: Lectures and 1-week partici-pation in a local treatment center (tobe finalized)

Contact Person:

Antonnette V. Graham, R.N., M.S.W.UHHC-Family MedicineUniversity HospitalCase Western Reserve University2079 Abington Rd.Cleveland, OH 441220Phone: 216-844-3791

Residency Example of Required/Integrated/In-bause Community Curriculum


Learning objectives stated in behavioralterms

Learning objectives integrated intocomposite behavioral program

Learning experiences traverse all 3 yearsof residency


General conceptsAttitudesDiagnosisAcute treatmentLong-term managementPathophysiologyReferralSelf-help groupsFamily

Strategies

Y ear 1: Orientation: Introduction toassessment, management of alcohol/chemical problems

25

FPI inpatient: Integrated with inpatientcare

Year 2: Supervised brief therapy ofambulatory patients with chemical andother psychiatric problems

Participation in program of privateinpatient additions facility

Readings (Whitfield et al.)

Year 3: FPI inpatient

Participation in (cofacilitation of) alco-holism therapy groups

Elective experiences (e.g., extendedgroup participation, research project,etc.)

Longitudinal: Patient care in family healthcenter and episodic care service

Contact Person:

C. Earl Hill, M.D.Family Practice Residency Program22 S. Greene St.Baltimore, MD 21201Phone: 301-528-5012

Residency Example of Elective orRequired/Block/Community Rotation ofAlcohol and Otlrer Drug Abuse


Intensive block experience allowingexamination of personal attitudes/riskwhile developing clinical skills

Broad coverage of objectives

Strong family physician role model

Learning through direct participationand hands-on experience

Pre- and post-test evaluation ofparticipants


Attitudes

PreventionGeneral conceptsDiagnosisAcute managementFamilyInterventionLong-term managementPsychotropic medicationsTherapeutic relationshipLegal issuesSelf-help groupsHealth professional impairment

Strategies

A 1-week experience at a communitytreatment center

Attend all routine conferences, patienteducation classes, and staff meetings

Talk with family members and patients(separately)

Participate In aftercare sessions withpatient, family, and physician

Attend conference on role of employeeassistance program

Visit local county treatment programand other community resources

Attend AA and Al-Anon meetingscommunity

Contact Persons:

Al Mooney, M.D.Susan Pajari, M.S.T.Willingway Hospital311 Jones Mill RoadStatesboro, GA 30458Phone: 912-764-6236

Example of Self-Instructional Program:Elective/Integrated/In-house/CommunityCurriculum Unit


and applied clinical skills with primarycare patients

Provides general overview of diagnosis,intervention, and management of alco-holic patient

Can be adapted for use at any edu-cational level including medical school,residency, CME, arxi for recertificationpurposes


Diagnosis: History taking; physicalexamination, laboratoryinvestigations

Intervention

Acute management: Withdrawal andoverdose

PathophysiologyAttitudesPreventionLong-term management

S tra tegies

Student has one mentor' or preceptoroverseeing study

Provision of study guide (with an anno-in tated bibliography) to be used in discus-

sions with mentor

Program serves as an adjunct to clinicalexperience in the primary care setting

Combination of community site visits

26

Identify and work up patient in primarycare setting

Visit to local alcohol and/or drug abusetreatment facility

Attend AA and Al-Anon meeting

Written paper on alcoholic patient en-couraged as topic for written paperrequirement

Contact Persom

Eugene Schoener, Ph.D.Director, Addiction Research Institute540 E. CanfieldDetroit, MI 84201Phone: 313-577-1388

3

LEARNING MATERIALS

Selection Criteria for Inclusion of Readings andAudiovisual Materials in the Resource Manual

The following sections contain annotatedreferences to readings and audiovisual ma-terials. It was the committee's collectiveopinion that publishing some descriptiveinformation on materials actually reportedto be useful would be more informative toeducators than a literature search or acommittee-generated list. Thus, from thecurriculum materials received, all readingsthat were to be "required" and all filmsreported to be used regularly were includedin this section. In addition, the committeefelt that the inclusion of readings that itsmembers had found useful would augmentthe survey-based list. As it turned out, allbut a very few of the "committee recom-mended" readings were indeed being used.

The bibliography is broken down bymajor content according to the goals dis-cussed under Educational Goals and 01,-

jectives. Readings are listed in alphabeticalorder according to the authors' last namesunder each goal heading. For all references,information is provided on source andeducational levelMedical School (MS) orResidency (R) or both (R/MS)at whichthey are reportedly being used. The readingsthat the committee determined were"recommended by virtue of its membership'sexperience" (through a totally independentprocess) are indic ced by an "*".

The list of audiovisual materials alsoprovides as much descriptive information aspossible and the level of education whereeach is being used. They are in descendingorder by the number of programs reportedusing them. They are not broken down bytopic under goal headings, but instead arefollowed by a general indication as to whichgoal(s) they address.

BIBLIOGRAPHY

Attitudes

Chappel, IN. Physician attitudes and thetreatment of drug dependent patients.Journal of Psychedelic Drugs 10(1):27-33, Jan.-Mar., 1978. R

Kinney, J., Bergen, B.J., and Price, T.R.P. Aperspective on medical students' per-ceptions of alcoholics and alcoholism.Journal of Studies on Alcohol 43(5):488-496, 1982. R

Lisansky, E.T. Why physicians avoid earlydiagnosis of alcoholism. New York StateMedical Journal 75(10):1788-1792, 1975.MS

Strachan, J.G. A complexity of attitudes. In:Alcoholisnr Treatable Illness. Vancouver:Mitchell Publications, 1968. pp. 31-48. R

General Concepts

Abel, E.L. Prenatal effects of alcohol ongrowth: A brief review. FederationProceedings 44(7):2318-2322, 1985. MS

American College of Physicians Health andPublic Policy Committee. Chemicaldependence (position paper). Annals ofInternal Medicine 102:405-408, 1985. R

Anonymous. Losing control: A personalperspective on alcoholism. OsteopathocAnnals 13:31-33, 1985. R

Anonymous. Adverse effects of cocaineabuse. The Medical Letter 26:662,1984. R

Blume, S.B. The alcoholism in our patients.Harvard Medical Alumni Bulletin54(6):7-9, 1980. R

Buffum, J., and Yeary, J. How alcohol,tobacco and other drugs tamper withyour real response. Sexology Today10-17, 1981. R

Clarren, S.K. Recognition of fetal alcoholsyndrome. Journal of the AmericanMedical Association 245(23):2436-2439,1981. R/MS

28

Dougherty, R. "Is cocaine use and alco-holism a problem?" Paper presented atthe New York State Division of Alcoholand Alcohol Abuse Conference, WhitePlains, NY, 1985. R/MS

Dougherty, R. Pseudo-speed. New YorkState Journal of Medicine 82(1):74-751982. R

Dougherty, R. Status of cocaine abuse 1984.Journal of Substance Abuse Treatnwnt1:157-161, 1984. R/MS

Inboden, W.C. Unique aspects of adolescentchemical dependency. Osteopathic Annals13:12-16, 1985. R

Jellinek, E.M. Phases of alcohol addiction.Quarterly Journal of Studies on Alcohol13(4):673-684, 1952. R/MS

Klatsky, A.L. Alcohol and mortality: A tenyear Kaiser-Perznanente experience.Annals of Internal Medicine 95:139-145,1981. R

MacDonald, DJ. Drugs, drinking and ado-lescence. Chicago: Year Book MedicalPublishers, 1984. MS

Mooney, A.J. Pharmacologic basis ofsymptoms. Consultant May 1983. R

Mulry, J.T. Chemical dependency: A unifiedillness. American Family Physician29(3):285-290, 1984. R

Nicholi, A.M. The nontherapeutic use ofpsych:active drugs. New England Journalof Medicine 308(16):925-931, 1983. R

Ohlms, D.A. The Disease Concept of Al-coholism. Belleville, IL: Gary WhiteakerCo., 1983. R

Ohlms, D.A. Pot. Belleville, IL: GaryWhiteaker Co., 1983. R

Schuckit, M.A. A clinical review of alcohol,alcoholism and the elderly patient.Journal of Clinical Psychology 43(10):396, 1982. R/MS

Schwartz, R.H. Frequent marijuana use inadolescence. American Family Physician31(1):201-205, 1985. R

Talbott, D. Alcoholism the diseaseA med-ical fact. Journal of the Medical

3 5

Association of Georgia 64:331-333,1975. R

Vaillant, G.E. Alcoholism and drug depend-ence. In: Nicholi, A.M., ed. HarvardGuide to Modern Psychiatry. Cambridge,MA: Belknap Press, 1978. pp. 567-577. R

Vaillant, G.E., and Milofsky, E.S. Naturalhistory of male alcoholism: IV. Paths torecovery. Archives of General Psy-chiatry 39:127-133, 1982. R/MS

West, L.J.; Maxwell, D.S.; Noble, E.P.; andSolomon, D.H. Alcoholism (UCLAconference). Annals of Internal Medicine100:405-416, 1984. R

F2 mily

Ablon, J. Al-Anon family groups. AmericanJournal of Psychotherapy 28:30, 1974. R

Anderson, S.C., and Henderson, D.C. Familytherapy in the treatment of alcoholism.Social Work in Health Care 8(4):79-94,1983. R

Baird, M. Chemical dependency: A protocolfor involving the family. Family SystemsMedicine 3(2):216-220, 1985. R

Black, C. It Will Never Happen to Me.Denver: MAC Printing and PublicationDivision, 1982. R

Jackson, J. The adjustment of the family zothe crisis of alcoholism. Quarterly Journalof Studies on Alcohol 15:562-586,1954. R/MS

Jacob, T.; Dunn, N.J.; and Leonard, K. Pat-terns of alcohol abuse and familystability. Alcoholism: Clinical and Experi-mental Research 7(4):382-385, 1983. R

Kaufman, E. Family system variables inalcoholism. Alcoholism Clinical andExperimental Research 8(1):4-8, 1984. R

Lanier, D.C. Familial alcoholism. Journal ofFamily Practice 18(3):417-422, 1984. R

Leckman, U.B. Alcoholism in families offamily practice outpatients. Journal ofFamily Practice 19(2):205-207, 1984. R/MS

Liepman, M.R. Helping alcoholics throughmanipulation of social resources. Seminarsin Family Medicine 1(4):271-281,1980. R

Smith, D.E., and Yeary, J. Dealing with fam-ily problems caused by substance abuse.Medical Aspects of Human Sexuality, inpress. R

Wegscheider, S. Another Chance: Hope and

Health for the Alcoholic Family. PaloAlto: Science and Behavior Books,1981. R/MS

Wolin, S.J.; Bennett, L.A.; and Noonan, D.L.Family rituals and the recurrence ofalcoholism over generations. AmericanJournal of Psychiatry 136(4B):589-593,1979. R

Prevention

Borg, V. Bromocriptine in the prevention ofalcohol abuse. Acta Psychiatry Scandi-navia 68:100-110, 1983. R

Jurich, A.P., and Poison, C.J. Reasons fordrug use: Comparison of drug users andabusers. Psychological Reports 55(2):371-378, 1984. R

Milam, J.R., and Ketcham, K. What makesan alcoholic: Predisposing factors. Underthe InfluenceGuide to Myths andRealities of Alcoholism. Seattle:Madrona Publications, 1981. pp. 31-46. R

Fathophysiology

Symposium on ethyl alcohol and disease.Medical Clinics of North America68(1):1-255, 1984. R

Clark, L.T. Alcohol use and hypertension:Clinical considerations and hypertension.Postgraduate Medicine 75(8):273-276,1984. R

Eckardt; KJ. Health hazards associatedwith alcohol consumption. Journal of theAmerican Medical Association 246(6):648-666, 1981. R/MS

Fallon, KJ., and Lesesne, H.R. Medicalcomplications of excessive drinking. In;Ewing, J.A., and Rouse, B.A., eds.Drinking Alcohol in American Society.Chicago: Nelson-Hall, 1978. MS

Food and Drug Administration. FDA DrugBulletin: Alcohol-Drug Interactions.DREW Publication. Rockville, MD: theAdministration, 1979. R

Goodman, L.S., and Gilman, A., eds. ThePharmacologic Basis of Therapeutics.New York: MacMillan, 1975. MS

Isselbacher, K.J. Metabolic and hepaticeffects of alcohol. New England Journalof Medicine 296(11):612-616, 1977. R

Lieber, C.S. Pathogenesis and early diag-nosis of alcoholic liver injury. New

2916

England Journal of Medicine 298(16):888-893, 1978. R

Maddrey, W.C., and Imboden, J.B. Alco-IvAism and associated medical problems.In: Harvey, M.; Johns, RJ.; Owens, A.H.;and Ross, R.S., eds. Principles andPractice of Medicine. 20th ed. NewYork: Appleton-Century-Crofts, 1980.pp. 1449-1455. MS

Mendelson, J.H., and Mello, N.K. Biologicconcomitants of alcoholism. New Eng-land Journal of Medicine 301:912,1979. R

Packard, R.C. The neurologic complicationsof alcoholism. American Family Phy-sician 14(3):111-115, 1976. R

Seixas, F.A. Alcohol and drug interactions.Annals of Internal Medicine 83:86-92,1975. R

Troncale, J.A. Endocrine effects of alco-holism. Journal of Family Practice19(1):17-32, 1984. R

Evaluation of tlm Patient

Alcenas Hospital. How to Identify the 300Alcoholics in Your Pn2ctice. Kirkland,WA: Alcenas Hospital, 1980. R

American Psychiatric Association. Diag-nostic and Statistical Manual of MentalDisorders-DSM III. Washington, D.C.: theAssociation, 1980. R

Bates, R.C. The hidden alcoholic: A historythat reveals the early clues. Diagnosis1(2)12-27, 1979. R

Beresford, T.; Low, D.; Hall, R.C.W.;Adduci, R.; and Goggans, F. A com-puterized biochemical profile for de-tection of alcoholism. Psychosomatics23(7):713-720, 1982. R

Brady, J.P.; Foulks, E.T.; Childress, A.R.;and Pertschuk, M. The MAST as a surveyinstrument. Journal of OperationalPsychiatry 13(1):27-31, 1982. R

Callahan, E.J., and Pecsok, E.H. Behavioralassessment of heroin addiction. In:Marlatt, A., and Donovan, D., eds.Assessment of Addictive Behaviors.New York: Guilford Press, in press. R

Clark, T.H.; Liepman, M.; Whitfield, C.; andWilliams, K.H. A protocol for identifyingalcoholism (practice aids). Patient Care13(11):154-162, 1979. R

Coller, Li., and Hirschfield, J. Doctor, you

30

are missing the diagnosis of 10% of yourpatientsWhy? A checklist. MarylandState Medical Journal 30(8):26-27,1981. MS

Cross, G., and Mooney, A.J. Office diagnosisof alcoholism. Georgia Academy ofFamily Practice Journal 6(4), 1985. R

Ewing, J.A. Detecting alcoholism: TheCAGE questionnaire. Journal of theAnwrican Medical Association 252(14):1905-1907, 1984. R/MS

Feighner, L.P. Diagnostic criteria for use inpsychiatric research. Archives ofGeneral Psychiatry 26:57-63, 1972. R

Gale, J., and Marsden, P. The role of theroutine clinical history. Journal ofMedical Education 18:96-100, 1984. R

Holt, S., and Skinner, WA. Early identifi-cation of alcohol abuse: U. Clinical andlaboratory indicators. Canadian MedicalAssociation Journal 124:1279-1293 1981.

Hood, B. Tracing and handling of high al-cohol consumption with the aid oflaboratory means (editorial). EuropeanJournal of Clinical Investigation 11:147-148, 1981. R

Hotch, D.F.; Sherin, K.M.; Harding, P.N.;and Zitter, R.E. Use of the self-administered Michigan alcoholismscreening test in a family practicecenter. Journal of Family Practice17(6):1021-1026, 1983. R

Mooney, A.J. Alcohol use. In: Taylor, R., ed.Health Promotion: Principles andClinical Applications. New York: Apple-ton-Century-Crofts, 1982. pp. 233-258.R/MS

Morse, R.M., and Hurt, R.D. Screening foralcoholism. Journal of the AmericanMedical Association 242(24):2688-2690,1979. R

National Council on Alcoholism. Criteria forthe diagnosis of alcoholism. AmericanJovrnal of Psychiatry 129:127-135,1972. R/MS

Selzer, M.L. The Michigan alcoholismscreening test: Quest for a new diag-nostic instrument. American Journal ofPsychiatry 127:12, 1971. R/MS

Silberfarb, P.M. Recognizing alcoholism byearly signs. Postgraduate Medicine59(4): 7941, 1976. R

Skinner, and Holt, S. Early identifi-cation of alcohol abuse: I. Critical issues

3 7

and psychosocial indicators for a com-posite index. Canadian Medical Assoc-iation Journal 124:1141-1142, 1981. R

Skinner, H.A.; Holt, S.; Schuller, R.; andRoy, J. Identification of alcohol abuseusing laboratory tests and a history oftrauma. Annals of Internal Medicine101:847-851, 1984. R

Sokol, R.J., and Miller, S.I. Identifying thealcohol-abusing obstetrical/gynecologicpatient: A practical approach. AlcoholHealth and Research World 4(4):36-40,1980. R

Unknown. Recognizing the middle-class pillpusher. Diagnosis 2(3):40-52, 1980, R

Valaske, M.J. Laboratory clues suggestingalcoholism. Maryland State MedicalJOU771111 29(10):59-61, 1980. R

Weinberg, J.R. Interview techniques fordiagnosing alcoholism. American FamilyPhysician 9(3):107-115, 1974. R/MS

Management of the Patient

Ackerman, R.J. Children of Alcoholics-AGuidebook for Educators. Therapists andParents. Holmes Beach, FL: LearningPublications, Inc., 1978. R

Alcoholics Anonymous. Alcoholics Anony-mous. New York: Alcoholics AnonymousWorld Services, 1976. R

Anonymous. Double withdrawal for thedouble addict. Emergency Medicine12(5):77, 1980. R

Bean, M. Alcoholics Anonymous. Psychi-atric Annals 5:2, 1975. R

Brown, C.G. The alcohol withdrawal syn-drome. Annals of Emergency Medicine11(5):276-280, 1982. R

Callahan, E.J. Alternative strategies in thetreatment of addiction: A review. In:Miller, W.R., ed. The Addictive Be-haviors. Chap. 3. Oxford: PergamonPress, 1980. R

Cass, A.R.; Frazier, S.H.; and Schanbacher,M. Alcoholism and Alcohol AbuseReference Guide 14. New York:American Board of Family Practice,1983. R

Clark, W.D. Alcolism: Blocks to diagnosisand treatment. American Journal ofMedicine 71:275-286, 1981. R/MS

Collins, G.B. Treatment of alcoholism-Role of the primary care physician.

31

Postgraduate Medicine 69(1):6-10,1981. MS

Craigie, F.C. Therapeutic homework: Theuse of behavioral assignments in officecounseling. Journal of Family Practice20(1):65-71, 1985. R

Cummings, S.R. Kicking the habit: Benefitsand methods of quitting cigarettesmoking. Western Journal of Medicine137(5):443-447, 1982. R

Digregorio, G.J., and Bukovinsky, M.A.Clonidine for narcotic withdrawal,American Family Physician 24(3):203-204, 1981. R

Doherty, W., and Baird, M. Treating chem-ical dependency in a family context.Family Therapy and Family Medicine:Toward the Primary Care of Families.New York: Guilford Press, 1983. R/MS

Dougherty, IL Transcutaneous electricalnerve stimulation in the treatment ofchronic pain. Hospital Formulary16(2):167-170, 1981. R/MS

Dougherty, R. Office management ofchronic pain. Postgraduate Medicine76(2):215-217, 1984. R/MS

Farris-Kurtz, L. Time in residential careand participation in AA as predictors ofcontinued sobriety. PsychologicalReports 48:633-634, 1981. R

Finney, LW.; Moos, R.F.; and Chan, D.A.Length of stay and program componenteffects in the treatment of alcoholism:A comparison of two techniques forprocess analysis. Journal of Consultingand Clinical Psychology 49(1):120-131,1981. R

Fisher, J.V. The family physician's role inmanaging alcohol and drug abuse: Aresponse to Stephen's decalogue.Continuing Education for the FamilyPhysician Mar:129-132, 1984. R

Glass, G. Recognizing and managing theoutpatient alcoholic. American FamilyPhysician 15(3):176-182, 1977. R

Graham, A.V.; Sedlacek, D.; Reeb, K.G.;and Thompson, J.S. Early diagnosis andtreatment of alcoholism. Journal ofFamily Practice 19(3):297-313, 1984. R

Groves, I.E. Taking care of the hatefulpatient. New England Journal ofMedicine 298:883, 1978. R

Grutchfield, L. AA as a learning tool. Em-ployee Assistance Program Digest Mar.-Apr:37-40, 1986. MS

3 S

Harper, R.G.: Solish, G.L; Purow, H.M.;Sang, E.; and Panepinto, W.C. The effectof a methadone treatment program uponpregnant heroin addicts and theirnewborn infants. Pediatrics 54(3):300-304, 1974. R

Hill, P.S. Alcoholism: Images, impairments,interventions. Postgraduate Medicine74(5):87-99, 1983. R

Khantzian, E.J. Acute toxic and withdrawalreactions associated with drug use andabuse. Annals of Internal Medicine90:361-372, 1979. R

Kleber, H.D. Clonidine in outpatient de-toxification from methadone mainte-nance. Archives of General Psychiatry42:391-393, 1985. R

Kleber, H.D. The clinical use of naltrexone:Potential candidates. Substance AbuseBulletin 1(2):1-4, 1985. R

Miller, G.W. Principles of alcohol detoxi-fication. Awrican Family Physician30(4):145-148, 1984. R/MS

Minter, R., and Murray, G.B. Diazepamwithdrawal: A current problem inrecognition. Journal of Family Practice7(6):1233-1235, 1978. R

National Institute on Drug Abuse. Detoxi-fication treatment manual. NationalInstitute on Drug Abuse TreatmentMonograph Series No. 6. Rockville, MD:the Institute. R

National Institute on Drug Abuse. Nal-trexone: Its clinical utility. NationalInstitute on Drug Abuse TreatmentResearch Report. Rockville, MD: theInstitute. R

Ohlrns, D.A. The Prescription Trap.Belleville, IL: Gary Whiteaker Co.,1983. R

Reilly, R.L. Five most common errors madeby primary care physicians treatingalcoholics. Osteopathic Annals 12:115-122, 1984. MS

Schachter, S. Recidivism and self-cure ofsmoking and obesity. American Psycho-logist 37(4):436-444, 1982. R

Schuckit, M.A. Disulfiram and the treat-ment of alcoholic men. Advances inAlcoholism 2(4), 1981. R

Sellers, E.M., Naranjo, C.A.; and Peachey,J.E. Drug therapyDrugs to decreasealcohol consumption. New EnglandJournal of Medicine 305(21):1255-1262,1981. R

32

Sellers, E.M., and Kalant, H. Alcohol in-toxication and withdrawal. New EnglandJournal of Medicine 294(14):757-762,1976. R/MS

Siegal, H.A., and Rudisill, J. The weekendintervention program: Identifying andconfronting problem drinkers. NewFamily Practice Teaching Acttvities 6(3),1984. R

Stephens, G.G. A decalogue for the man-agement of alcohol and drug abuse.Continuing Education for the FamilyPhysician, 1984. p. 125. R/MS

Waldo, M., and Gardiner, T. Vocationaladjustment patterns of alcohol and drugmisusers following treatment. Journal ofStudies on Alcohol 45(6):547-549, 1984.

Weinberg, J.R. AA: An interpretation forthe professional. New York: AlcoholicsAnonymous General Services Organi-zation. R/MS

Whitfield, C.L. Outpatient management ofthe alcoholic patient. Psychiatric Annals12(4):447-459, 1982. MS

Zimberg, S. The Clinical Management ofAlcoholism. New York: Bnmner/Mazel,1982. MS

Legal Issues

Chapman, S. Can you spot the gamespatients play to get the pills? LegalAspects of Medical Practice 7(7):32-35,1979. R


Bissel, L., and Jones, R.W. The alcoholicphysician: A survey. American Journal ofPsychiatry 133:1142-1146, 1976. R

Herrington, R.E.; Benzer, D.C.; Jacobson,G.R.; and Hawkins, M.K. Treating sub-stance use disorders among physicians.Journal of the American MedicalAssociation 247(16):2253-2257, 1982. R

Hyde, G.L., and Doggherty, R. Alcoholismand the physician . . . Thoughts on mybrothers keeper. The Phi Gamma DeltaSummer 1984. R

Mooney, J. No alcoholic doctor's case ishopeless. Take mine. Medical Economics55(18):86-106, 1978. R

Vaillant, G.E.; Sobowale, N.C.; andMcArthur, C. Some psychological vul-

3r,;

nerabilities of physicians. New EnglandJournal of Medicine 287(8):372-375,1972. R/MS

All or Most Topics

American Board of Family Practice. Alco-holism and Alcohol Abuse. ReferenceGuide #14. New York: the Board,1983. R

Anderson, R.C., et al. Alcoholism and sub-stance abuse. In: Taylor, R.B., ed. FamilyMedicine: Principles and Practice. 1sted. New York: Springer-Verlag, MS

Coggan, P.G. Alcoholism. In: Eisenberg, M.,and Cummins, R., eds. Blue Book ofMedical Diagnosis. Philadelphia:Saunders, 1986. R

Gitlow, S.E., and Peyser, H.S., eds. Alco-holismA Practical Treatment Guide.

33

New York: Grune and Stratton,1980. RIMS

Johnson, V.E. I'll Quit Tonbarrow. SanFrancisco: Harper and Row, 1980. 182pp. R/MS

Mendelson, J.H., and Mello, N.K. Diagnosisand Treatment of Alcoholism. 2d ed. NewYork: McGraw-Hill, 1985. R

Mooney, A.J. Alcohol use and dependence.In: Taylor, R., ed. Family Medicine:Principles and Practice. 2d ed. NewYork, Heidelberg, and Berlin; Springer-Verlag, 1983. R

Whitfield, C.L.; Davis, J.E.; and Barker,R.L. A Synopsis of Alcoholism and OtherDrug Problems. Baltimore: The ResourceGroup, 1981. R

Wilford, B.B. Drug Abuse: A Guide for thePrimary Care Physician. Chicago:American Medical Association, 1981. R

.4

AUDIOVISUAL MATERIALS REPORTED TO BE USEFULBY PROGRAMS SURVEYED

(Listed in order by number of programs reported using them)

Alcoholism and the Pksician. Parts I-IV. Operation Cork, Gerald T.Rogers Production. Suite #6, 5225 Old Orchard Road, Skokie, IL60077; 312-967-8080.

Each part 20 minutes. R/MSAttitudes, general concepts, evaluation of patient, patientmanagement.

Soft Is the Heart of a Child. Operation Cork, Gerald T. RogersProductioL. Suite #6, 5225 Old Orchard Road, Skokie, IL 60077;312-967-8080.

28 minutes. R/MSGeneral concepts, farrily.

The Intervention. The Johnson Institute. 10700 Olson MemorialHighway, Minneapolis, MN 55441-6199; 612-341-0435.

31 minutes. R/MSGeneral concepts, patient management, family.

Our Brother's Keeper. Operation Cork, Gerald T. Rogers Production.Suite #6,5225 Old Orchard Road, Skokie, IL 60077; 312-967-8080.

57 minutes or 35 minutes. R/MSHealth prof ezsional impairment.

Chalk Talk on Counseling. FMS Productions, Inc. 1777 North VineStreet, Los Angeles, CA 90028; 213-461-4567.

22 minutes. R/MSPatient management.

If You Loved Me. Operation Cork, Gerald T. Rogers Production. Suite#6,5225 Old Orchard Road, Skokie, IL 60077; 312-967-8080.

54 minutes.General concepts, family.

The Family Trap. Health Communications, Inc. 2119-A HollywoodBoulevard, Hollywood, CA 33020; 305-920-9435.

30 minutes.General concepts, evaluation of patient, patient management,family.

34

Disease Concept of Alcohollsm, II. Gary Whiteaker Co. 5204 WestMain Street, Belleville, IL 62223; 618-277-0560; 800-851-5406.

35 minutes.

Attitudes, general concepts, pathophysiology.

Doctor, You've Been Lied To. Ayerst Laboratories. 585 ThirdAvenue, New York, NY 10017.

27 minutes. R/MSPatient management.

The Enablers. The Johnson Institute. 10700 Olson Memorial Highway,Minneapolis, MN 55441-6199; 612-341-0435.

23 minutes.General concepts, evaluation of patient; family.

Quit Tomorrow. The Johnson Institute. 10700 Olson MemorizlHighway, Minneapolis, MN 55441-6199; 612-341-0435.

90 minutes. R/MSGeneral concepts, evaluation of patient, patient management,family.

Medical Aspects of Alcoholism. Parts 1 and 2. Southerby Productions,Inc. 5000 East Anaheim Street, Long Beach, CA 90804; 213-434-3446.

54 minutes.General concepts, pathophysiology.

Calling the Shots. Cambridge Docurr, -.! Films. P.O. Box 385,Cambridge, MA 02139; 617-354-3677.

30 minutes.General concepts, prevention.

The Twelve Steps of AA Father Martin Associates. 8 Howard Street,Aberdeen, MD 21001; 301-272-1975.

Patient management.

Alcoholism: Early Diagnosis and Management. American MedicalAssociation, Division of Marketing Services. 535 North DearbornStreet, Chicago, IL 60610; 312-751-6000.

3/4" and 1/2" video.Evaluation of patient, patient management, pathophysiology.

Drug Abuse in Adolescents (NCME #457). Network for ContinuingMedical Education. 15 Columbus Circle, New York, NY 10023;212-541-8088.

General concepts.

The New Life of Sandra Blain. Part 2. Southerby Productions, Inc.5000 East Anaheim Street, Long Beach, CA 90804; 212-434-3446.

25 minutes.Patient management.

4 C35

The Prescription Trap. Gary Whiteaker Co. 5204 West Main Street,Belleville, IL 62223; 618-277-0560; 800-851-5406.

Patient management.

The Secret Love of Sandra Blain. Part 1. Southerby Productions, Inc.5000 East Anaheim Street, Long Beach, CA 90804; 212-434-3446.

25 minutes.General concepts, patient management.

Substance Use Diaorders - Diagnosis and Management (NCME #414).Network for Continuing Medical Education. 15 Columbus Circle, NewYork, NY 10023; 212-541-8088.

Evaluation of patient, patient management. R

Wonwn and Alcohol. FMS Productions. 1777 North Vine Street, LosAngeles, CA 90028; 213-461-4567.

28 minutes.General concepts, patient management, family.

Alcoholism Disease or Bad Habit (NCME #429). Network forContinuing Medical Education. 15 Columbus Circle, New York, NY10023; 212-541-8088.

Attitudes, general concepts.

Alcohol Use and Its Medical Consequences Slide Series. 7 parts.Milner-Fenwick, Inc. 2125 Greenspring Drive, Timonium, MD 21093;800-638-8652.

25-64 slides. MSPathophysiology.

Disease Concept of Alcoholism. Father Martin Associates. 8 HowardStreet, Aberdeen, MD 21001; 301-272-1975.

General concepts.

Guidelines. Father Martin Associates. 8 Howard Street, Aberdeen,MD 21001; 301-272-1975.

45 minutes. MSAttitudes.

Alcoholism (NOVA Television Series Program). Public BroadcastingSystem. 800-344-3337.

60 minutes. R/MSAttitudes, general concepts, patient management, prevention,pathophysiology.

Pot. Gary Whiteaker Co. 5204 West Main Street, Belleville, IL 62223;618-277-0560; 800-851-5406.

General concepts.

Stress and the Resident. American Academy of Family Physicians.1740 West 92nd Street, Kansas City, MO 64114; 816-333-9700.

Health professional impairment.

36

4 3

Alcoholics Anonymous - An Inside View. AA World Services, Inc.,General Services Office. Box 459, Grand Central Station, New York,NY 10017; 212-686-1100.

27 minutes. R,Patient management.

, The Troubled Employee. Dartnell. 4660 Ravenswood Avenue, Chicago,IL 60640-9981; 312-561-4000.

25 minutes. RGeneral concepts, evaluation of patient.

Sex, Booze and Blues. FMS Productions. 1777 North Vine Street, LosAngeles, CA 90028; 213-461-4567.

15 minutes. RGeneral concepts, patient management, pathophysiology, family.

Cocaine: Beyond the Looking Glass. Hazelden Educational Services.Box 176, Center City, MN 55012; 800-328-9000; 612-257-2905.

30 minutes. RGeneral concepts.

EDUCATIONAL MATERIAL RESOURCES

Addiction Research Foundation.33 Russell StreetToronto, Canada M5S251807-595-6000

Offers a number of educational materials for sale, includingpamphlets, fact sheets, audiovisual materials and books. AnEDUCATIONAL MATERIALS CATALOGUE can be obtained bywriting them.

Alanon Family Group Headquarters, Inc.P.O. Box 182Madison Square StationNew York, NY 10010

Alcoholics Anonymous General Services Organization468 Park Avenue SouthNew York, NY 10016212-686-1100

American Medical Society on Alcoholism and Other DrugDependencies (AMSAODD)12 West 21st StreetNew York, NY 10010212-206-6770

Center of Alcohol StudiesResearch Information and Publications DivisionRutgers UniversityP.O. Box 969Piscataway, NJ 08864201-932-3510

Participate in collection, classification, and abstractingscientific literature on alcohol and alcoholism. Their journal,The Journal of Studies on Alcohol, is a primary source of suchscientific, up-to-date information. An annual subscription canbe obtained by writing to The Journal of Studies on Alcahol atthe above address. Other publications, bibliouaphies andinformation services can be obtained or inquired about bycontacting them.

Hazelden Educational ServicesBox 176Center City, MN 55012800-328-9000 or 612-257-2905

38 4',;

International Doctors in Alcoholics Anonymous (IDAA)1950 Volney RoadYoungstown, OH 44511216-782-6216

National Council on Alcoholism (NCA)Publications Department733 Third AvenueNew York, NY 10017212-986-4433

For a full listing of the wide variety of publications offered,write NCA and request a Catalogue of Publications.

Project Cork Resource CenterDepartment of PsychiatryDartmouth Medical SchoolHanover, NH 03755603-646-754 '

Veterans AdministrationSubstance Abuse Fellowship ProgramDepartment of Medicine and SurgeryWashington, D.C. 20420202-389-5171

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