Training in Substance-Related and Addictive Disorders, Part 2: Updated Curriculum Guidelines.

Training in the management of substance-related and addictive disorders in psychiatry has been disproportionately limited in psychiatric residency training programs, compared with other major psychiatric disorders. Few psychiatry residents received training in addictions unless elective experiences were pursued. Moreover, a lack of experienced faculty, negative attitudes toward addicted patients, lack of adequate curriculum and poorly defined educational goals and requirements have been identified as factors leading to the lack of training in substance-related and addictive disorders.1,2 With the further recognition that treatment outcomes improve when patients with concurrent addiction and mental disorders receive integrated care, rather than separate treatment in a sequential or parallel manner,3–8 it becomes increasingly evident that the knowledge, attitudes and diagnostic– management skills for all new psychiatrists will need to become more sophisticated in the area of substance-related and addictive disorders. In 1997, the initial Curriculum Guidelines for Residency Training of Psychiatrists in Substance-Related Disorders was published by the Canadian Psychiatric Association (CPA) as a position paper.9 The stated goals of those guidelines were as follows, to: improve the knowledge, skills, and attitudes of psychiatrists about substance-related disorders to a level comparable to other mental disorders; ensure better evaluation and treatment of alcohol and other substance abusers; foster recognition of the impact of comorbid substance abuse on the treatment and evolution of other physical and psychiatric conditions; prevent marginalization and excessive demedicalization of clinical services to substance abusers; ensure that psychiatrists develop an understanding of the spectrum of health care systems providing services to substance abusers; and foster advanced training and subspecialization of a greater number of psychiatrists to develop clinical services, teaching, and research in substance abuse.p 1–2 However, without these proposed guidelines9 being incorporated into the Royal College of Physicians and Surgeons of Canada (RCPSC) Specialty Training Requirements (STR) in Psychiatry,10 curriculum changes were left up to individual programs to voluntarily implement, and relatively little change occurred. To attempt to begin to address the training deficiency in substance-related and addictive disorders, in 2007, the RCPSC released the new STR in Psychiatry10 outlining more specific expectations in training for psychiatry residents. While the Objectives of Training (OTR) in Psychiatry mentions alcohol and other substance use disorders (SUDs), it does not currently include gambling disorder or conditions for further study (for example, Internet gaming disorder), which we, the authors of this position paper, would recommend including to reflect the changes in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), terminology and trends in addiction treatments. Proficiencies in substance-related and addictive disorders are currently part of the training requirements for all Canadian psychiatry residents who began their training as of July 1, 2009, to be realized during the five years of residency training, with no less than the equivalent of a one-month clinical experience evaluated separately from other rotations occurring sometime in the postgraduate years (PGYs) 2 to 5. Although it is unlikely that a one-month experience would fully allow the resident to realize the proficiencies expected, the one-month experience, coupled with seminars, should provide an adequate foundation for residents in addictions to be augmented by further training experiences and ongoing continuing medical education (CME) to meet the requirements. The OTR–STR as they apply to training in substance-related and addictive disorders include the following: Supervised experience in the treatment of patients with substance-related and addictive disorders in various settings. A learning portfolio or log should be maintained and reviewed by the program director. This experience must be undertaken as a discrete rotation of no less than one month or incorporated as a longitudinal experience (at any time during PGY-2 to -5) of no less than the equivalent of one month. This must be documented and evaluated separately from other rotations. Availability of a selective rotation in substance-related and addictive disorders of no less than three months, but preferably six months, during senior psychiatric residency training (PGY-4 to -5), to develop advanced knowledge (definition in Table 1) in addiction psychiatry. Table 1 RCPSC knowledge and skills definitions38

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