Training in Substance-Related and Addictive Disorders, Part 1: Overview of Clinical Practice and General Recommendations.
Bibliographic record
Abstract
Substance-related and addictive disorders include the substance use disorders (SUDs) and the behavioural addiction of gambling disorder.1 Together, they represent some of the most prevalent mental disorders, where it is estimated that 11 to 14 per cent of North Americans will meet lifetime criteria for an SUD2–6 and a further 0.4 to 1.1 per cent will meet criteria for gambling disorder.7 The peak age of onset for SUD is in young adulthood (ages 18 to 20), apart from cannabis use disorder, which typically has its peak age of onset in later adolescence (ages 16 to 18), and comorbid mental disorders often being established early, then extending into adulthood.8–11 In addition to contributing to a wide range of social problems, including abuse, neglect, crime, unemployment, suicide, accidents, and family dysfunction, substance-related and addictive disorders are a major contributor to potentially preventable medical illnesses and premature death, where the estimated cost to Canadian society is $40 billion, annually.12,13 Psychiatric comorbidity in people with substance-related and addictive disorders are all too common, where between one-quarter and one-half of all patients seeking psychiatric treatment meet criteria for a lifetime SUD,14–17 and for those patients seeking addiction treatment, 40 to 60 per cent are identified to have an independent (nonsubstance-induced) mood disorder.15 In the Canadian health care system, mental health and addiction treatment services have been traditionally compartmentalized and have functioned independently with different philosophies. While we have known for some time that people suffering from a serious and persistent mental disorder with a co-occurring addiction tend to respond less well to traditional abstinence-focused addiction services,18 current fragmented services have impeded the development of a specialized capacity to effectively treat this population. These patients can do well with what has been called integrated treatment, where the treatment of the mental disorder and the addiction illness is provided by the same team of professionals. In fact, more than 50 controlled studies have established the importance of integrating the treatment of patients with co-occurring disorders, which inherently solve the typical problems encountered in the separate systems of care for these individuals.19 For these reasons, Canadian clinical guidelines recommend that all people seeking help from mental health treatment services be screened for co-occurring SUDs.20 Health Canada Best Practices20 further recommend an integrated treatment approach at the program level for people suffering from serious and persistent mental disorders with co-occurring addiction. In 1997, a first position paper was published by the Canadian Psychiatric Association (CPA) in the form of Curriculum Guidelines for Residency Training of Psychiatrists in Substance-Related Disorders.21 Since then, the field of addiction psychiatry has continued to advance, with the emergence of new scientific data regarding neurobiology and psychosocial interventions. Importantly, clinical guidelines have been published for the treatment of SUDs by the American Psychiatric Association (APA)22 and the World Federation of Societies of Biological Psychiatry.23,24 Health Canada also published Best Practices recommendations on concurrent mental and SUDs.20 In addition, in 2007, the Royal College of Physicians and Surgeons of Canada (RCPSC) released the new Specialty Training Requirements (STR) in Psychiatry,25 outlining more specific expectations in addiction training for psychiatry residents. The Objectives of Training (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 postgraduate year [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 definitions81
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.007 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.004 | 0.003 |
| Insufficient payload (model declined to judge) | 0.049 | 0.018 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".