Management and treatment efficacy of drug and alcohol problems: what do doctors believe?

We conducted a survey of the attitudes of postgraduate medical trainees in Australia on the management of drug and alcohol problems and examined the medical practitioner's role in managing drug and alcohol problems, factors influencing prognosis and beliefs about the efficacy of a number of treatment interventions. Of 2461 trainees enrolled in specialty training programmes in internal medicine, psychiatry and general practice 1361 (55%) participated. There was a high level of acceptance of responsibility for management of alcohol and drug problems, with the strongest support observed among psychiatry trainees. However, views of the efficacy of various treatment interventions were less positive. Alcoholics Anonymous was considered to be an approach well supported by the research literature. Dynamic psychotherapy was less well supported, and there was considerable uncertainty about the evidence for brief advice and cognitive-behaviour therapies. The opinions expressed on treatment efficacy were in many cases in striking contrast to the research evidence. The implications for future training in drugs and alcohol in specialty programmes are discussed.

Managing alcohol and drug problems in general practice: a survey of trainees' knowledge, attitudes and educational requirements.

To establish baseline data on Family Medicine Programme trainees' knowledge of and attitudes to drug and alcohol problems, we posted questionnaires to all trainees in New South Wales, Queensland, Victoria and South Australia. A total of 1647 trainees was surveyed, with a response rate of 55 per cent (n = 908). The mean age of respondents was 29 years and 54 per cent were female. The majority of respondents (58 per cent) were in their final year of training. Overall knowledge levels were reasonably good (the mean score was 76 per cent), but there were significant areas of deficit. Senior trainees generally performed better than their junior counterparts. Knowledge was best for alcohol and weakest for opiates. Attitudes towards involvement with drug and alcohol problems were very positive; however, confidence in the efficacy of various interventions was mixed.

Substance abuse disorders: psychiatric trainees' knowledge, diagnostic skills and attitudes.

OBJECTIVE: The drug and alcohol related knowledge and attitudes of trainee psychiatrists were examined to obtain a baseline measure of these factors in order to determine whether current training is appropriate and adequate. METHOD: A questionnaire was distributed to trainees enrolled in the training program of the Royal Australian and New Zealand College of Psychiatrists in New South Wales, Victoria, Queensland and South Australia (N = 425). Questions were asked relating to theoretical knowledge, diagnostic and problem solving skills for a number of drug groups; further questions concerned the respondents' attitudes and opinions on aspects of management. RESULTS: Sixty per cent of recipients returned the questionnaire. Theoretical and applied knowledge levels were of an adequate standard overall, but highly variable. Notable areas of weakness included knowledge of opiates, barbiturates and stimulants. Trainees' views regarding treatment options were also variable. Alcoholics Anonymous was considered the best supported form of treatment from evidence from controlled trials. Low levels of self efficacy and little support were recognised for early intervention strategies. CONCLUSIONS: While positive views were generally expressed towards involvement with patients with alcohol and drug problems, specific strategies to enhance training and performance are needed. Findings are discussed in terms of continuing education. It is recommended that if sufficient training in this area is not provided then psychiatrists will have little confidence in appropriate therapeutic approaches in treating substance misusers.