ADDICTION. Observations, Perceptions, Policies. Noor Alzarka

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1 ADDICTION Observations, Perceptions, Policies Noor Alzarka

2 Purpose Describe medical students and medical professionals perceptions, attitudes, and beliefs about addiction and related policies Consider interactions between addiction perceptions, education, and policies Explore approaches to shaping addiction perceptions and policies

3 Observations Addiction is both socially and medically stigmatized Addiction is often attributed to individuals failures Addiction often is not accepted into the medical model of disease and commonly lacks parity with general medical conditions or even with mental illness Substance use often elicits negative attitudes or penalties rather than empathy

4 Perceptions Negative perceptions of addiction as well as lack of belief in treatment efficacy and in physician role responsibility tend to increase as medical training advances (e.g., medical students vs. residents) Addiction medical curricula, training, and physician role models can promote positive changes in medical student attitudes and beliefs Clinical and immersive experiential training produces positive changes and helps reduce regression of positive perceptions Personal or frequent work experiences with addiction promote positive attitudes among medical professionals

5 Policies U.S. emphasizes and spends more on supply reduction policies (e.g., punitive, criminal justice) than demand reduction policies (e.g., public health, prevention, education, training, treatment funding) Factors influencing policy attitudes include: political orientation, gender, race, beliefs about physicians community and advocacy roles Most medical students favor supply reduction strategies Negative attitudes are associated with suboptimal healthcare practices; addiction portrayal impacts attitudes

6 Korszun A, Dinos S, Ahmed K, Bhui K. Medical student attitudes about mental illness: does medical-school education reduce stigma?. Acad Psychiatry. 2012;36(3): References Geller G, Levine DM, Mamon JA, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and house staff regarding the diagnosis and treatment of alcoholism. JAMA. 1989;261(21): Gopalan R, Santora P, Stokes EJ, Moore RD, Levine DM. Evaluation of a model curriculum on substance abuse at The Johns Hopkins University School of Medicine. Acad Med. 1992;67(4): Miller NS, Sheppard LM, Colenda CC, Magen J. Why physicians are unprepared to treat patients who have alcohol- and drug-related disorders. Acad Med. 2001;76(5): Lewis DC. Medical education for alcohol and other drug abuse in the United States. CMAJ. 1990;143(10): Agrawal S, Everett WW, Sharma, S. Medical student views of substance abuse treatment, policy and training. Drugs: education, prevention and policy. 2010;17(5): Rasyidi E, Wilkins JN, Danovitch I. Training the next generation of providers in addiction medicine. Psychiatr Clin North Am. 2012;35(2): Van boekel LC, Brouwers EP, Van weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131(1-2): Van boekel LC, Brouwers EP, Van weeghel J, Garretsen HF. Healthcare professionals' regard towards working with patients with substance use disorders: comparison of primary care, general psychiatry and specialist addiction services. Drug Alcohol Depend. 2014;134:92-8. Williams B, Boyle M, Fielder C. Empathetic attitudes of undergraduate paramedic and nursing students towards four medical conditions: A three-year longitudinal study. Nurse Educ Today. 2015;35(2):e14-8. Crapanzano K, Vath RJ, Fisher D. Reducing stigma towards substance users through an educational intervention: harder than it looks. Acad Psychiatry. 2014;38(4): Boyle MJ, Williams B, Brown T, et al. Attitudes of undergraduate health science students towards patients with intellectual disability, substance abuse, and acute mental illness: a cross-sectional study. BMC Med Educ. 2010;10:71. Livingston JD, Milne T, Fang ML, Amari E. The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review. Addiction. 2012;107(1): Hoffmann NG, Chang AJ, Lewis DC. Medical student attitudes toward drug addiction policy. J Addict Dis. 2000;19(3):1-12. Garland TS, Bumphus VW. Race, bias, and attitudes toward drug control policy. J of Ethnicity in Criminal Justice. 2012;10: Morin SF, Collins C. Substance abuse prevention: moving from science to policy. Addiction Behaviors. 2000;25(6): Hawkins JD, Catalano RF, Arthur MW. Promoting science-based prevention in communities. Addict Behav. 2002;27(6): Mcginty EE, Goldman HH, Pescosolido B, Barry CL. Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination. Soc Sci Med. 2015;126: Ghitza UE, Tai B. Challenges and opportunities for integrating preventive substance-use-care services in primary care through the Affordable Care Act. J Health Care Poor Underserved. 2014;25(1 Suppl):36-45.

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