Survey of Pharmacy Abuse Substance Course Content 1

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1 Survey of Pharmacy Abuse Substance Course Content 1 Jeffrey N. Baldwin a, Ernest J. Dole b, Philip J. Levine c, Kim E. Light d, Matthew M. Murawski e, Christopher Stock f, Anthony C. Tommasello g, George A.W. Waterhouse h a College of Pharmacy, University of Nebraska, 600 S. 42nd Street, Omaha NE ; b College of Pharmacy, University of New Mexico, Albuquerque NM ; c College of Pharmacy and Health Sciences, Drake University, Des Moines LA ; d College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock AR ; e School of Pharmacy, Virginia Commonwealth University, Richmond VA ; f College of Pharmacy University of Utah, Salt Lake City UT 84112; g School of Pharmacy, University of Maryland, Baltimore MD ; h School of Pharmacy, Campbell University, Buies Creek NC CHARGE In July, 1992, Hugh F. Kabat, chair of the Council of Faculties (COF) of the American Association of Colleges of Pharmacy (AACP), established the Substance Abuse Course Content Committee with the following charges: 1. survey AACP member Schools/ Colleges to assess the degree of utilization and implementation of Substance Abuse and Addictive Disease core curriculum(1); 2. develop strategies to foster implementation and utilization of core curriculum and resources; and 3. prepare recommendations and/or resolutions for transmission to the COF Resolutions Committee for action at the 1993 annual business meeting. The Committee was reappointed with the addition of Ernest Dole by R. Lee Evans, chair of the COF in July, 1993 because funding for the survey was not available until Fall, Charge 3 was revised to reflect potential action at the 1994 annual business meeting. METHODS Members of the Substance Abuse Course Content Committee developed and field-tested a survey (see appendix) designed to evaluate the degree of utilization and implementation of Substance Abuse and Addictive Disease core curriculum(1) [hereafter the guidelines ] and to provide input regarding Charge 2 during AACP approved funding of the survey during Fall, AACP sent out the surveys, which contained a copy of the guidelines with instructions to return them to the Committee chair. The survey was mailed during December, 1993 addressed to the chairman of each college s curriculum committee, with a follow-up letter being mailed in January Additional surveys were mailed in February, 1994 addressed to the deans of colleges from which no response had been received. During April, 1994, the Committee chair sent a final mailing of surveys to members of the SIG on Substance Abuse Education and Assistance (hereafter, the SIG ) at nonresponding colleges asking that they assist in obtaining the needed information. RESULTS Responses were received from 63 of the 75 U.S. pharmacy colleges surveyed (84 percent return). Sixty-six percent of respondents were aware of the existence of the curricular guidelines (Question la). About 50 percent of the material had been adopted by the 51 1 Report of The Council of Faculties Substance Abuse Course Content Committee. American Journal of Pharmaceutical Education Vol. 58, Winter Supplement S

2 responding colleges (Question lb); 52 percent curricular concordance with the recommendations was reported by 59 responding schools (Question 1c). Goals in the guidelines were felt to be consistent with the desired goals of the substance abuse content in their curriculum by 58 responding colleges (97 percent); there were three colleges which did not respond to the question (Question Id). The required curriculum at the 62 colleges responding to question 2 contained an average of 63 percent of recommended pharmacologic, toxicologic, and therapeutic alcohol and other drug (AOD) use content, 54 percent of recommended content concerning AOD use legal issues, 41 percent of recommended issues related to psychosocial aspects of AOD use, and 39 percent of recommended content concerning identification, intervention and treatment for addictive disease. Elective curriculum covered 43 percent (pharmacology, etc.), 29 percent (legal), 44 percent (psychosocial), and40 percent (addiction treatment) of the recommendations for the same 62 respondents. Approximately half of the respondents indicated their intention to change their substance abuse curricular content in the future. Those who planned to change curriculum indicated that they planned to increase their required AOD pharmacology (required, from 63 to 68 percent; elective, from 43 to 62 percent), their AOD legal issues content (required, from 54 to 63 percent; elective, from 29 to 50 percent), AOD psychosocial aspects content (required, from 41 to 58 percent; elective, from 44 to 62 percent), and addictive disease treatment content (required, from 39 to 57 percent; elective, from 40 to 63 percent). When asked to list any extracurricular programs concerning substance abuse which involved their students, 21 colleges (33 percent) indicated they were involved in community drug abuse presentations, six (10 percent) reported involvement in state pharmacist recovery networks, and seven (11 percent) indicated their students attended the University of Utah School on Alcoholism and Other Drug Dependencies. A variety of other activities are listed in the narrative. 2 Four respondent colleges (6 percent) felt that the guidelines were not useful since their AOD curriculum was presently adequate, three (five percent) indicated that the guidelines were not useful because they had no plans to change their curriculum, 13 (21 percent) responded that the guidelines would be used to a limited extent, 32 (52 percent) planned to use them to a large extent, and 11 (17 percent) indicated they adopt them as closely as possible. The listing of resources contained in the guidelines was felt to be useful by 56 (97 percent) of the 58 colleges responding to Question 7. Comments indicated these were felt to be useful in developing substance abuse curricular content. Several commented that this resource list should be updated periodically. Question 8 asked respondents to list additional resources they felt they needed to facilitate substance abuse curricular development. Faculty with expertise in the area, administrative commitment, course or lecture outlines, and videotapes were each cited at least twice as needs. Question 9 asked respondents to list changes they would suggest were the guidelines being revised. Changes recommended more than once included reducing the emphasis in the required curriculum recommendations concerning counseling/ intervention and inclusion of more experiential emphasis. Question 10 asked respondents to identify and prioritize topics which they felt would be useful to their faculty in preparing them to deal with substance abuse prevention, assistance, and education issues at their colleges, with 1 being most important. Respondents were instructed to leave blank any choices which they felt would not be useful to their faculty. The highest priority is assigned to recognizing alcoholism and other addictions (score 2.10, 58 respondents), with psychosocial aspects of alcoholism and other drug dependencies (2.95, N=57), getting help for alcoholics and other addicts (3.45, N=56), and intervention 2 A summary of the results and a narrative summary of comments can be obtained by writing the Committee chair training (3.75, N=53) receiving relatively high levels of support. Question 11 requested that respondents identify formats which they felt would work best for their faculty in providing information identified in question 10. Respondents were asked to identify and prioritize those formats which they felt would work best for their faculty, leaving blank any items they felt would not be useful. The top five choices, in order of decreasing preference were; faculty retreat (3.24, N=45), local lecture/seminar using an outside speaker (score 3.25, N=52), faculty attendance at the University of Utah School on Alcoholism and Other Drug Dependencies Pharmacist Section (3.44, N=48), videotape lectures viewed as a group (4.17, N=42), and seminar in conjunction with an AACP meeting (4.34, N=47). Forty-four respondents (70 percent) reported that at least 1 of their faculty (average 1.9/college) had attended the University of Utah School on Alcoholism and Other Drug Dependencies. Respondents were asked to list other programs concerning substance abuse which they had found useful in the education of their faculty or students. State pharmacist recovery programs were cited by nine respondents, regional pharmacist recovery network meetings by five, and the Southeastern Conference of Alcoholism and Drug Abuse (SECAD) by two. Other responses often identified resources recommended already in the guidelines. When asked Do you think your college would support inclusion of minimum competencies concerning substance abuse education as a requirement of the accreditation process, 37 (64 percent) of 58 respondents indicated they would. Comments suggested that this might force change, but concern was expressed that these should not be as comprehensive as the guidelines. Others suggested that this should not be a separate entity, but rather, a component of the definition of professional competencies and testing these for licensure. Respondents were asked to list what AACP and the SIG could be doing to assist them in their college s efforts in the areas of substance abuse education, assistance, and prevention. Responses receiving more than one mention (and number of mentions) included: assistance in educating faculty (four), prioritization of substance abuse curriculum development through AACP recommendation (three), provision of AACP programming at an annual meeting (three), assistance with specific course content (three), inclusion in accreditation guidelines or licensure competencies (three), visiting professors or a speaker network (two), and developing canned resources such as videotapes or lectures (two). DISCUSSION The first mailings were to curriculum committee chairs, while later mailings were to deans and members of the SIG. This may potentially have resulted in the completion of these surveys by faculty with varying levels of knowledge and interest at the responding colleges. However, survey recipients were requested to consult with other faculty members where appropriate to obtain pertinent information. A preliminary report submitted in February, 1994 reflecting returns from 30 colleges where only the curriculum committee chairs had received surveys agrees closely with the results reported herein. Responses were not obtained from the following colleges: Auburn, Samford, San Francisco, Florida A&M, Northeast Louisiana, Massachusetts, Creighton, A&M Schwartz, Campbell, Ohio State, Medical University of South Carolina, and Wyoming. The provision of the guidelines to the curriculum committee chair may have increased the awareness of this resource and the need for substance abuse curricular revision. About one-third of respondents were unaware of the existence of these guidelines, yet 97 percent of 60 respondents indicated that the goals in the guidelines were consistent with their desired substance abuse curricular course content and 97 percent of responding colleges felt that the resource list would be useful. When compared with guideline recommendations, curricular offerings concerning AOD use were most often in place for pharmacologic/toxicologic/therapeutic and legal aspects of AOD use and were least inclusive of psychosocial and treatment aspects of AOD use. About half of the 48S American Journal of Pharmaceutical Education Vol. 58, Winter Supplement 1994

3 respondents indicated they planned to increase their substance abuse-related curricular offerings. Plans included the greatest expansion in the areas of psychosocial and treatment aspects of AOD use. Fifty-six respondents (89 percent) indicated they would use the guidelines in some way to assist in substance abuse curricular revision; 4 additional colleges already felt they had an adequate curriculum in place. Student involvement in community drug abuse education, involvement in state pharmacist recovery programs, and attendance at the Utah School on Alcoholism and Other Drug Dependencies were often listed as extracurricular programs for students. Since this was an open-ended question, it is probable that student involvement is higher than cited: for example, about 25 colleges had students who attended the Utah School in 1993 and 40 colleges were so represented in When asked to identify faculty needs concerning their preparation to deal with substance abuse prevention, assistance, and education issues at their colleges, respondents were instructed not to rank items which they did not feel were needs. Fifty-seven respondents (90 percent) identified issues which they felt merited attention. Priority ranking indicated the greatest need in the areas of addiction recognition, psychosocial aspects of AOD use. getting help for addictions, and intervention training. Preferred methods for delivery (maximum N=52) included faculty retreats, local lectures or seminars using an outside speaker or videotapes, faculty attendance at the Utah School, or seminars at an AACP meeting. Use of the speakers bureau through the APhA Pharmacist Recover} Network and available campus or community substance abuse counselors would permit the accomplishment of many of these educational needs. Seminars or prioritized mainstream programming at an AACP meeting may facilitate administrative acceptance of the need for curricular revision and for faculty education in these areas. Annual regional pharmacist recovery network meetings and state pharmacist recovery programs are additional cited resources which a number of colleges have found to be valuable in faculty and student education concerning AOD use. Although most colleges indicated their college would support inclusion of minimum competencies concerning substance abuse education as a requirement for college accreditation, course content for accreditation purposes is defined only in broad, general categories. The inclusion of competencies related to the impact of AOD use on pharmaceutical care in NABPLEX licensure examinations and ongoing education of faculty and administrators through AACP and the SIG is a more feasible approach. Additional recommendations for AACP and the SIG include assisting in the development of specific course content and the development of videotapes and lecture outlines. STRATEGIES TO FOSTER IMPLEMENTATION The SIG should work with AACP to develop mechanisms for providing updated lists of resource materials for the development of substance abuse curricular content and use in the education of faculty members. This could include publication in the Journal, in newsletters, or inclusion on a computer bulletin board service; it should be a media which could potentially reach the entire AACP membership. The SIG and AACP should, in cooperation, assist in the aggressive promotion of resources such as the University of Utah School on Alcoholism and Other Drug Dependencies, regional pharmacist recovery network meetings, APhA s Pharmacist Recovery Network and its speaker bureau, and state pharmacist recovery programs as educational opportunities for pharmacy faculty and students. The SIG and AACP should consider the establishment of a networking mechanism for the sharing of information such as course outlines and of information other than resource materials, such as meeting schedules and student activities (computer bulletin board?). The SIG and AACP should explore the inclusion of a substance abuse seminar in the mainstream programming of future AACP national meetings (Teachers Seminar, workshops, trainthe-trainer, highlighted poster and platform sessions at AACP February or July meetings). The SIG and AACP should explore methods for providing faculty education concerning substance abuse at the local level. The development of a substance abuse speakers bureau within AACP or in cooperation with APhA s speakers bureau which could provide visiting professors and other lecturers for retreats, lectures, seminars, or train-the-trainer programs at colleges lacking these resources for faculty and student education should be considered. Support for the development of videotapes and other educational resources is recommended. Prioritization of addiction recognition, intervention, and referral, and psychosocial aspects of AOD use is recommended. The SIG and AACP should explore the inclusion of pharmacy faculty in the NIDA/NIAAA career teacher s program which currently includes only medical, nursing, and social work faculty. The SIG and AACP should promote the inclusion of test items reflecting competencies related lo the AOD use issues which impact pharmaceutical care in NABPLEX licensure examinations through liaison activities with NABP. RECOMMENDATIONS/RESOLUTIONS RECOMMENDATION 1: AACP should actively advocate the inclusion of test items reflecting competencies related to the alcohol and other drug use issues which impact pharmaceutical care in NABPLEX licensure examinations through liaison activities with NABP. RECOMMENDATION 2: Colleges of pharmacy should be encouraged by AACP to promote the knowledge, skills, attitudes, and values necessary to provide quality pharmaceutical care in the prevention and treatment of substance abuse disorders as a critical component in the preparation of pharmacists. RECOMMENDATION 3: Colleges of pharmacy should be encouraged and assisted by AACP in developing core curricular content concerning substance abuse disorders. This should encompass the recommendations previously published(1) and should include psychosocial and treatment content as well as legal and pharmacotherapeutic issues. RECOMMENDATION 4: AACP should explore with NIDA/ NIAAA the inclusion of pharmacy faculty in the career teachers program. RECOMMENDATION 5: AACP should prioritize the education of pharmacy faculty concerning substance abuse. Weaknesses especially exist in the areas of psychosocial and treatment (i.e., recognition, intervention, referral, treatment, recovery support) aspects of substance abuse, which discourage the development of substance abuse assistance and educational programs in the colleges. Prioritization of substance abuse issues in mainstream educational offerings at national AACP meetings, the development of a substance abuse speaker s bureau within AACP of faculty and other individuals who can assist in faculty education at the local level, and the development of an information-sharing resource which is available to the membership (e.g., bibliographic resource, videotape resources, lecture and course outlines, networking, meetings) as a computer bulletin board are recommended as AACP projects. RECOMMENDATION 6: AACP should promote faculty and student attendance at substance abuse related conferences such as the University of Utah School on Alcoholism and Other Drug Dependencies and regional pharmacist recovery network meetings through the inclusion of articles and meeting schedules in AACP publications. RECOMMENDATION 7: AACP should continue to promote faculty attendance at the University of Utah School on Alcoholism and Other Drug Dependencies Pharmacist Section through the American Journal of Pharmaceutical Education Vol. 58, Winter Supplement S

4 coordination of the faculty scholarship program. AACP should seek additional outside funding to facilitate faculty attendance. Am J. Pharm. Educ., 58, 47S-52S(1994); received 9/28/94. Reference (1) Baldwin. J.N., et al., Curricular guidelines for pharmacy education: Substance abuse and addictive disease, Am. J. Pharm. Educ., 55, (1991). APPENDIX A. SURVEY ON UTILIZATION AND IMPLEMENTATION OF SUBSTANCE ABUSE AND ADDICTIVE DISEASE CORE CURRICULUM 1. A copy of Curricular Guidelines for Pharmacy Education: Substance Abuse and Addictive Disease, Am. J. Pharm. Educ., 55, (1991) is enclosed. a. Have you seen this before? ( ) Yes (go to Question 1b) ( ) No (go to Question 1c) b. To what extend has your college adopted these guidelines (circle the most representative number)? Not at all Totally c. How closely does the substance abuse content of your curriculum correspond with these guidelines? Not at all Totally d. Do you feel that the goals suggested in these guidelines (page 312) would be consistent with the desired goals of the substance abuse content in your own curriculum? ( )Yes ( )No If no please explain why not or identify which specific goals are inconsistent with your curricular goals. 2. Please review the guidelines (pages ) and objectives (pages ) in the enclosed article and estimate and circle the approximate percentage of the objectives for each category which are covered in your presently required and elective curriculum. IF YOU COVER OTHER TOPICS IN ANY OF THE CATEGORIES PLEASE LIST THEM AS COMMENTS; ALSO PLEASE INDICATE AREAS WHERE YOUR PRESENT CURRICULUM SIGNIFICANTLY DIFFERS FROM THE REC- OMMENDATIONS, SUCH AS POSITIONING IN THE CURRICULUM OR CONTENT. a. Psychosocial Aspects of Alcohol and Other Drug Use b. Pharmacology/Toxicology and Therapeutic Aspects of Alcohol and Other Psychoactive Drugs c. Addictive Disease: Identification, Intervention and Treatment d. Legal Issues 3. Please review the guidelines (pages ) and objectives (pages ) in the enclosed article and estimate and circle approximate percentage of the objectives for each category (including present content) which you hope to cover in your required and elective curriculum in the future. IF YOU PLAN TO MAKE NO FURTHER CHANGES IN THE CONTENT, PLEASE PROCEED DIRECTLY TO QUESTION 4 WITHOUT ANSWERING THIS QUESTION. IF YOU PLAN TO TEACH LESS IN A CATEGORY, LIST A LOWER PERCENTAGE THAN IN QUESTION IF YOU PLAN TO COVER OTHER TOPICS IN ANY OF THE CATEGORIES, PLEASE LIST THEM AS COMMENTS; ALSO PLEASE INDICATE AREAS WHERE YOUR FUTURE PLANS WILL SIGNIFICANTLY DIFFER FROM THE RECOMMENDATIONS. SUCH AS POSITIONING IN THE CURRICULUM OR CONTENT 50S American Journal of Pharmaceutical Education Vol. 58, Winter Supplement 1994

5 a. Psychosocial Aspects of Alcohol and Other Drug Abuse b. Pharmacology /Toxicology and Therapeutic Aspects of Alcohol and Other Psychoactive Drugs c. Addictive Disease: Identification, Intervention and Treatment d. Legal Issues 4. If there are extracurricular programs concerning substance abuse which involve your students, please list them here and give a brief explanation of their involvement. 5. If you plan to develop extracurricular programs concerning substance abuse which will involve your students, please list what you plan to do and how you plan to involve students. 6. How useful will these guidelines be in revising your own curricular content concerning substance abuse? ( ) Not useful at all; we already have an adequate curriculum in place ( ) Not useful at all; we do not plan to change our curriculum ( ) Useful but only to a limited extent ( ) Will be used to a large extent, but not completely ( ) Will be adopted as closely as possible COMMENTS (Why or why not?): 7. Is the listing of resources (pages ) useful to you? ( ) Yes ( ) No COMMENTS (Why or why not?): 8. What additional resources do you feel you need? (Please list) 9. If the guidelines were being revised, what would your suggestion(s) be: Deleted: Changed: Added: 10. Faculty may be poorly prepared to deal with substance abuse prevention, assistance, and education issues as many of these programs are being developed at colleges of pharmacy. Which of the following topics do you feel would be useful to your faculty in helping to prepare them for these issues? Please rank the following, using each number only once, with 1 being most important, leaving blank any choices which you feel would not be useful to your faculty. Psychosocial aspects of alcoholism and other drug dependencies Pharmacology/toxicology of alcohol and other addicting substances Intervention training Recognizing alcoholism and other addictions Getting help for alcoholics and other addicts Recovery support for alcoholics and other addicts Legal aspects of alcoholism and other addictions American Journal of Pharmaceutical Education Vol. 58, Winter Supplement S

6 11. Which of the following formats do you feel would work best for your faculty in providing information contained in question 10? Please rank the following, using each number only once, with 1 being most important, leaving blank any choices which you feel would not useful to your faculty. Local lecture or seminar by a faculty member from your college Local lecture or seminar by an outside speaker Faculty retreat format Videotape lectures viewed as a group Videotape lectures viewed on an individual basis Computerized literature sources Pharmacy substance abuse resource center Seminar in conjunction with an AACP meeting Faculty attendance at the University of Utah School on Alcoholism and Other Drug Dependencies Pharmacist Section Other format {PLEASE EXPLAIN): 12. Have any faculty members at your college attended the University of Utah School on Alcoholism and Other Drug Dependencies Pharmacist Section? ( )Yes (How many? ) ( )No 13. What other local, regional, or national programs concerning substance abuse which you have found useful in the education of your faculty or students? 14. Do you think your college would support inclusion of minimum competencies concerning substance abuse education as a requirement of the accreditation process? ( ) Yes ( ) No 15. What more could AACP and its SIG on Substance Abuse Education and Assistance be doing to assist your college in your substance abuse education, assistance and prevention efforts? 52S American Journal of Pharmaceutical Education Vol. 58, Winter Supplement 1994