January 31, 2003

H. Westley Clark, MD, JD, MPH

Director, Center for Substance Abuse Treatment

Rockwall II, Suite 615

5600 Fishers Lane

Rockville MD 20857

Dear Dr. Clark

As you know, since its inception, the American Academy of Addiction Psychiatry has strongly advocated for requiring information about addictions at all levels of medical education. Given the tremendous unmet treatment needs of individuals with alcohol and other drug problems, there can be no doubt that there is a significant role for all health professionals in the prevention and treatment of substance use disorders—it is not the province of a single discipline! It is in this context that we wish to bring to your attention our concerns about several of the recommendations contained in the Strategic Plan for Interdisciplinary Faculty Development that was released in September 2002. We are especially concerned because this report and activities associated with Project MAINSTREAM received CSAT funding, prominently display CSAT’s support and could, therefore, be interpreted as representing the views of CSAT.

There are two specific recommendations that exemplify our concerns; they appear to ignore extant resources and call into question the motivation of the writers and the viability of any of the options presented. Recommendation #5 calls for the creation of a HRSA interdisciplinary faculty development fellowship specialist training program in substance use disorders. Although the concept is a good one, the operational definitions appear to overlook existing manpower resources in the field that could serve as the core of such a training program such as the PGY-5 addiction psychiatry residencies in 43 medical schools across the country. Additionally, according to the Strategic Plan, the "interdisciplinary specialist educators in substance abuse" would be drawn primarily from alumni of Project MAINSTREAM. This group of highly qualified individuals does not appear to be broadly representative of the cadre of educators who are needed to make a significant impact on the field. For example, specialists in addiction psychiatry are notably absent. We believe that the involvement of addiction psychiatrists is crucial to improving medical education in substance abuse.

Another example of our concern appears in Recommendation #9 that calls for the convening of representatives of licensure, certification and accreditation bodies to consider how certification requirements can better address SUDs. Unfortunately, there is no reference in the document to the experience gained by addiction psychiatry in achieving subspecialty status. The lengthy and intensive route to achieving recognition of SUDs as a legitimate area of medicine or of any other health profession, is likely to benefit greatly by the decade long battles fought and won within psychiatry. The American Academy of Addiction Psychiatry has, within its membership, many of the resources to provide advice and consultation to others interested in increasing attention to SUDs within their profession. This includes identifying core competencies, developing criteria and questions for examinations and offering review courses to prepare for the examinations.

We would be pleased to discuss these issues with you in more depth and offer the resources of the Academy to collaborate with you in improving the substance abuse education of health professionals.

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