Medical education about substance abuse: changes in curriculum and faculty between 1976 and 1992

PURPOSE: To examine changes in substance abuse education in U.S. medical schools between 1976 and 1992. METHODS. In 1991–92 the authors conducted a 16-year follow-up survey of six clinical departments in each of the 126 U.S. medical schools. Two previous surveys by scholars and surveys conducted by the Liaison Committee on Medical Education, Association of American Medical Colleges, and the National Center for Medical Fellowships in the Addictions provided baseline data for comparison. The statistical methods used in the comparisons were paired t-tests, one-way analyses of variance, and tests of differences between proportions. RESULTS. Significant increases were found in the numbers of required and elective curriculum units for medical students between 1986–87 and 1991–92. The number of medical schools requiring courses in substance abuse treatment increased from five to eight between 1986–87 and 1991–92. For residents, there were significant increases in the numbers of curriculum units for residents in family medicine and pediatrics. The average number of faculty in the 116 medical schools that reported units on substance abuse was 4.1. There were 45 fellowships in addiction medicine identified in 1991–92, with a total of 61 fellows in training. CONCLUSION. While the findings confirm positive changes, the amount of curricula time and the number of faculty having expertise in substance abuse education do not compare well with the amounts of time and numbers of faculty involved in clinical problems of similar prevalence, such as cancer and heart disease.