Serving Substance Abuse Professionals Since 1993

Last Update: 06.03.12

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Professional Education

82 citations. 2010 to present

Prepared: March 2012

Anderson BL; Dang EP; Floyd RL; Sokol R; Mahoney J; Schulkin J. Knowledge, opinions, and practice patterns of obstetrician-gynecologists regarding their patients' use of alcohol. Journal of Addiction Medicine 4(2): 114-121, 2010. (26 refs.)

Objective: To evaluate the evolution of fetal alcohol spectrum disorder prevention practices including awareness and use of recently published tools. Methods: Fellows of the American College of Obstetricians and Gynecologists were asked about their knowledge, opinions, and practice regarding alcohol-related care. Eight hundred obstetrician-gynecologists (ob-gyns) were selected; 48.1% returned the survey. Results: The majority (66.0%) indicated that occasional alcohol consumption is not safe during any period of pregnancy. There was no consensus when asked if alcohol's effect on fetal development is clear (46.9% thought it was clear and 45.9% did not). Most (82.2%) ask all pregnant patients about alcohol use only during patients' initial visit, whereas 10.6% ask during initial and subsequent visits. Most (78.5%) advise abstinence when pregnant women report alcohol use. When asked which validated alcohol risk screening tool they most commonly use with pregnant patients, 57.8% said they use no tool. Although 71.9% felt prepared to screen for risky or hazardous drinking, older ob-gyns indicated feeling significantly more unprepared than younger ob-gyns. "Patient denial or resistance to treatment" was the top issue affecting alcohol screening and "referral resources for patients with alcohol problems" was the resource needed most. Most ob-gyns were not aware of the National Institute on Alcohol Abuse and Alcoholism "Clinician's Guide" or the American College of Obstetricians and Gynecologists "Fetal Alcohol Spectrum Disorder Prevention Tool Kit." Conclusions: There are few changes in the alcohol-related screening and treatment patterns of ob-gyns since 1999; although perceived barriers and needs have changed. Interventions, including referral resources and continuing medical education training, are warranted.

[Anonymous]. Addiction medicine and substance abuse care. (editorial). Canadian Family Physician 57(11): e429-e429, 2011. (1 refs.)

Balls JE; Price JH; Dake JA; Jordan TR; Khuder S. African American primary care physicians' perceptions and practices regarding smoking cessation therapy. Journal of The National Medical Association 102(7): 579-589, 2010. (39 refs.)

African American smokers (34% of males and 23% of females) need formal interventions to assist them in quitting smoking, a major method of preventing premature mortality from smoking-related illnesses. The purpose of this study was to examine African American primary care physicians' perceptions and practices regarding smoking cessation counseling. A national random sample (n = 202) of primary care physicians was asked about their perceptions and practices regarding smoking cessation therapy. Most (89%) placed themselves in the maintenance stage for asking their patients about their smoking status and regularly documented the smoking status of their patients (70%). Most physicians did not comply with all of the components of the US Public Health Services' smoking cessation guidelines (eg, 5 A's and 5 R's). The component most often implemented of the 5 A's was to "advise" patients to quit (89%), and "arrange" follow-up was the least frequently (60%) used component. Perceived barriers to engaging in smoking cessation interventions were time (38%) and patients not interested in quitting (19%). Although physicians used many of the steps in the 5 A's and 5 R's, they were far less compliant in recommending, nicotine replacement therapy, prescribing pharmacotherapy, and providing support and/or follow-up for patients who were willing to quit smoking. Physicians need more academic preparation in providing smoking cessation counseling since few received such training in medical school (31%) or during their residency programs (18%).

Beidas RS; Koerner K; Weingardt KR; Kendall PC. Training research: Practical recommendations for maximum impact. Administration and Policy in Mental Health and Mental Health Services Research 38(4, special issue): 223-237, 2011. (108 refs.)

This review offers practical recommendations regarding research on training in evidence-based practices for mental health and substance abuse treatment. When designing training research, we recommend: (a) aligning with the larger dissemination and implementation literature to consider contextual variables and clearly defining terminology, (b) critically examining the implicit assumptions underlying the stage model of psychotherapy development, (c) incorporating research methods from other disciplines that embrace the principles of formative evaluation and iterative review, and (d) thinking about how technology can be used to take training to scale throughout all stages of a training research project. An example demonstrates the implementation of these recommendations.

Butler S. Addiction studies at Trinity College Dublin. (editorial). Drugs: Education, Prevention and Policy 18(4): 241-242, 2011. (8 refs.)

Carroll KM; Martino S; Rounsaville BJ. No Train, No Gain? (editorial). Clinical Psychology: Science and Practice 17(1): 36-40, 2010. (20 refs.)

What kind of training is needed for what type of clinician to deliver what type of therapy? Beidas and Kendall's (2010) well-considered recommendations for further research into systematic strategies for training clinicians to utilize evidence-based treatments highlight the limitations of didactic training alone (without supervision, fidelity monitoring, and feedback) in conferring specific skills to clinicians. To further amplify some of the points made, we summarize findings from our recent series of trials, which involved training community-based addiction clinicians to perform evidence-based therapies in a multisite randomized clinical trial. In particular, review of tapes from the "treatment as usual" condition in that study suggests that (a) delivery of interventions associated with evidence-based treatment was infrequent, (b) clinicians overestimated the time spent on evidence-based interventions, and (c) ongoing supervision and performance-based feedback appear to suppress time spent in session on discourse unrelated to the patient's problems and concerns. We also discuss computer-assisted treatment and computer-assisted clinician training as important new tools for disseminating evidence-based therapies.

Chandrashekar J; Manjunath BC; Unnikrishnan M. Addressing tobacco control in dental practice: A survey of dentists' knowledge, attitudes and behaviours in India. Oral Health & Preventive Dentistry 9(3): 243-249, 2011. (47 refs.)

Purpose: Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. The objective of this study was to assess the tobacco cessation knowledge, attitudes and behaviours of dental practitioners in Kochi (Cochin), Kerala, India. Materials and Methods: A sampling frame of dentists enrolled in the Indian Dental Association (IDA), Kochi (Cochin) branch, practising in Ernakulam city, was obtained from the IDA. The letter describing the rationale for the study contained a 35-item pre-tested questionnaire and was personally delivered along with a stamped envelope. One hundred fourteen dentists returned a usable questionnaire. Data were entered and analysed using SPSS 12. Frequencies were calculated 'for all variables. Results: Based on the responding dentists' self-reports, 54.6% were not confident in tobacco cessation counselling, 10.6% never asked, 60.9% asked in 50% of their patients about tobacco use and 17.6% of the dentists surveyed were smokers themselves. Participating dentists perceived that they were interested in using tobacco cessation counselling, but were not sure of quitting rates in their patients. The average time spent counselling patients about tobacco cessation was less than 2 minutes. Conclusion: The dentists perceived that lack of formal training leads to less motivation about tobacco counselling and hence infrequently incorporated tobacco cessation into their dental practices. The cessation of tobacco habits among dentists is essential.

Chen PL; Huang WG; Chao KY. Factors associated with Taiwanese junior high school personnel advising students to quit smoking. Journal of School Health 81(2): 91-99, 2011. (35 refs.)

METHODS: School personnel (N = 7129) were recruited by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004. RESULTS: Most personnel (70%) had advised students to quit smoking. School personnel who were older, male, responsible for teaching health, smokers, with positive attitude against tobacco, or with more knowledge of tobacco hazards were more likely to advise students to quit smoking. Personnel with more interest in and access to tobacco-related materials were more likely to advise students to quit smoking. Personnel who had received tobacco-prevention training were 2.41 times more likely to persuade students to quit smoking after adjusting for other factors. However, only half of the participants had ever had access to educational materials about tobacco use, and 8% had ever received training to prevent tobacco use. CONCLUSIONS: To reduce youth smoking prevalence, school tobacco-control programs should support tobacco-prevention training for school personnel.

Christie G; Merry S; Robinson E. Do young people attending addiction services differ from those attending youth mental health services? Drug and Alcohol Review 29(4): 406-412, 2010. (50 refs.)

Introduction and Aims. We aimed to describe and compare the self-reported substance use, psychopathology and psychosocial morbidity in adolescents attending two adolescent outpatient services, a triage-based mental health service and an engagement-focused addiction service in Auckland, New Zealand. Design and Methods. A naturalistic cross-section of 131 (addiction service = 67, mental health service = 64) 14-18-year-old boys and girls attending each service completed a standardised screening and assessment instrument, the Drug Use Screening Inventory-Revised. The Drug Use Screening Inventory-Revised measures self-reported problems across 10 domains of functioning, including substance use, behaviour, psychiatric symptoms and school and family functioning. Descriptive statistics were used to provide an overview of the self-reported morbidity in each group and t-tests were used to determine differences between the two groups. Results. Adolescents attending the addiction service reported significantly more problems with substance use, school performance and peer relationships than those attending the mental health service. There was no significant difference in reported psychiatric symptoms, behavioural problems, social competency, health problems, family problems, difficulties in work functioning or leisure time between the two groups. Discussion and Conclusions. Young people presenting to engagement-focused substance use services report similar difficulties to those at mental health services across most areas of psychosocial functioning. Addiction services may require equivalent staffing expertise and workforce development to that in mental health to effectively meet young people's needs.

Clifford A; Shakeshaft A. Evidence-based alcohol screening and brief intervention in Aboriginal Community Controlled Health Services: Experiences of health-care providers. Drug and Alcohol Review 30(1): 55-62, 2011. (32 refs.)

Introduction and Aims. Alcohol screening and brief intervention (SBI) is a cost-effective treatment for reducing alcohol misuse in non-Indigenous populations. To increase the likelihood of alcohol SBI proving cost-effective for Indigenous Australians in practice, strategies to increase its uptake in Aboriginal Community Controlled Health Services (ACCHSs) should be implemented. The aim of this study is to describe the experiences of health-care providers supported to implement evidence-based alcohol SBI in two ACCHSs. Design and Methods. Pre- and post-surveys were administered to health staff (n = 32) participating in training workshops, followed by group interviews with health-care providers delivering alcohol SBI. Patient group interviews were also conducted. Survey results were summarised using descriptive statistics and interviews were analysed using a phenomenological approach. Results. Thirty-two per cent (n = 10) of workshop participants were confident or very confident at baseline to deliver alcohol SBI, increasing significantly to 81% (n = 25) post-training (McNemar Test, P < 0.05). Fifty-seven per cent (n = 16) of health-care providers attending workshops reported delivering alcohol SBI in the following 6 months. Group interviews with health-care providers elicited five themes relating to their experiences of alcohol SBI delivery. Patients in group interviews expressed a preference to be screened for alcohol as part of health assessments. Discussion and Conclusions. Training workshops appear to be an acceptable initial strategy for disseminating alcohol SBI to ACCHSs. Outreach support is required to assist health-care providers to tailor guidelines and resources, and optimally integrate their clinical skills with evidence-based practice. Patients' needs should inform the tailoring process. Tailored collaborative and supportive strategies are probably required to optimally disseminate alcohol SBI in ACCHSs.

Copello A; Templeton L; Orford J; Velleman R. The 5-step method: Principles and practice. Drugs: Education, Prevention and Policy 17(special issue): 86-99, 2010. (19 refs.)

This article includes a description of the 5-Step Method. First, the origins and theoretical basis of the method are briefly described. This is followed by a discussion of the general principles that guide the delivery of the method. Each step is then described in more detail, including the content and focus of each of the five steps that include: listening non-judgementally; providing relevant information; exploring ways of coping; discussing social support and establishing the need for further help. Finally, issues of training, supervision and on-going support are discussed. It is concluded that the 5-Step Method offers a flexible response that can be delivered to family members affected by addiction problems by a range of helpers and in a range of settings and health systems.

Davis JM; Ramseier CA; Mattheos N; Schoonheim-Klein M; Compton S; Al-Hazmi N et al. Education of tobacco use prevention and cessation for dental professionals - a paradigm shift. International Dental Journal 60(1): 60-72, 2010. (88 refs.)

The use of tobacco continues to be a substantial risk factor in the development and progression of oral cancer, periodontitis, implant failure and poor wound healing. Dental and dental hygiene education providers have made great advances towards the incorporation of tobacco education into their curricula in recent years. Unfortunately, however, both medical and dental education research has consistently reported schools providing only basic knowledge-based curricula that rarely incorporate more effective, behaviourally-based components affecting long-term change. The limited training of oral healthcare students, at least in part, is reflected in practising dental professionals continuing to report offering incomplete tobacco interventions. In order to prepare the next generation of oral healthcare providers, this paper proposes a paradigm shift in how tobacco use prevention and cessation (TUPAC) may be incorporated into existing curricula. It is suggested that schools should carefully consider: to what level of competency should TUPAC be trained in dental and dental hygiene schools; the importance of establishing rapport through good communication skills; the core knowledge level for TUPAC; suggested instructional and assessment strategies; the importance of continuing professional education for the enhancement of TUPAC.

Davis JM; Stockdale MS; Cropper M. Evaluation of a comprehensive tobacco cessation curriculum for dental hygiene programs. Journal of Dental Education 74(5): 472-479, 2010. (29 refs.)

Dental health care providers continue to offer inconsistent and limited tobacco use cessation (TUC) interventions even though smoking-related morbidity and mortality continue to be a substantial health concern. Our purpose was to conduct a comprehensive, three-year (2003-06) TUC curriculum evaluation that included assessment of existing TUC education offered; dental hygiene educators' readiness to incorporate TUC education into the curriculum; and development of a pre-test/post-test assessment instrument and faculty development program. This curriculum study was carried out alongside a research study to evaluate the effectiveness of a peer-reviewed tobacco curriculum (Tobacco Free! Curriculum). Faculty members (baseline n=97; third-year n=42) from the twelve dental hygiene associate degree programs in Illinois participated in the study, which included a pre-treatment survey, six hours of on-site TUC curriculum training, and a post-treatment survey to determine the attitudes, perceived barriers, and current practices in tobacco education. Results showed an average increase of eighty-five minutes spent on tobacco education in the dental hygiene curriculum, a large positive increase in the percentage of faculty members who formally assessed the use of 5As and 5Rs (21 percent to 88 percent), and a dramatic increase (+100) in the percentage of faculty members who taught or included most of the thirteen TUC content areas following the introduction of the curriculum and training program.

De Jong C; Luycks L; Delicat JW. The master in addiction medicine program in The Netherlands. Substance Abuse 32(2, special issue): 108- 114, 2011. (15 refs.)

Since 2007 there is a full-time, 2-year professional training in addiction medicine in the Netherlands. The aim of this article is to describe in detail the development and present status of the Dutch Master in Addiction Medicine (MiAM) program. In this competency-based professional training, theoretical courses are integrated with learning in clinical practice under guidance of an experienced clinical teacher. The theoretical courses consist of evidence-based medicine, communication and basic psychotherapeutic skills, neurobiology of addiction, addiction medicine, addiction and psychiatry, and public health. The 7 main competencies are made ready for operation in the personal education plan and are evaluated by different styles of examination.

Decker SE; Jameson MT; Naugle AE. Therapist training in empirically supported treatments: A review of evaluation methods for short- and long-term outcomes. (review). Administration and Policy in Mental Health and Mental Health Services Research 38(4, special issue): 254-286, 2011. (126 refs.)

Therapist training efforts have been assessed using several outcomes. A model for evaluating therapist training in empirically supported treatments is presented, adapted from Kirkpatrick's (in: Craig and Bittel (eds.) Training and development handbook, 1967) training evaluation model. The adapted framework includes short-term outcomes, such as reactions to training and changes in attitude, knowledge, or skills, and longer-term outcomes, such as changes in therapist behavior in practice or client outcomes. Evaluation methods for these outcomes are reviewed, with information on their validity, reliability, and feasibility. An agenda for further research to improve therapist training evaluation is presented, with discussion of how evaluation can inform other areas of the field.

Dickson-Gomez J; Bodnar G; Guevara CE; Rodriguez K; De Mendoza LR; Corbett AM. With God's help I can do it: Crack users' formal and informal recovery experiences in El Salvador. Substance Use & Misuse 46(4): 426-439, 2011. (34 refs.)

Crack use has increased dramatically in El Salvador in the last few decades. As with other developing countries with sudden onsets of drug problems, El Salvador has few medical staff trained in addictions treatment. Little research has examined drug users" attempts to reduce or abstain from drug use in countries where government-regulated formal medical treatment for drug addiction is scarce. This paper uses qualitative and quantitative data gathered from active crack users to explore their formal and informal strategies to reduce or abstain from drugs, and compares these with components of informal and formal treatment in developed countries.

Doran N; Hohman M; Koutsenok I. Linking basic and advanced motivational interviewing training outcomes for juvenile correctional staff in California. Journal of Psychoactive Drugs 2011(7): 19-26, 2011. (34 refs.)

Motivational interviewing (MI) is an evidence-based communication method that can be effective in engaging incarcerated juveniles in substance abuse programming and other treatment services. However, MI can be difficult to learn and often requires several training exposures for skill change. Few studies have examined MI training outcomes over time. This study reports outcomes for 222 juvenile corrections workers trained in MI in a three-day introductory and two-day advanced training. MI skills were measured via video-administered pre- and post-tests and with a written questionnaire. Combined results from a linear mixed model found that overall MI skills were positively associated with staff education level, and negatively associated with age and time between trainings. Those who attended their second training within nine months of the first training were more likely to score in the proficiency range. Motivation to use MI, belief in its efficacy with youth, job classification, and sex were not related to skill attainment.

Egan JE; Casadonte P; Gartenmann T; Martin J; McCance-Katz EF; Netherland J et al. The Physician Clinical Support System-Buprenorphine (PCSS-B): A novel project to expand/improve buprenorphine treatment. Journal of General Internal Medicine 25(9): 936-941, 2010. (39 refs.)

Opioid dependence is largely an undertreated medical condition in the United States. The introduction of buprenorphine has created the potential to expand access to and use of opioid agonist treatment in generalist settings. Physicians, however, often have limited training and experience providing this type of care. Some physicians believe having a mentoring relationship with an experienced provider during their initial introduction to the use of buprenorphine would ease implementation. Our goal was to describe the development, implementation, resources, and evaluation of the Physician Clinical Support System-Buprenorphine (PCSS-B), a federally funded program to improve access to and quality of treatment with buprenorphine. We provide a description of the PCSS-B, a national network of 88 trained physician mentors with expertise in buprenorphine treatment and skills in clinical education. We provide information regarding the use the PCSS-B core services including telephone, email and in-person support, a website, clinical guidances, a warmline and outreach to primary care and specialty organizations. Between July 2005 and July 2009, 67 mentors and 4 clinical experts reported providing mentoring services to 632 participants in 48 states, Washington DC and Puerto Rico. A total of 1,455 contacts were provided through email (45%), telephone (34%) and in-person visits (20%). Seventy-six percent of contacts addressed a clinical issue. Eighteen percent of contacts addressed a logistical issue. The number of contacts per participant ranged from 1-125. Between August 2005 and April 2009 there were 72,822 visits to the PCSS-B website with 179,678 pages viewed. Seven guidances were downloaded more than 1000 times. The warmline averaged more than 100 calls per month. The PCSS-B model provides support for a mentorship program to assist non-specialty physicians in the provision of buprenorphine and may serve as a model for dissemination of other types of care.

el-Guebaly N; Crockford D; Cirone S; Kahan M. Addiction medicine in Canada: Challenges and prospects. Substance Abuse 32(2, special issue): 93-100, 2011. (12 refs.)

In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of ogeneralistso in family medicine and osophisticated generalistso among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.

el-Guebaly N; Violato C. The international certification of addiction medicine: Validating clinical knowledge across borders. Substance Abuse 32(2, special issue): 77-83, 2011. (12 refs.)

The experience of the International Society of Addiction Medicine in setting up the first international certification of clinical knowledge is reported. The steps followed and the results of a psychometric analysis of the tests from the first 65 candidates are reported. Lessons learned in the first 5 years and challenges for the future are identified.

Fiore MC; Baker TB. Treating smokers in the health care setting. New England Journal of Medicine 365(13): 1222-1231, 2011. (51 refs.)

A 45-year-old overweight woman with a history of depression sees her physician with a recurrence of acute bronchitis. She began smoking at 15 years of age and now smokes 10 to 15 cigarettes per day. She smokes her first cigarette immediately on awakening. She has made multiple attempts to quit, once briefly using a nicotine patch, but she had a relapse because of strong urges to smoke and weight gain. She is bothered by the cost of cigarettes and is worried about the effects of smoking on her health and that of her children. However, she is reluctant to attempt to quit now, in part because she fears she will not succeed. What would you advise?

Galvani S; Hughes N. Working with alcohol and drug use: Exploring the knowledge and attitudes of social work students. British Journal of Social Work 40(3): 946-962, 2010. (27 refs.)

Many social workers in the UK work daily with the social harms linked to problematic substance use. Historically, however, their drug and alcohol training needs have been overlooked. This study set out to achieve two key objectives: (i) to assess social work students' knowledge of, and attitudes towards, working with people with substance problems; and (ii) to develop and test a questionnaire to meet this objective. A four-part self-completion questionnaire was developed and administered to a purposive sample of 156 social work students. The focus of this article will be on the results of Part 2 of the pilot survey, which focused on the students' attitudes towards, and knowledge of, substance use. One hundred and twenty-one completed questionnaires were used as the basis for analysis. Three factors emerged as the key explanatory factors demonstrating significant relationships between them: 'knowledge', 'support from colleagues' and 'legitimacy of role'. Social work training needs to recognize the need for alcohol and drug education within social work qualifying programmes in order that future social workers will feel equipped with the knowledge and legitimacy to do their job and meet the needs of people who have problems with alcohol and drugs.

Gill JS; O'May FP. Is It my job? Alcohol brief interventions: Knowledge and attitudes among future health-care professionals in Scotland. Alcohol and Alcoholism 46(4): 441-450, 2011. (44 refs.)

Aims: To document knowledge and perceptions relating to the professional role in the area of alcohol misuse within a sample of first year (n = 278) and final year (n = 527) medical, nursing and allied health professional (NAHP) students in Scotland. Methods: A cross sectional survey design involving self-completed questionnaires administered in autumn 2008 (first year students) and spring 2009 (final year students) through course websites and lectures. Results: Gaps in the knowledge relating to current UK health guidelines were identified but more so among NAHP students than medical students. Exploration of the perceived role in this area of practice identified three broad groups of students: those clear about their role (medical and nursing students), those advocating a role but not identified by fellow students (occupational therapy and pharmacy) and those uncertain of their role (radiographers, speech and language therapists/audiologists and physiotherapy). Conclusions: Higher education institutions should address the gaps in the knowledge around guidance for alcohol consumption. The effectiveness of brief interventions may depend on it. Additionally, through inter-professional teaching and in collaboration with the relevant professional bodies, more could be done to promote the contribution of practitioners other than those traditionally linked (i.e. medical and nursing) to this important clinical role.

Goebel JR; Sherbourne CD; Asch SM; Meredith L; Cohen AB; Hagenmaier E et al. Addressing patients' concerns about pain management and addiction risks. Pain Management Nursing 11(2): 92-98, 2010. (36 refs.)

Fear of engendering addiction is frequently reported as both a provider and a patient barrier to effective pain management. In this study, a clinical scenario ascertained nursing staff members' usual practice in addressing addiction fears for patients with concerns about the addictive potential of pain medication. One hundred forty-five Veterans Health Administration nursing staff members from eight ambulatory care sites were queried to identify variables associated with proclivity to address patient fears about addiction risks in a population where pain is prevalent and the risk for substance abuse is high. Regarding addressing addiction concerns, 66% of nursing staff were very likely, 16% somewhat likely, 9% unsure, 6% somewhat unlikely, and 2% very unlikely to take action. Health technicians were less likely to address addiction concerns than registered or licensed vocational nurses (odds ratio [OR] 0.116; p=.004). Nursing staff with more years' experience (OR 1.070; p=.005) and higher levels of self-efficacy/confidence (OR 1.380; p=.001) were more likely to engage in discussions related to addiction risks. Targeted efforts to improve pain management activities should focus on retaining experienced nursing staff in initial assessment positions and improving the skills and confidence of less experienced and less skilled staff.

Guo FR; Hung LY; Chang CJ; Leung KK; Chen CY. The evaluation of a Taiwanese training program in smoking cessation and the trainees' adherence to a practice guideline. BMC Public Health 10: 77, 2010. (32 refs.)

Background: The Taiwanese government began reimbursement for smoking cessation in 2002. Certification from a training program was required for physicians who wanted reimbursement. The program certified 6,009 physicians till 2007. The objective of this study is to evaluate the short-and long term efficacy of the training program. Methods: For short term evaluation, all trainees in 2007 were recruited. For long term evaluation, computer randomly selected 2,000 trainees who received training from 2002 to 2006 were recruited. Course satisfaction, knowledge, confidence in providing smoking cessation services and the adherence to a practice guideline were evaluated by questionnaires. Results: Trainees reported high satisfaction with the training program. There was significant difference between pre- and post-test scores in knowledge. Confidence in providing services was lower in the long term evaluation compared to short term evaluation. For adherence to a practice guideline, 86% asked the status of smoking, 88% advised the smokers to quit, 76% assessed the smoker's willingness to quit, 59% assisted the smokers to quit, and 60% arranged follow-up visits for smokers. The incentive of reimbursement was the most significant factor affecting confidence and adherence. Conclusions: The training program was satisfactory and effective. Adherence to a practice guideline in our study was better than studies without physician training in other countries.

Haber PS. International perspectives in postgraduate medical training in addiction medicine. (editorial). Substance Abuse 32(2, special issue): 75-76, 2011. (6 refs.)

Haber PS; Murnion BP. Training in addiction medicine in Australia. Substance Abuse 32(2, special issue): 115-119, 2011. (0 refs.)

Barriers to entering addiction medicine (AM) have led to a persisting workforce shortage. To address this problem, the Chapter of Addiction Medicine (AChAM) was formed in 2001 as a subdivision of the Royal Australasian College of Physicians (RACP). Through consultation, AChAM has identified the scope of practice and offered fellowship to suitable established practitioners. The Chapter successfully applied to the Australian Government for recognition of AM as a medical specialty, which was finalized in November 2009. Specialist reimbursement item numbers were incorporated into that decision process and commence operating in November 2010. AChAM has designed and implemented a training scheme using a model similar to that of the RACP internal medicine training program. This comprises 3 years of basic general medical training post internship followed by 3 years of discipline-specific supervised training. The training is broadly based, with experience in both ambulatory care and inpatient care, and including physical health as well as mental health. Assessment is continuous and competency based. There is no exit examination. The overriding clinical approach rests upon the harm minimization framework consistent with long-established national drug policy in Australia and favors evidence-based treatment.

Hayes-Roth B; Saker R; Amano K. Automating individualized coaching and authentic role-play practice for brief intervention training. Methods of Information In Medicine 49(4): 406-411, 2010. (16 refs.)

Objectives: Brief intervention helps to reduce alcohol abuse, but there is a need for accessible, cost-effective training of clinicians. This study evaluated STAR Workshop, a web-based training system that automates efficacious techniques for individualized coaching and authentic role-play practice. Methods: We compared STAR Workshop to a web-based, self-guided e-book and a no-treatment control, for training the Engage for Change (E4C) brief intervention protocol. Subjects were medical and nursing students. Brief written skill probes tested subjects' performance of individual protocol steps, in different clinical scenarios, at three test times: pre-training, post-training, and post-delay (two weeks). Subjects also did live phone interviews with a standardized patient, post-delay. Results: STAR subjects performed significantly better than both other groups. They showed significantly greater improvement from pre-training probes to post-training and post-delay probes. They scored significantly higher on post-delay phone interviews. Conclusion: STAR Workshop appears to be an accessible, cost-effective approach for training students to use the E4C protocol for brief intervention in alcohol abuse. It may also be useful for training other clinical interviewing protocols.

Hepner KA; Hunter SB; Paddock SM; Zhou AJ; Watkins KE. Training addiction counselors to implement CBT for depression. Administration and Policy in Mental Health and Mental Health Services Research 38(4, special issue): 313-323, 2011. (48 refs.)

Many clients in publicly funded substance abuse treatment programs suffer from depression yet lack access to effective mental health treatment. This study sought to examine whether addiction counselors could be effectively trained to deliver group CBT for depression and to ascertain client perceptions of the treatment. Five counselors were trained in the therapy and treated 113 clients with depression symptoms. Counselors demonstrated high fidelity to the therapy and client perceptions of the therapy were positive. Our results suggest that training addiction counselors to deliver group CBT for depression is a promising integrated treatment approach for co-occurring depression and substance disorders.

Hill RG; Atnas CI; Ryan P; Ashby K; Winnington J. Whole team training to reduce burn-out amongst staff on an in-patient alcohol ward. Journal of Substance Use 15(1): 42-50, 2010. (24 refs.)

In 2005 the alcohol in-patient ward at South London and Maudsley NHS Foundation Trust participated in a 2-day training programme designed to reduce levels of burn-out amongst staff. The training intervention was derived from a large-scale project that focused on in-patient and community mental health staff in five European countries. A research component was built into the work, with levels of staff burn-out being measured prior to the training intervention and 1 month afterwards, using the Maslach Burn-out Inventory (MBI). The team were able to identify four sources of stress at work. A 1-month follow-up using the MBI showed that levels of emotional exhaustion and depersonalization had been reduced and feelings of personal accomplishment at work risen. Staff identified four main sources of stress at work. These were: (i) group-work; (ii) dealing with complex clients; (iii) effectively evaluating the shift; and (iv) client aggression. The implications of whole team training is discussed in the context of staff working with high turnover clients.

Holmqvist M; Nilsen P. Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care: A national-based investigation into midwives' alcohol-related education, knowledge and practice. Midwifery 26(4): 430-434, 2010. (19 refs.)

Objective: to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy. Design: a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians. Setting: maternity health-care centres in Sweden. Participant: 2106 midwives. Findings: nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels(national, local and management) on how to address alcohol with expectant parents and work with risky drinkers. Key conclusions: more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.

Howard V; Holmshaw J. Inpatient staff perceptions in providing care to individuals with co-occurring mental health problems and illicit substance use. Journal of Psychiatric and Mental Health Nursing 17(10): 862-872, 2010. (25 refs.)

The extent of illicit substance use within inpatient mental health settings is becoming a major cause of concern. This poses growing challenges not only for the management of inpatient units, but also for providing continuity of care. Service users with co-occurring substance use are more likely to disengage from services. The process of engagement can be hindered by negative attitudes of staff. This study aimed to identify and explore multidisciplinary staff attitudes and experiences in caring for inpatients with co-occurring ill-mental health problems and illicit substance use. A questionnaire incorporating the Drug and Drugs Problems Perceptions Questionnaire (DDPPQ) was used with a non-probability sample of 84 multidisciplinary staff working on nine mental health units. Semi-structured interviews were then carried out with 10 members of staff. Overall, respondents reported: lack of training; difficulty in accessing support structures; and problematic issues with multidisciplinary decision making and processes. The DDPPQ results showed that staff who had received training held less negative attitudes towards illicit substance users regardless of their length of clinical work experience or type of work setting. Recommendations are made about the importance of training and staff support for the development of less negative attitudes towards this client group.

Huang BY; Inagaki K; Yoshii C; Kano M; Abbott PV; Noguchi T et al. Social nicotine dependence in Australian dental undergraduate students. International Dental Journal 61(3): 152-156, 2011. (18 refs.)

Objectives: This study aimed to investigate dental undergraduate students' tobacco usage and social nicotine dependence in Australia. A special interest was to identify the role of factors such as age, gender, year of dental education and cohabitants' smoking status for social nicotine dependence. Materials and methods: A sample of 252, first-to-fifth year undergraduate students in an Australian dental school was used. Each completed a self-administered questionnaire. Results: The smoking rate was 4.8%. Current smokers displayed higher social nicotine dependence than those that had never smoked (t = 3.1, df = 244, P = 0.002). Dental undergraduate students that showed higher social nicotine dependence (P = 0.001, OR = 1.3, 95% CI: 1.1-1.6), or that had smoking cohabitants (P = 0.016, OR = 4.8, 95% CI: 1.3-17.0), were more likely to smoke. Students' social nicotine dependence increased with year of dental study (P = 0.043, beta = 0.4, t = 2.0). Social nicotine dependence enhanced tobacco usage among Year-1-to-4 students (P = 0.005, OR = 1.4, 95% CI: 1.1-1.7) but not Year-5 undergraduates (P = 0.432). Conclusions: Social nicotine dependence has become a developing issue in dental education. Tobacco control should be highlighted in the dental curriculum. Future investigations into the effects of dental education on social nocotine dependence and tobacco usage are indicated.

Huggett KN; Westerman GH; Barone EJ; Lofgreen AS. Substance use and dependence education in predoctoral dental curricula: Results of a survey of U.S. and Canadian dental schools. Journal of Dental Education 75(8): 1003-1009, 2011. (11 refs.)

The purpose of this study was to obtain information about education in substance use and dependence that appears in the predoctoral curricula of U.S. and Canadian dental schools. Sixty-eight deans were sent a twenty-item survey requesting information about when in the curriculum these subjects were taught, what instructional methods were used, and whether behavior change instruction was included to address these issues in clinical interactions. The survey had an 81 percent response rate. The topics of alcohol use and dependence, tobacco use and dependence, and prescription drug misuse and abuse were reported in over 90 percent (N=55) of responding schools' predoctoral curricula. The topic of other substance use and dependence was reported in only 72.7 percent (N=40) of these schools. The primary instructional method reported was the use of lecture. Less frequently used methods included small-group instruction, instruction in school-based clinic, community-based extramural settings, and independent study. As future health professionals, dental students are an important source for patients concerning substance use, abuse, and treatment. Our investigation confirmed that alcohol, tobacco, and prescription drug abuse is addressed widely in predoctoral dental curricula, but other substance use and dependence are less frequently addressed.

Iles-Shih M; Sve C; Solotaroff R; Bruno R; Gregg J. Health and illness in context: A pragmatic, interdisciplinary approach to teaching and learning applied public health within an urban safety net system. Journal of Public Health Management and Practice 17(4): 308- 312, 2011. (10 refs.)

Background: Academic centers and community programs are too often separated by institutional and cultural chasms. Such divides weaken our capacity to develop a diverse public health-oriented, community-based workforce. This article describes one bridge designed to connect the academy to local safety net systems and the lessons learned during its construction. Program Description: "Health & Illness in Context" is an interdisciplinary program developed in 2008 by students at Oregon Health & Science University and staff at Portland's Central City Concern. Over a 7-week period, small cohorts of medical, nursing, and public health students gain an intimate, street-level understanding of the local safety net and the structural forces that shape it. Guided by program faculty, they traverse the maze of urban social services - following clients' pathways from homelessness and addiction to treatment, recovery, and social reintegration. In each 4-hour session, students: (1) apply key concepts from public health to challenging real-world contexts, (2) explore effective, innovative approaches to addressing complex health and social issues, and (3) directly engage members of underserved communities and the diverse professionals that serve them. Outcomes: Although too early to formally assess its impact on career choice, Health & Illness in Context is already serving as an incubator for novel public health-oriented experiences, curricula, and activism that are further narrowing the community-university divide. Citing Health & Illness in Context as a primary inspiration, students have developed complementary elective courses, community-outreach activities, and long-term community collaborations. Meanwhile, program faculty members, now formally advise student initiatives, serve as mentors/preceptors, and have expanded their involvement at the university.

Kerr S; Whyte R; Watson H; Tolson D; McFadyen AK. A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people. Worldviews on Evidence-Based Nursing 8(3): 177-186, 2011. (48 refs.)

Background: Older people who smoke derive significant health benefits from stopping smoking in later life. Healthcare practitioners have an important role to play in raising the issue of smoking cessation with this client group; however, they often fail to do so. Aim: To assess the effectiveness of smoking cessation training for healthcare practitioners who have regular contact with older adults. Methods: Mixed-methods were used to explore satisfaction with the training, the participants' learning and any resultant changes in behaviour. The effectiveness of the training was assessed using a two-group parallel design randomised controlled trial, followed by semistructured qualitative interviews. Participants (n = 57) were recruited from a cohort of community nurses and allied health professionals (e. g., occupational therapists) working in Scotland. The intervention was 1-day brief intervention smoking cessation training. Validated measures of knowledge, attitudes and practice, were used to assess learning and behaviour at baseline, 1 week and 3 months post training. Data were analysed using two-factor repeated measure analysis of variance, where the factors were "group" and "time." Qualitative data were gathered from members of the intervention group during semistructured interviews (n = 8) and were analysed thematically. Results/Findings: Levels of satisfaction with the training were high. There was a statistically significant improvement in the knowledge and attitudes of the intervention group following the training, with a noticeable, but nonsignificant, improvement in practice. The qualitative findings demonstrate how the training impacted positively on practice. Conclusions: Smoking cessation interventions in later life are important, as older smokers generally have long-term conditions caused or complicated by smoking. The delivery of brief smoking cessation interventions is known to be highly cost-effective; however, research demonstrates that practitioners often fail to raise the issue of smoking cessation with older adults. This study has demonstrated the effectiveness of a 1-day training course for practitioners. Further research is recommended.

Khami MR; Murtomaa H; Razeghi S; Virtanen JI. Smoking and its determinants among Iranian dental students. Medical Principles and Practice 19(5): 390-394, 2010. (25 refs.)

Objective: The objective of the present study was to investigate smoking habits of Iranian dental students in relation to their background characteristics and oral self-care (OSC). Subjects and Methods: A survey in the form of a questionnaire was conducted of 327 senior dental students in seven randomly selected state dental schools in Iran. In addition to smoking habits and background characteristics, the students were asked about OSC. A recommended level of OSC was defined as a combination of brushing at least twice a day, frequent use of fluoridated toothpaste, and eating sugary snacks less than daily. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 263 students (113 males and 150 females) completely answered the questions and were included in the analyses. Results: Of the 263 students, 59 (23%, 37 males and 22 females) reported current smoking (cigarette, pipe, or water pipe). Current smoking was associated with male gender (OR = 2.9, 95% CI = 1.4-5.6), level of father's education (OR = 1.4, 95% CI = 1.1-1.8), and OSC (OR = 4.4, 95% CI = 1.3-14.9). Conclusion: Smoking among Iranian dental students is similar to their socioeconomic group, and is associated with the characteristics of their background, such as gender and father's level of education, as well as the quality of OSC. The results indicate a need to include smoking cessation education and public health activities in the dental curriculum to provide future health care professionals and role models for patients with adequate training in up-to-date patient management to control smoking.

Lee N; Jenner L; Baker A; Ritter A; Hides L; Norman J et al. Screening and intervention for mental health problems in alcohol and other drug settings: Can training change practitioner behaviour? Drugs: Education, Prevention and Policy 18(2): 157-160, 2011. (12 refs.)

Aims: The comorbidity of substance use and mental health problems poses a significant challenge for alcohol and other drug (AOD) treatment services. In many cases, AOD practitioners do not have experience or training in identifying or managing mental health conditions. Methods: This project examined the implementation of screening and intervention practices for mental health disorders among AOD clients. Training and supervision was provided to 20 AOD practitioners across five sites in four agencies with a focus on enhancing skills in detection of, and intervention for, mental health conditions among their clients. A package developed for this purpose, known as PsyCheck, was used. A random file audit was undertaken to examine changes in detection of mental health conditions. Findings: There were significant improvements in detection after training and supervision, with detection rates almost doubling in this time. Conclusions: Training and supervision using the PsyCheck package appears to have the potential to improve mental health detection and intervention in AOD services. This study shows promise for the implementation of mental health intervention in AOD services.

Llambi L; Esteves E; Martinez E; Forster T; Garcia S; Miranda N et al. Teaching tobacco cessation skills to Uruguayan physicians using information and communication technologies. Journal of Continuing Education in the Health Professions 31(1): 43-48, 2011. (31 refs.)

Introduction: Since 2004, with the ratification of the Framework Convention on Tobacco Control, Uruguay has implemented a wide range of legal restrictions designed to reduce the devastating impacts of tobacco. This legal process generated an increase in demand for tobacco cessation treatment, which led to the need to train a large number of physicians. Information and Communication Technologies (ICTs) are evolving constantly, creating new opportunities to make online education more interactive. The evolution of ICTs presents an opportunity to develop innovative continuing medical education (CME) experiences to meet the increasing demand for this topic. Methods: A blended-learning course on tobacco cessation was developed and implemented, combining face-to-face and online activities. Educationational strategy focused on (1) facilitating interaction among generalists and between generalists and experts, and (2) providing high impact CME incorporating multifaceted interventions with wiki-type collaborative construction of practical knowledge. Multiple-choice tests and commitments-to-change were used for evaluation. Results: Three hundred thirty-five health professionals participated in the course. Of these, 145 (43.3%) attended the on-site workshop, 216 (64.5%) participated in the online activities, and 109 (32.5%) completed both phases. Fifty of the 105 (47.6%) participants completing the pretest had a passing score, while 78.1% received a passing score on the final test (p < .001). Differences between mean pretest and posttest scores among those who completed both phases compared with those who only did the online phase were statistically significant (p = .003 and p = .009, respectively). Discussion: The need to train physicians on tobacco cessation skills can be addressed via ICTs and educational activities that include participant interaction.

Lofwall MR; Wunsch MJ; Nuzzo PA; Walsh SL. Efficacy of continuing medical education to reduce the risk of buprenorphine diversion. Journal of Substance Abuse Treatment 41(3): 321-329, 2011. (31 refs.)

As office-based opioid dependence treatment (OBOT) has grown in the United States, postmarketing surveillance data reveal increased reports of buprenorphine misuse and diversion, it is important that doctors understand buprenorphine clinical pharmacology and engage in practices to decrease risk of misuse, diversion, and other adverse events. This study evaluated the efficacy of continuing medical education (CME) in two U.S. regions with surveillance signals of buprenorphine misuse/diversion. Four surveys (before, on-site, and 1 and 3 months post CME) evaluated physician characteristics, practice behaviors, and buprenorphine pharmacology and legislative knowledge. The results show that physicians had limited addictions training. Knowledge and practice behaviors significantly improved after the CME, which should enhance the quality of OBOT and may decrease risk of buprenorphine misuse and diversion from their practices. Mandatory CME targeting OBOT-certified physicians could have a positive impact on patient and public health outcomes.

Maremmani I; Pacini M; Pani PP. Basics on addiction: A training package for medical practitioners or psychiatrists who treat opioid dependence. (review). Heroin Addiction and Related Clinical Problems 13(2): 5-40, 2011. (113 refs.)

Opioid dependence is a chronic, relapsing brain disease that causes major medical, social and economic problems to both the individual and society. This seminar is intended to be a useful training resource to aid healthcare professionals - in particular, physicians who prescribe opioid pharmacotherapies in assessing and treating opioid-dependent individuals. Herein we describe the neurobiological basis of the condition; recommended approaches to patient assessment and monitoring; and the main principles and strategies underlying medically assisted approaches to treatment, including the pharmacology and clinical application of methadone, buprenorphine and buprenorphine naloxone.

Martin BA; Chewning BA. Evaluating pharmacists' ability to counsel on tobacco cessation using two standardized patient scenarios. Patient Education and Counseling 83: 319-324, 2011. (34 refs.)

Objectives: To evaluate the impact that role-playing two pre/post standardized patient scenarios within a tobacco cessation training program had on pharmacists' counseling skills. Second, to analyze the validity of the observation coding tool used to evaluate pharmacist's role-play performance. Methods: Pharmacists performed two role-playing scenarios which incorporated national guidelines, the 5A's counseling process, and the "preparation" and "action" phases of the transtheoretical model. Pharmacists' performance was evaluated with an observation coding tool. Results: Pharmacists' (n = 25) counseling performance improved significantly post-training (p < 0.02: Action Scenario; p < 0.004: Preparation Scenario). More than 50% of pharmacists provided patient-directed tobacco consultation services in the one year following training. The observation tool score for the "action phase" scenario was highly associated with pharmacists' subsequent delivery of tobacco cessation services in community practice. Conclusion: Role-playing facilitated pharmacists' skill development. The evaluation tool and Action Scenario may be powerful for predicting pharmacists' delivery of tobacco cessation services. Practice implications: Incorporating role-playing and structured tools for performance evaluation can help enhance pharmacist performance during training and predict service delivery in community practice. Together they could facilitate tailored feedback to help pharmacists struggling with the difficult task of extending cognitive service roles in practice.

Martino S; Ball SA; Nich C; Canning-Ball M; Rounsaville BJ; Carroll KM. Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction 106(2): 428-441, 2011. (57 refs.)

Aims: The effectiveness of expert-led (EX) and train-the-trainer (TT) strategies was compared to a self-study approach (SS) for teaching clinicians motivational interviewing (MI). Design: Twelve community treatment programs were assigned randomly to the three conditions. EX and TT conditions used skill-building workshops and three monthly supervision sessions guided by treatment integrity ratings, performance feedback and coaching techniques. Trainers in TT were first trained and certified in MI and then prepared carefully to deliver the workshops and supervise MI at their programs. Clinicians in SS only received the training materials. Setting: Licensed out-patient and residential addiction and mental health treatment programs in the US state of Connecticut were involved in the study. Participants: Ninety-two clinicians who provided addiction treatment within these programs and had limited experience with MI participated in the study. Measurements: Primary outcomes were the clinicians' MI adherence and competence and the percentage of clinicians meeting clinical trial standards of MI performance. Assessments occurred at baseline, post-workshop, post-supervision and at 12-week follow-up. Findings: The study found EX and TT, in comparison to SS, improved clinicians' adherence and competence significantly, with higher percentages of clinicians reaching clinical trial standards of MI performance and few differences between EX and TT. Conclusions: This study supports the combined use of workshops and supervision to teach community program clinicians MI and suggests the train-the-trainer approach may be a feasible and effective strategy for disseminating empirically supported treatments.

Martino S; Canning-Ball M; Carroll KM; Rounsaville BJ. A criterion-based stepwise approach for training counselors in motivational interviewing. Journal of Substance Abuse Treatment 40(4): 357- 365, 2011. (36 refs.)

This pilot study evaluated a criterion-based stepwise approach for training counselors in motivational interviewing (MI). Three sequential steps of training in MI were provided to 26 counselors who worked within the U.S. State of Connecticut Veterans Administration addiction treatment programs: a distance learning Web course (Step I), a skill-building workshop (Step 2), and a competency-based individual supervision (Step 3). Counselors first participated in the course and then only received the next step of training if they failed to meet an independently rated criterion level of adequate MI performance. The results showed that counselors who showed inadequate MI performance immediately after taking the Web course and who subsequently participated in a workshop or supervision improved their adherence to fundamental MI strategies over time, whereas those who performed MI adequately following the Web course continued to demonstrate similar levels of fundamental and advanced MI adherence and competence over a 24-week period without additional training. The pilot study's findings, although preliminary, suggest that different counselors likely require different types and amounts of training to perform a behavioral treatment well.

Mathew M; Goldstein AO; Kramer KD; Ripley-Moffitt C; Mage C. Evaluation of a direct mailing campaign to increase physician awareness and utilization of a Quitline fax referral service. Journal of Health Communication 15(8): 840-845, 2010. (10 refs.)

Research has shown that fax referral services play an important role in linking people who are ready to quit tobacco use with effective cessation support provided through telephone-based quitlines. While many states have implemented fax referral services to assist health care providers in connecting their patients to quitlines, few published studies delineate optimum ways to promote this service to providers, particularly the role of direct mail educational campaigns. This is one of the first studies to evaluate the effectiveness of a small-scale educational and promotional campaign designed to increase health care providers' awareness and utilization of a state tobacco cessation quitline fax referral service. The campaign included a direct mailing to 6,197 health care providers in North Carolina. The mailing consisted of a large tube, in the shape of cigarette, with enclosed fax referral promotional materials. An 8-month follow-up survey was mailed to a 10% random sample of family physicians, pediatricians, dentists, and orthodontists who were sent the promotional tube mailing. Valid surveys were returned by 271 providers (response rate=46%). Forty-four percent of respondents remembered receiving the tube mailing, and 40% reported familiarity with the fax referral service. While only 3.5% of respondents reported referring a patient to the quitline using the fax referral service in the previous 6 months, almost one-third reported an intention to use the fax referral service in the future. The pilot promotional campaign increased awareness of the fax referral service more than service utilization. While increased utilization of the service by health care providers appears promising, additional research is needed on how to maximize educational and promotional campaigns that influence clinician fax referral behaviors. The results of this study can help guide the development of future fax referral promotional campaigns to increase clinician access to and utilization of state quitlines.

Mayet S; Manning V; Williams A; Loaring J; Strang J. Impact of training for healthcare professionals on how to manage an opioid overdose with naloxone: Effective, but dissemination is challenging. International Journal of Drug Policy 22(1): 9-15, 2011. (38 refs.)

Background: Opioid overdose has a high mortality, but is often reversible with appropriate overdose management and naloxone (opioid antagonist). Training in these skills has been successfully trialled internationally with opioid users themselves. Healthcare professionals working in substance misuse are in a prime position to deliver overdose prevention training to drug users and may themselves witness opioid overdoses. The best method of training dissemination has not been identified. The study assessed post-training change in clinician knowledge for managing an opioid overdose and administering naloxone, evaluated the 'cascade method' for disseminating training, and identified barriers to implementation. Methods: A repeated-measures design evaluated knowledge pre-and-post training. A sub-set of clinicians were interviewed to identify barriers to implementation. Clinicians from addiction services across England received training. Participants self-completed a structured questionnaire recording overdose knowledge, confidence and barriers to implementation. Results: One hundred clinicians were trained initially, who trained a further 119 clinicians (n=219) and thereafter trained 239 drug users. The mean composite score for opioid overdose risk signs and actions to be taken was 18.3/26 (+/- 3.8) which increased to 21.2/26 (+/- 4.1) after training, demonstrating a significant improvement in knowledge (Z=9.2, p<0.001). The proportion of clinicians willing to use naloxone in an opioid overdose rose from 77% to 99% after training. Barriers to implementing training were clinician time and confidence, service resources, client willingness and naloxone formulation. Conclusions: Training clinicians how to manage an opioid overdose and administer naloxone was effective. However the 'cascade method' was only modestly successful for disseminating training to a large clinician workforce, with a range of clinician and service perceived obstacles. Drug policy changes and improvements to educational programmes for drug services would be important to ensure successful implementation of overdose training internationally.

Merrill RM; Gagon H; Harmon T; Milovic I. The importance of tobacco cessation training for nurses in Serbia. Journal of Continuing Education In Nursing 41(2): 89-96, 2010. (32 refs.)

Background: This study assessed smoking prevalence, attitudes, and perceived patient counseling responsibilities among practicing nurses in Serbia. The need for nurses to receive tobacco cessation training is explored. Methods: Data were collected through a cross-sectional survey of 230 nurses at public institutions in Belgrade, a health care center in Belgrade, and public health care facilities throughout Serbia. Results: The smoking prevalence was 52% for male nurses and 47% for female nurses. Nurses had the greatest mean level of agreement with statements about controlling smoking through policy, followed by statements about being role models. Only 15% (n = 35) of nurses regularly counseled their patients about smoking, and only 16% of nurses (45% of males vs. 12% of females, p < .0001) had received training in counseling patients about smoking. Nurses' training in counseling patients about smoking was positively associated with the nurses' belief that their counseling could help patients stop smoking or never start smoking. In addition, nurses with training in counseling patients about smoking considered themselves significantly better prepared to assist patients to quit smoking. Nurses who smoked were significantly less likely to believe that their counseling about smoking could be effective. They also felt significantly less well prepared to assist patients to quit smoking. Conclusion: These findings show that nurses' training in tobacco cessation counseling results in greater self-perceived confidence and frequency of regular tobacco cessation counseling in Serbia.

Moretti-Pires RO; Ferro SBG; Buchele F; de Oliveira HM; Goncalves MJF. Family health nurse in the Amazon: Concepts and management of themes regarding alcohol use. Revista da Escola De Enfermagem da USP 45(4): 920-926, 2011. (20 refs.)

The objective of this study is to identify the concept that nurses in the Amazon have on alcohol abuse and the forms used for management. Focal group and individual interviews were performed with all nurses of twelve family health teams from a city in the Amazon. It was observed there was a lack of university degrees, continuing education and of support/reference - counter - reference towards the dimension of alcohol use in the studied population. There is need to reform nursing courses and perform continuing education for family health team members, and provide them with the necessary support regarding this important theme and its consequences, for individuals and their families, as well as for the society as a whole.

O'Brien J; Geikie A; Jardine A; Oakes W; Salmon A. Integrating smoking care in community service organisations to reach disadvantaged people: Findings from the Smoking Matters project. Health Promotion Journal of Australia 21(3): 176-182, 2010. (40 refs.)

Issue addressed: Smoking rates among very disadvantaged populations groups are much higher than for the general Australian population. Smoking makes a significant contribution to the reduced health and material well-being experienced by these groups. Community service organisations have been suggested as a promising setting to provide smoking cessation support for disadvantaged people, but few initiatives have explored the feasibility of this strategy. Methods: The project involved work with five non-government community service organisations as demonstration sites for the integration of smoking care. Sites were offered staff training, smoking-care resources and policy support to address tobacco in the service environment and in their work with clients. Pre-and post-training surveys were undertaken with training participants and a follow-up survey was conducted after three months. Survey questions assessed staff members' confidence, knowledge and skills to address smoking, as well as changes in staff practice. Results: The response rate for the surveys before and after the training sessions was almost 100%, with 63 of the 64 participants providing post-training surveys. The response rate of the three-month follow-up survey was approximately 50% with 34 respondents. Findings: indicate that staff did develop confidence, skills and knowledge to address tobacco issues. Some organisations made changes to policy, such as introducing designated smoking areas and providing financial support for clients and staff to quit smoking. Practice change was evident among some staff, particularly in addressing smoking as part of routine case management and use of the 5A's brief intervention framework. Conclusions: The project findings lend support to the view that community service organisations could play a role in providing smoking care to disadvantaged people.

O'Connor PG; Nyquist JG; McLellan AT. Integrating addiction medicine into graduate medical education in primary care: The time has come. Annals of Internal Medicine 154(1): 56-U192, 2011. (25 refs.)

Substance use disorders create an enormous burden of medical, behavioral, and social problems and pose a major and costly public health challenge. Despite the high prevalence of substance use and its consequences, physicians often do not recognize these conditions and, as a result, provide inadequate patient care. At the center of this failure is insufficient training for physicians about substance use disorders. To address this deficit, the Betty Ford Institute convened a meeting of experts who developed the following 5 recommendations focused on improving training in substance abuse in primary care residency programs in internal medicine and family medicine: 1) integrating substance abuse competencies into training, 2) assigning substance abuse teaching the same priority as teaching about other chronic diseases, 3) enhancing faculty development, 4) creating addiction medicine divisions or programs in academic medical centers, and 5) making substance abuse screening and management routine care in new models of primary care practice. This enhanced primary care residency training should represent a major step forward in improving patient care.

O'Donnell JA; Hamilton MK; Markovic N; Close J. Overcoming barriers to tobacco cessation counselling in dental students. Oral Health & Preventive Dentistry 8(2): 117-124, 2010. (25 refs.)

Purpose: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. Materials and Methods: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. Results: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. Conclusions: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Olmstead T; Carroll KM; Canning-Ball M; Martino S. Cost and cost-effectiveness of three strategies for training clinicians in motivational interviewing. Drug and Alcohol Dependence 116(1-3): 195-202, 2011. (33 refs.)

Objective: To evaluate the cost and cost-effectiveness of three strategies for teaching community program clinicians motivational interviewing (MI): self-study (SS), expert-led (EX), and train-the-trainer (TT). Methods: This economic analysis was conducted as part of a three-arm clinician training trial comprising 12 community treatment programs randomly assigned to the three conditions (n = 92 clinician participants). EX and IT conditions used skill-building workshops and three monthly supervision sessions. SS provided clinicians MI training materials only. The primary outcome measure was the number of clinicians meeting MI performance standards at 12-week follow-up. Unit costs were obtained via surveys administered at the 12 participating programs. Resource utilizations and clinician outcomes were obtained from the training trial. Costs and outcomes were normalized to account for differing numbers of clinicians across programs and conditions. Incremental cost-effectiveness ratios and cost-effectiveness acceptability curves were used to evaluate the relative cost-effectiveness of the three training strategies. Results: SS is likely to be the most cost-effective training strategy if the threshold value to decision makers of an additional clinician meeting MI performance standards at 12-week follow-up is less than approximately $2870, and EX is likely to be the most cost-effective strategy when the threshold value is greater than approximately $2870. Conclusions: This study provides accurate estimates of the economic costs and relative cost-effectiveness of three different strategies for training community program clinicians in motivational interviewing and should be of interest to decision makers seeking to implement empirically supported addiction treatments with scarce resources.

Orford J; Templeton L; Copello A; Velleman R; Ibanga A. Working with teams and organizations to help them involve family members. Drugs: Education, Prevention and Policy 17(special issue): 154-164, 2010. (13 refs.)

In this article we describe our work in trying to influence whole service teams to move their practice towards greater involvement of affected family members. Work with five teams is described. The process varied but in all cases it included recruitment of the team, training, continued support and evaluation of results. Use of a standard questionnaire for assessing attitudes towards working with affected family members showed significant changes in team members' knowledge, confidence and team support for working with family members. Records of all project events and meetings suggested that change takes time but that a 'cultural change' can take place whereby earlier misgivings are dispelled and positive attitudes towards involving family members become embedded in a team's approach. Diary audit indicated that the frequency of involvement of family members in sessions can be increased three- to five-fold, with teams beginning to carry out work with a diversity of family members, in diverse ways and with diverse positive outcomes. In a number of cases, teams were encouraged to institute new family-friendly procedures, for example changes to appointment letters, assessments and design of waiting and counselling rooms. Lessons have been learnt, including the need to accommodate different levels of initial experience of working with family members, and the need to be clear about project aims and objectives. Sustainability of change remains an issue. A general conclusion is that the capacity of services to take on work with family members affected by substance misuse of close relatives varies greatly. Where organizations already have a mission to involve family members, capacity is good. Where alcohol and drug services have previously been focused on individuals who are misusing substances, change is difficult but can be achieved. For most non substance-specialist organizations, such as primary care health centres and most non-statutory organizations, capacity is very limited. In addition to training and continued support for practitioners, explicit commissioning of work with family members combined with management support is necessary.

Payne JM; France KE; Henley N; D'Antoine HA; Bartu AE; O'Leary CM et al. RE-AIM evaluation of the Alcohol and Pregnancy Project: Educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder. Evaluation & the Health Professions 34(1): 57-80, 2011. (29 refs.)

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http: www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.

Pinxten WJL; De Jong C; Hidayat T; Istiqomah AN; Achmad YM; Raya RP et al. Developing a competence-based addiction medicine curriculum in Indonesia: The training needs assessment. Substance Abuse 32(2, special issue): 101- 107, 2011. (23 refs.)

Indonesia has one of the fastest growing, injecting drugs user-driven, human immunodeficiency virus (HIV) epidemics in Asia. Coverage of needle and syringe programs (NSPs), opioid substitution therapy (OST), and antiretroviral treatment (ART) is increasing, but is still low, whereas professional training in addiction medicine is not yet established. Urgent development and scaling-up of professional capacity in comprehensive, evidence-based addiction medicine is needed. In this article the results of the first step is presented, being the training needs assessment (TNA) and the process of further developing a national evidence- and competence-based addiction medicine curriculum in Indonesia.

Rassool GH. . Addiction for Nurses. Chichester: Wiley-Blackwell, 2010

This is an introductory textbook directed to nurses. The book begins with a discussion of the different settings in which nursing interventions can occur from community-based services and specialist alcohol and drug services, to hospital-based settings. The first chapter considers the historical, cultural and social context of alcohol and substance use and the cultural understandings of addiction. Current UK policy initiatives, strategies and guidelines for treatment are highlighted. The next chapters address the nature of addiction, screening and assessment, and interventions. Individual chapters are then devoted to the major substances � alcohol, nicotine, opiates, cannabis, stimulants, and hallucinogens. These include material on screening tools, assessment and interventions strategies relevant to each substance. Management of overdose and withdrawal is explored for each substance, and evidence-based pharmacological interventions are described. The author highlights the importance of psychological interventions and refers particularly to the benefits of opportunistic brief interventions, motivational interviewing and relapse prevention strategies. The importance of developing a �therapeutic alliance� between the worker and client is stressed. Harm minimisation strategies are explored, as are nursing emergencies, special needs and diverse populations, the family, and self-help. It concludes issues related to professional development.

Rey GN; Mora-Rios J; Sainz MT; Aguilar PM. An international perspective: Constructing intervention strategies for families in Mexico. Drugs: Education, Prevention and Policy 17(special issue): 193-202, 2010. (23 refs.)

In this article, the authors comment on the contribution of the Alcohol, Drugs and the Family research group to draw public and scientific attention to the suffering and needs of families coping with addiction problems. The article also describes the impact of the stress-strain-coping-support model and the 5-Step Method on the research, intervention and education domains in Mexico. Some of the limitations to positively influence public policy are underscored; these include the nature of the sociocultural context which favors the view of addictions as private problems that must be solved within the family. The experience of delivering the 5-Step Method to Mexican urban population and its adaptation to indigenous communities and web-based format are discussed as well. Overall, the development and implementation of the 5-Step Method in Mexico has been positive, as demonstrated particularly by a cost-effectiveness study carried out with indigenous communities. Based on this review, the scope and challenges for family intervention in Mexico are outlined considering: (1) the dissemination of the 5-Step Method in both the rural and urban contexts; (2) extensive training of family counsellors; and finally (3) policy making to fulfil the needs of families facing addictive problems.

Roosa M; Scripa JS; Zastowny TR; Ford JH. Using a NIATx based local learning collaborative for performance improvement. Evaluation and Program Planning 34(4): 390-398, 2011. (50 refs.)

Local governments play an important role in improving substance abuse and mental health services. The structure of the local learning collaborative requires careful attention to old relationships and challenges local governmental leaders to help move participants from a competitive to collaborative environment. This study describes one county's experience applying the NIATx process improvement model via a local learning collaborative. Local substance abuse and mental health agencies participated in two local learning collaboratives designed to improve client retention in substance abuse treatment and client access to mental health services. Results of changes implemented at the provider level on access and retention are outlined. The process of implementing evidence-based practices by using the Plan-Do-Study-Act rapid-cycle change is a powerful combination for change at the local level. Key lessons include: creating a clear plan and shared vision, recognizing that one size does not fit all, using data can help fuel participant engagement, a long collaborative may benefit from breaking it into smaller segments, and paying providers to offset costs of participation enhances their engagement. The experience gained in Onondaga County, New York, offers insights that serve as a foundation for using the local learning collaborative in other community-based organizations.

Seale JP; Shellenberger S; Clark DC. Providing competency-based family medicine residency training in substance abuse in the new millennium: A model curriculum. BMC Medical Education 10, 2010. (87 refs.)

Background: This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse. Methods: The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME. The curriculum provides basic training in high risk substance use to all residents, while also addressing current training challenges presented by U. S. work hour regulations, increasing international diversity of Family Medicine resident trainees, and emerging new primary care practice models. Results: This paper offers a core curriculum, focused on screening, brief intervention and referral to treatment, which can be adapted by residency programs to meet their individual needs. The curriculum encourages direct observation of residents to ensure that core skills are learned and trains residents with several "new skills" that will expand the basket of substance abuse services they will be equipped to provide as they enter practice. Conclusions: Broad-based implementation of a comprehensive Family Medicine residency curriculum should increase the ability of family physicians to provide basic substance abuse services in a primary care context. Such efforts should be coupled with faculty development initiatives which ensure that sufficient trained faculty are available to teach these concepts and with efforts by major Family Medicine organizations to implement and enforce residency requirements for substance abuse training.

Sheffer CE; Barone C; Anders ME. Training nurses in the treatment of tobacco use and dependence: Pre- and post-training results. Journal of Advanced Nursing 67(1): 176-183, 2011. (36 refs.)

Aim. This paper is a report of a study conducted to examine the effects of a brief training in the treatment of tobacco use and dependence on the tobacco use intervention-related knowledge and attitudes of nurses. Background. Nurses are the largest group of healthcare providers and they have an extended reach into the population of tobacco users. Thus, increasing the number of nurses who deliver brief evidence-based interventions for tobacco use and dependence, such as that prescribed by the Public Health Service Clinical Practice Guideline in the United States of America, is likely to expose more tobacco users to evidence-based treatments and lead to more successful quit attempts. Effective training is key to improving provider proficiency in delivering evidence-based interventions for tobacco use and dependence. Method. A 1-hour didactic training was delivered to 359 nurses from 2006 to 2007, including 54 Advanced Practice Nurses, 250 Registered Nurses and 55 Licensed Practical Nurses. Pre- and post-training tests assessed attitudes, knowledge and behaviours. Paired samples t-tests were used to compare pre- and post-test results. Results. Statistically significant increases on nearly all measures were achieved, with Registered Nurses and Licensed Practical Nurses realizing the largest gains. Conclusion. Given the overwhelming impact of tobacco use on patients, all nurses should be provided with training in the delivery of brief, evidence-based interventions for tobacco use. As the most trusted healthcare provider group with an extended reach into the tobacco using population, nurses have a large potential impact on the prevalence of tobacco use.

Smith AJ; Tett SE. Improving the use of benzodiazepines-Is it possible? A non-systematic review of interventions tried in the last 20 years. BMC Health Services Research 10: e-article 321, 2010. (69 refs.)

Background: Benzodiazepines are often used on a long term basis in the elderly to treat various psychological disorders including sleep disorders, some neurological disorders and anxiety. This is despite the risk of dependence, cognitive impairment, and falls and fractures. Guidelines, campaigns and prescribing restrictions have been used to raise awareness of potentially inappropriate use, however long term use of benzodiazepine and related compounds is currently increasing in Australia and worldwide. The objective of this paper is to explore interventions aimed at improving the prescribing and use of benzodiazepines in the last 20 years. Methods: Medline, EMBASE, PsychINFO, IPA were searched for the period 1987 to June 2007. Results: Thirty-two articles met the study eligibility criteria (interventions solely focusing on increasing appropriate prescribing and reducing long term use of benzodiazepines) and were appraised. Insufficient data were presented in these studies for systematic data aggregation and synthesis, hence critical appraisal was used to tabulate the studies and draw empirical conclusions. Three major intervention approaches were identified; education, audit and feedback, and alerts. Conclusions: Studies which used a multi-faceted approach had the largest and most sustained reductions in benzodiazepines use. It appears that support groups for patients, non-voluntary recruitment of GPs, and oral delivery of alerts or feedback may all improve the outcomes of interventions. The choice of outcome measures, delivery style of educational messages, and requests by GPs to stop benzodiazepines, either in a letter or face to face, showed no differences on the success rates of the intervention.

Smith DE. Editor's Note: Integration of pharmacotherapy and psychosocial treatment in opiate-addicted youth. Journal of Psychoactive Drugs 43(3): 175-179, 2011. (26 refs.)

Misuse of prescription opioids, particularly by adolescents, is a growing problem in the United States. It is a leading cause of death and disability in this age group. The primary form of treatment available to adolescents is drug free psychosocial programs. For the high risk group that has relapsed after traditional psychosocial treatment, pharmacotherapy needs to be explored. Two primary issues need to be addressed: the development of effective treatment, including the use of opiate antagonists and ongoing monitoring, and education and training of clinicians regarding appropriate prescribing practices in pain management, with better identification of those who misprescribe for personal gain.

Smith DE; Lee DR; Davidson LD. Health care equality and parity for treatment of addictive disease. Journal of Psychoactive Drugs 42(2): 121-126, 2010. (32 refs.)

Substance abuse represents a significant underlying cause of the health issues faced in the United States, which severely impacts the nation's health care system and economy. Recently enacted parity legislation mandates that benefits for addiction and mental health treatment be provided on an equal footing with those for treatment for physical health. Diversion and abuse of prescription medications is growing in young people, with much of the diversion occurring between family and friends. Addiction has been accepted by mainstream medicine as a brain disease, and is associated with many other medical disorders. Early intervention and treatment for addiction provides extraordinary cost-benefit outcomes. Additional training for addiction professionals will be necessary. Stigmatization of substance abusers continues to exist at the state and federal levels, although research during the past 10 years indicates that patient compliance and relapse rates for substance abusers are not significantly different than those for individuals with other chronic diseases, e.g. diabetes, hypertension, and cardiac issues. While parity for addiction treatment has become policy at the federal level, great challenges lie ahead in funding access, facilities, and training, as well as redirecting societal perceptions and legislated penalties.

Spector AY; Pinto RM. Let's talk about sex: Helping substance abuse counsellors address HIV prevention with men who have sex with men. Culture Health & Sexuality 13(4): 399-413, 2011. (49 refs.)

Integrating HIV prevention into substance abuse counselling is recommended to ameliorate the health outcomes of men who have sex with men. However, culture-based countertransferences (CBCs) may hamper this effort. Using a case illustration, this paper will explain the manifestation of CBCs held among substance abuse counsellors and how they hinder counsellors' work with men who have sex with men. The following CBCs will be explored: distancing, topic avoidance, heteronormativity, assumptions and denying client strengths. These CBCs allow counsellors to avoid discussions about sexual practices and curtail HIV prevention counselling, while undermining the counsellor-client relationship. Based on the empirical literature on HIV and substance abuse prevention with men who have sex with men, we provide recommendations to help counsellors overcome CBCs and integrate HIV prevention consistently with men who are in treatment for substance abuse.

Succar CT; Hardigan PC; Fleisher JM; Godel JH. Survey of tobacco control among Florida dentists. Journal of Community Health 36(2): 211-218, 2011. (22 refs.)

Cigarette smoking contributes to the largest number of preventable deaths with a recent report estimating that nearly 5 million annual deaths worldwide and 400,000 in the United States were attributed to cigarette smoking. Dentists, in particular, are in a unique position to educate their patients about the health effects of tobacco. Tobacco cessation knowledge, behaviors, and compliance of Florida dentists were assessed using survey methodology. The survey was administered to a random sample of 6,000 dentists, which was provided by the Florida Department of Health. The survey inquired about (1) general demographic information, (2) Ask, Advise, Assess, Assist, and Arrange behaviors, (3) barriers to the incorporation of tobacco cessation activities, and (4) willingness to participate in further training. A large majority of dentists (88%) are not familiar with the concept of the Ask, Advise, Assess, Assist, and Arrange behaviors when asked directly. When asked about each individual component of this approach, however, dentists had much higher response rates. Dentists were best at routinely asking (59%), advising (46%), & assessing (32%) their patients about their smoking. However, they were much less helpful when assisting and arranging follow-up (70% stated that they never arrange follow-up). This study discovered that the majority of dentists who counsel patients spend only 1-4 min. Sixty-six percent of the dentists surveyed were willing to receive specific training, with 50% preferring an online course and 42% preferring a continued education course.

Taniguchi C; Hibino F; Kawaguchi E; Maruguchi M; Tokunaga N; Saka H et al. Perceptions and practices of Japanese nurses regarding tobacco intervention for cancer patients. Journal of Epidemiology 21(5): 391-397, 2011. (15 refs.)

Background: We investigated the perceptions and practices regarding tobacco intervention among nurses, as improvement of such practices is important for the management of patients who smoke. Methods: Self-administered questionnaires were delivered by hospital administrative sections for nursing staff to 2676 nurses who were working in 3 cancer hospitals and 3 general hospitals. Of these, 2215 (82.8%) responded. Results: Most nurses strongly agreed that cancer patients who had preoperative or early-clinical-stage cancer but continued to smoke should be offered a tobacco use intervention. In contrast, they felt less need to provide tobacco use intervention to patients with incurable cancer who smoked. Most nurses felt that although they assessed and documented the tobacco status of cancer patients, they were not successful in providing cessation advice, assessing patient readiness to quit, and providing individualized information on the harmful effects of tobacco use. In multivariate analysis, nurses who received instruction on smoking cessation programs during nursing school were more likely to give cessation advice (odds ratio, 1.61; 95% confidence interval, 1.15-2.26), assess readiness to quit (1.73, 1.09-2.75), and offer individualized explanations of the harmful effects of tobacco (1.94, 1.39-2.69), as compared with nurses who had not received such instruction. Conclusions: The perceptions of Japanese nurses regarding tobacco intervention for cancer patients differed greatly by patient treatment status and prognosis. The findings highlight the importance of offering appropriate instruction on smoking cessation to students in nursing schools in Japan.

Thompson M. The best bang for our buck: Recommendations for the provision of training for tobacco action workers and indigenous health workers. Contemporary Nurse 37(1, special issue): 90-91, 2010. (11 refs.)

While smoking rates among Australians in general have declined over the past two decades, rates for Aboriginal Australians have remained high and continue to contribute to the overall poor health of Aboriginal people. Aboriginal health workers are proposed as one way to help reduce smoking rates for Aboriginal people however there is a need for specifically developed courses to train health workers to deliver smoking interventions.

Toll BA; Martino S; Latimer A; Salovey P; O'Malley S; Carlin-Menter S et al. Randomized trial: Quitline specialist training in gain-framed vs standard-care messages for smoking cessation. Journal of the National Cancer Institute 102(2): 96-106, 2010. (58 refs.)

Background: Smoking accounts for a large proportion of cancer-related mortality, creating a need for better smoking cessation efforts. We investigated whether gain-framed messages (ie, presenting benefits of quitting) will be a more persuasive method to encourage smoking cessation than standard-care messages (ie, presenting both costs of smoking [loss-framed] and benefits of quitting). Methods: Twenty-eight specialists working at the New York State Smokers' Quitline (a free telephone-based smoking cessation service) were randomly assigned to provide gain-framed or standard-care counseling and print materials. Smokers (n = 2032) who called the New York State Smokers' Quitline between March 10, 2008, and June 13, 2008, were exposed to either gain-framed (n = 810) or standard-care (n = 1222) messages, and all medically eligible callers received nicotine replacement therapy. A subset of 400 call recordings was coded to assess treatment fidelity. All treated smokers were contacted for 2-week and 3-month follow-up interviews. All statistical tests were two-sided. Results: Specialists providing gain-framed counseling used gain-framed statements statistically significantly more frequently than those providing standard-care counseling as assessed with frequency ratings for the two types of gain-framed statements, achieving benefits and avoiding negative consequences (for achieving benefits, gain-framed mean frequency rating = 3.9 vs standard-care mean frequency rating = 1.4; mean difference = -2.5; 95% confidence interval [CI] = -2.8 to -2.3; P < .001; for avoiding negative consequences, gain-framed mean frequency rating = 1.5 vs standard-card mean frequency rating = 1.0; mean difference = -0.5; 95% CI = -0.6 to -0.3; P < .001). Gain-framed counseling was associated with a statistically significantly higher rate of abstinence at the 2-week follow-up (ie, 99 [23.3%] of the 424 in the gain-framed group vs 76 [12.6%] of the 603 in the standard-care group, P < .001) but not at the 3-month follow-up lie, 148 [28.4%] of the 522 in the gain-framed group vs 202 [26.6%] of the 760 in the standard-care group, P = .48). Conclusions: Quitline specialists can be trained to provide gain-framed counseling with good fidelity. Also, gain-framed messages appear to be somewhat more persuasive than standard-care messages in promoting early success in smoking cessation.

Tomas-Rossello J; Rawson RA; Zarza MJ; Bellows A; Busse A; Saenz E et al. United Nations Office on Drugs and Crime International Network of Drug Dependence Treatment and Rehabilitation Resource Centres: Treatnet. Substance Abuse 31(4): 251-263, 2010. (42 refs.)

Key to the dissemination of evidence-based addiction treatments is the exchange of experiences and mutual support among treatment practitioners, as well as the availability of accurate addiction training materials and effective trainers. To address the shortage of such resources, the United Nations Office on Drugs and Crime (UNODC) created Treatnet, a network of 20 drug dependence treatment resource centers around the world. Treatnet's primary goal is to promote the use of effective addiction treatment practices. Phase I of this project included (1) selecting and establishing a network of geographically distributed centers; (2) conducting a capacity-building program consisting of a training needs assessment, development of training packages, and the training of 2 trainers per center in 1 content area each; and (3) creating good-practice documents. Data on the training activities conducted by the trainers during their first 6 months in the field are presented. Plans for Phase II of the Treatnet project are also discussed.

Tong EK; Strouse R; Hall J; Kovac M; Schroeder SA. National survey of US health professionals' smoking prevalence, cessation practices, and beliefs. Nicotine & Tobacco Research 12(7): 724-733, 2010. (35 refs.)

Tobacco dependence treatment efforts have focused on primary care physicians (PCPs), but evidence suggests that they are insufficient to help most smokers quit. Other health professionals also frequently encounter smokers, but their smoking prevalence, cessation practices, and beliefs are less well known. The study included 2,804 subjects from seven health professional groups: PCPs, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. Outcomes included self-reported smoking status, smoking cessation practices, and beliefs. Multivariate regression was used to examine factors associated with health professionals (except pharmacists) self-reportedly performing the "5 A's": asking, advising, assessing, assisting, or arranging follow-up about tobacco. Health professionals have a low smoking prevalence (< 6%), except nurses (13%). Many health professionals report asking (87.3%-99.5%) and advising (65.6%-94.9%) about smoking but much less assessing smokers' interest (38.7%-84.8%), assisting (16.4%-63.7%), and arranging follow-up (1.3%-23.1%). Controlling for health professional and practice demographics, factors positively associated in the multivariate analyses with self-reportedly performing multiple components of the 5 A's include awareness of the Public Health Service guidelines, having had cessation training, and believing that treatment was an important professional responsibility. Negative associations include the health professional being a current smoker, not being a PCP, being uncomfortable asking patients if they smoke, believing counseling was not an appropriate service, and reporting competing priorities. U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.

Tontchev GV; Housel TR; Callahan JF; Kunz KB; Miller MM; Blondell RD. Specialized training on addictions for physicians in the United States. Substance Abuse 32(2, special issue): 84- 92, 2011. (7 refs.)

In the United States accredited residency programs in addiction exist only for psychiatrists specializing in addiction psychiatry (ADP); nonpsychiatrists seeking training in addiction medicine (ADM) can train in nonaccredited fellowships, or can receive training in some ADP programs, only to not be granted a certificate of completion of accredited training. Information about ADP residency programs has been tabulated, but it is not available for ADM fellowships. The authors conducted a national survey to compile information about the location, structure, curriculum, and other characteristics of active ADM fellowships. Of the 40 accredited ADP residency programs, 7 offered training in addiction to nonpsychiatrists. The authors identified 14 nonaccredited ADM fellowships. In 2009 and 2010, there were approximately 15 nonpsychiatrists in ADP programs and 25 in ADM fellowships. Clinical experiences included inpatient services, outpatient treatment services such as methadone maintenance or buprenorphine maintenance, and providing addiction consult services. The most common academic activities included weekly lectures and the teaching of medical students.

Uti OG; Sofola OO. Smoking cessation counseling in dentistry: Attitudes of Nigerian dentists and dental students. Journal of Dental Education 75(3): 406-412, 2011. (27 refs.)

The study was aimed at assessing the awareness, attitude, practices, willingness, and perceived barriers of dental students and dentists in Lagos University Teaching Hospital, Lagos, Nigeria, in relation to smoking cessation in the dental care setting. An anonymous self-administered questionnaire that contained questions relating to attitudes, views, and perceived barriers to smoking cessation activities in the dental clinic was hand-delivered to all dentists and clinical dental students in 2007. One hundred and thirty-six respondents took part in the study (response rate=81.9 percent). Although 95 percent of the respondents believed that smoking affects the dental management of the patient, only 65 percent always ask their patients about their smoking habits, and only 30 percent have heard about smoking cessation programs. A significantly higher proportion of students always ask patients about their smoking habits compared with dentists (p=0.0017). Also, a significantly higher proportion of dentists (97 percent) advised their patients against tobacco use compared with 77 percent of students (p=0.0000). Only 2 percent and 3 percent agreed that it is their professional responsibility to educate or encourage patients to quit smoking, respectively. Also, 98 percent strongly disagreed that it is within the scope of dental practice to ask about tobacco use, and 86 percent disagreed that tobacco counseling can be effective in helping patients quit tobacco use. Perceived barriers reported were lack of time (88 percent), lack of necessary materials (81 percent), and lack of knowledge of smoking cessation (74 percent). However, 81 percent of the respondents said they are willing to undergo training in tobacco use cessation. Since most of the dentists and dental students had poor attitudes and negative perceptions of smoking cessation activities, possibly due to lack of training and resources to carry it out in the clinics, there is need to include smoking cessation training in the dental curriculum in Nigeria.

Vandermause RK; Townsend RP. Teaching thoughtful practice: Narrative pedagogy in addictions education. Nurse Education Today 30(5): 428-434, 2010. (37 refs.)

Preparing practitioners for this rapidly changing and demanding health care environment is challenging. A surge in knowledge development and scientific advancement has placed a priority on technical skill and a focus on content driven educational processes that prepare students for evidence-based practice. However, the most difficult health care scenarios require thinking-in-action and thoughtfulness as well as didactic knowledge. It is our contention that interpretive educational methods, like narrative pedagogy, will promote judgment-based practice that includes use of evidence and delivery of thoughtful care. In this article, we describe and interpret a narrative approach to addictions content and teaching thoughtful practice. We present our pedagogical process, including observations and field notes, to show how interpretive pedagogies can be introduced into nursing curricula. By presenting this process, the reader is invited to consider interpretive methods as a way to inspire and habituate thoughtful practice and judgment-based care.

Vered Y; Livny A; Zini A; Shabaita S; Sgan-Cohen HD. Dental students' attitudes and behavior toward smoking cessation as part of their professional education. Teaching and Learning In Medicine 22(4): 268-273, 2010. (15 refs.)

Background: Dental professionals have a major role in promoting tobacco use cessation (TUC). Purpose: The objective is to assess dental students' knowledge, attitudes, behavior, and perception regarding their potential expected role. Methods: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. Results: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. Conclusions: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

von Garnier C; Meyer M; Leuppi J; Battegay E; Zeller A. Smoking cessation counselling: Impact of chart stickers and resident training. Swiss Medical Weekly 140(11-12): 175-180, 2010. (32 refs.)

Objectives: To assess the effect of a training program for smoking cessation combined with chart stickers on resident's (physicians-in-training) practice of counselling smoking patients. Setting: A single centre prospective observational study at the Basel University Hospital Medical Outpatient Department. Methods: 456 consecutive outpatients were contacted by phone within 24 hours of their initial consultation. Information concerning questions asked about smoking and/or cessation advice provided by the resident to patients was collected and compared with a historical pre-interventional cohort using the identical questionnaire and study design. Results: Of 272 patients included, 106 (39%) were current smokers, 123 (45%) had never smoked, and 43 (16%) were former smokers. The mean age was 43 +/- 11 (range 16-87) years and 49% were male. Equal proportions of participants were in the pre-contemplation (40%) and contemplation stages (42%), 16% were preparing to quit and 2% had stopped in the previous 6 months. Results related to smoking cessation advice were compared to those obtained during an identical survey one year earlier performed prior to the intervention (pre-interventional). Residents questioned 82% (pre-interventional 81%) of the patients about smoking and inquired about smoking duration in 71% (pre-interventional 44%) of the patients. 46% (pre-interventional 28%) of the patients received information on smoking-related risks, whereas cessation was discussed with 32% (pre-interventional 10%) and offered to 23% (pre-interventional 9%) of the patients. Conclusion: Compared with a historical pre-interventional cohort, the rates of patients receiving appropriate counselling approximately doubled following the introduction of systematic training on smoking cessation and chart labels. Extended regular training for physicians on smoking-related issues may have a potentially beneficial effect in improving counselling of smokers and meeting the global tobacco challenge.

Waheedi M; Al-Tmimy AM; Enlund H. Preparedness for the smoking cessation: Role among health sciences students in Kuwait. Medical Priniciples and Practice 20(3): 237- 243, 2011. (31 refs.)

Objective: Our aim was to assess students' preparedness for the smoking cessation role after a teaching module on tobacco cessation and to assess the relationship between smoking status and preparedness. Methods: Pharmacy students attended a 4-hour module on the role of health professionals in smoking cessation based on the Rx for Change training program. Two years after the first introduction of the module, a questionnaire on preparedness and smoking status was filled in by 64 pharmacy students who had attended the module and 243 students from other health sciences that had not been exposed to the module. Results: Preparedness scores for the smoking cessation role for pharmacy students were significantly higher (mean = 19.5, n = 63) for the nonsmoking pharmacy students compared to other nonsmoking students in medicine (mean = 16.2, n = 149), dentistry (mean = 16.1, n = 40) and physical therapy (mean = 14.9, n = 16) (p = 0.009). The smoking prevalence was 3% among all females and 31% among all males. Smoking students were significantly less likely (p = 0.031) to agree that it is their professional responsibility to help patients quit smoking. Conclusion: Significant and long-lasting differences in students' perception of preparedness for the smoking cessation role based on exposure to a short teaching module were demonstrated. Furthermore, our results support previous findings that smoking compromises attitude towards helping smokers to quit.

Warren CW; Sinha DN; Lee J; Lea V; Jones N; Asma S. Tobacco use, exposure to secondhand smoke, and cessation counseling training of dental students around the World. Journal of Dental Education 75(3): 385-405, 2011. (18 refs.)

The Global Health Professions Student Survey (GHPSS) has been conducted among third-year dental students in schools in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called "sites" in this article). In more than half the sites, over 20 percent of the students currently smoked cigarettes, with males having higher rates than females in thirty sites. Over 60 percent of students reported having been exposed to secondhand smoke in public places in thirty-seven of forty-eight sites. The majority of students recognized that they are role models in society and believed they should receive training on counseling patients to quit using tobacco, but few reported receiving formal training. Tobacco control efforts must discourage tobacco use among dentists, promote smoke-free workplaces, and implement programs that train dentists in effective cessation-counseling techniques.

Washington TA; Brocato J. Exploring the perspectives of substance abusing Black men who have sex with men and women in addiction treatment programs: A need for a human sexuality educational model for addiction professionals. American Journal of Men's Health 5(5): 402-412, 2011. (75 refs.)

This study examined the perspectives of African American male injection drug users who have sex with both men and women (IDU-MSM/W) and who are involved in sex trade regarding the need for a human sexuality educational model (HSEM) for addiction professionals. Focus groups were conducted involving an exploratory sample (N = 105) of men who met the following parameters: aged 18 to 40 years, African American, engage in injection drug using behavior, have sex with male and female partners, and who frequent parks and other sex working areas in Baltimore City and surrounding areas. Data suggest that an HSEM may be useful for addiction professionals who work with substance abusing Black MSM/W. Moreover, the model should include opportunities for addiction professionals to (a) identify their personal biases about homosexuality in general (acknowledging personal biases so not to allow those personal biases to influence service); (b) understand the diversity within the Black MSM/W community (e.g., challenge assumptions that all Black MSM/W self-identify as gay); (c) understand how to, and the need for, assessing sexual trauma in Black MSM/W; and (d) understand the need to incorporate risk factors and safer sex practices that may be of concern to a subpopulation of Black MSM/W, such as "barebacking." These findings suggest the need for, and topics to include in, an HSEM that assists professionals with exploring their biases about sexuality and MSM/W and better prepares counselors to address HIV prevention and risky behavior using language that is appropriate for the Black IDU-MSM/W population.

Wilson GB; Lock CA; Heather N; Cassidy P; Christie MM; Kaner EF. Intervention against excessive alcohol consumption in primary health care: A survey of GPs' attitudes and practices in England 10 years on. Alcohol and Alcoholism 46(5): 570-577, 2011. (48 refs.)

Aims: To ascertain the views of general practitioners (GPs) regarding the prevention and management of alcohol-related problems in practice, together with perceived barriers and incentives for this work; to compare our findings with a comparable survey conducted 10 years earlier. Methods: In total, 282 (73%) of 419 GPs surveyed in East Midlands, UK, completed a postal questionnaire, measuring practices and attitudes, including the Shortened Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ). Results: GPs reported lower levels of post-graduate education or training on alcohol-related issues (< 4 h for the majority) than in 1999 but not significantly so (P = 0.031). In the last year, GPs had most commonly requested more than 12 blood tests and managed 1-6 patients for alcohol. Reports of these preventive practices were significantly increased from 1999 (P < 0.001). Most felt that problem or dependent drinkers' alcohol issues could be legitimately (88%, 87%) and adequately (78%, 69%) addressed by GPs. However, they had low levels of motivation (42%, 35%), task-related self-esteem (53%, 49%) and job satisfaction (15%, 12%) for this. Busyness (63%) and lack of training (57%) or contractual incentives (48%) were key barriers. Endorsement for government policies on alcohol was very low. Conclusion: Among GPs, there still appears to be a gap between actual practice and potential for preventive work relating to alcohol problems; they report little specific training and a lack of support. Translational work on understanding the evidence-base supporting screening and brief intervention could incentivize intervention against excessive drinking and embedding it into everyday primary care practice.

Woods M; Butler S. 'A victim of its own success'? The diploma in addiction studies at Trinity College Dublin. Drugs: Education, Prevention and Policy 18(4): 243-250, 2011. (13 refs.)

This article reviews and reflects on the Diploma in Addiction Studies: a 1-year, full-time programme taught at the School of Social Work and Social Policy in Trinity College Dublin since the academic year 1983/1984, which has recently had its external funding withdrawn. The programme was aimed at multidisciplinary classes, including students from backgrounds in community responses to drug problems and in personal recovery from alcohol and drug problems. Drawing on its status as a university-based programme, Addiction Studies saw its function as educational rather than training, and saw itself as having particular value against the somewhat dogmatic policy and practice background of the Irish addictions scene. This article sets out the background to the programme, as well as its teaching philosophy and its attempts to deal with the issue of transfer of learning.

Yang TZ; Abdullah AS; Rockett IRH; Li M; Zhou YH; Ma J et al. Assessment of tobacco control advocacy: Behavioural capacity among students at schools of public health in China. Tobacco Control 20(1): 20-25, 2011. (32 refs.)

Objectives To evaluate student tobacco control advocacy behavioural capacity using longitudinal trace data. Methods A tobacco control advocacy curriculum was developed and implemented at schools of public health (SPH) or departments of public health in seven universities in China. Participants comprised undergraduate students studying the public health curriculum in these 13 Universities. A standardised assessment tool was used to evaluate their tobacco control advocacy behavioural capacity. Repeated measures analysis of variance, paired t tests and paired c 2 tests were used to determine differences between dependent variables across time. Multivariate analysis of variance (MANOVA) and multivariate logistic regression were used to assess treatment effects between intervention and control sites. Results Respective totals of 426 students in the intervention group and 338 in the control group were available for the evaluation. Approximately 90% of respondents were aged 21 years or older and 56% were women. Findings show that the capacity building program significantly improved public health student advocacy behavioural capacity, including advocacy attitude, interest, motivation and anti-secondhand smoke behaviours. The curriculum did not impact student smoking behaviour. Conclusions This study provides sufficient evidence to support the implementation of tobacco control advocacy training at Chinese schools of public health.

Zito R. Introduction: Moving forward to improve addiction treatment in California. (editorial). Journal of Psychoactive Drugs Supplement 6: 205-206, 2010. (0 refs.)