Internal medicine residency training for unhealthy alcohol and other drug use: recommendations for curriculum design

We review the development of unhealthy substance use related competencies, and describe a curriculum in unhealthy substance use that integrates these competencies into internal medicine resident physician training. We outline strategies to facilitate adoption of such curricula by the residency programs. This paper provides an outline for the actual implementation of the curriculum within the structure of a training program, with examples using common teaching venues. We describe and link the content to the core competencies mandated by the Accreditation Council for Graduate Medical Education, the formal accrediting body for residency training programs in the United States. Specific topics are recommended, with suggestions on how to integrate such teaching into existing internal medicine residency training program curricula.Given the burden of disease and effective interventions available that can be delivered by internal medicine physicians, teaching about unhealthy substance use must be incorporated into internal medicine residency training, and can be done within existing teaching venues.Unhealthy substance use (SU) is the spectrum from use that risks harm, to use associated with consequences or problems, to the diagnosable conditions substance abuse and dependence often referred to as substance use disorders [1]. Unhealthy SU is a major public health problem in the United States. Many physician interventions (e.g., brief counseling, pharmacotherapy) have proven efficacy. Internal medicine physicians are among the most commonly visited physicians in the US [2]. Yet internal medicine physician training in substance use-related preventive services, diagnosis, treatment, and chronic disease management has been inadequate. This inadequacy leaves patients and the health system without sufficient expertise to address one of the most common and costly health conditions.Among people 12 and older, there were 20.4 million current users of illicit drugs, 125 million users of