Educational approaches to prescribing practices and substance abuse

The history of medical education in treating and prescribing for additive disorders is primarily one of omission. This began to change in the 1970s, leading to positive developments in medical education; however, much still remains to be done. Training in writing prescriptions should cover four areas: (1) prescribing to prevent addiction; (2) prescribing for alcohol or other drug dependent patients; (3) prescribing for withdrawal from alcohol or other drugs; and (4) prescribing for patients in recovery from alcohol or other drug addiction. Other areas of importance to medical education are inappropriate prescribing practices, self-prescribing, and prescribing for dual diagnosis patients. Physicians need to know how to avoid becoming duped, dated, impaired or "script doctors." The educational techniques used in attaining these goals emphasize adult, or andragogical, education, sequencing curricula over the years of medical school and residency training, utilizing a variety of instructional techniques, and evaluating the results after each educational unit. The use of clinical vignettes, patient management problems and simulated patients is recommended.