First addiction medicine residencies to begin in July

About 20 physicians will begin training this summer in the first 10 residency programs to be accredited by the American Board of Addiction Medicine.

The programs are designed to provide doctors from a variety of specialty backgrounds with comprehensive training in the identification and treatment of patients with substance abuse issues.

Ultimately, the ABAM hopes to become a member of the American Board of Medical Specialties and have the residency programs accredited by the Accreditation Council for Graduate Medical Education.

For now, the focus is getting the training programs under way, said Kevin Kunz, MD, MPH, president of the ABAM and the ABAM Foundation.

"Addiction medicine is a specialized field of practice open to all physicians from all medical specialties," he said.

It is related to, but distinct from, the addiction psychiatry subspecialty, which is limited to psychiatrists and falls under the American Board of Psychiatry and Neurology, an ABMS member. The ABAM was incorporated in 2007 and offers a certification exam in addiction medicine. About 2,500 physicians have that certification, Dr. Kunz said.

The field has developed in response to unmet needs of people struggling with substance abuse, said Daniel Alford, MD, MPH, associate professor and director of the new addiction medicine residency program at Boston University School of Medicine.

Most people with addiction issues enter the health care system through primary care, but many fall through the cracks because their physicians don't have the expertise to treat them, he said. "Most often these patients don't want a referral," he said.

High demands for care

The ABAM wants to increase the number of physicians able to diagnose and treat addiction, so patients can access care from a variety of avenues, Dr. Kunz said.

"The need is great. Addiction and substance abuse disorders are a leading cause of mortality and morbidity in the United States," he said.

Prescription drug overdoses killed more than 27,000 people in 2007, according to the Centers for Disease Control and Prevention. Admission and discharge data from hospitals, emergency departments and primary care clinics show that each year an estimated 6 million people with severe drug dependence receive health care in those settings, and the need is projected to increase 12% by 2020, Dr. Kunz said.

At the one-year addiction medicine program at the Addiction Institute of New York at St. Luke's-Roosevelt Hospital, residents will gain experience in substance abuse screening, intervention, detoxification and rehabilitation, as well as the psycho-social aspects of addiction, said Petros Levounis, MD, program director and chief of addiction psychiatry.

Despite the medical complexities of addiction and emergence of new medications to help treat the disease, such services typically are provided by nonphysicians. "People have not realized the medical aspects of addiction work," Dr. Levounis said.

Boston University will begin its addiction medicine program with two residents this summer. The program is one year for residents seeking clinical training only and two years for those interested in gaining both clinical and research experience, Dr. Alford said.

Residents will train in various settings, including Boston Medical Center's inpatient detoxification unit, two different programs for opioid addiction and an outpatient adolescent addiction program.

Becoming a specialty

There is no time frame for the ABAM to seek ABMS membership or ACGME approval of its residency programs, Dr. Kunz said. Both organizations have rigorous requirements for approving new specialties and specialty boards.

To gain ABMS membership, boards must be approved through a joint process of the ABMS and the American Medical Association Council on Medical Education, said Sheldon D. Horowitz, MD, special adviser to the ABMS president. The organizations evaluate applicants on a variety of criteria, including whether a new field is based on significant medical advancements and represents a distinct and well-defined field of medical practice. The American Board of Medical Genetics was the last board to join the ABMS in 1991.

"There is a lot of talk that medicine is fragmented, so we have to consider new specialty boards very carefully," Dr. Horowitz said. "Is this going to move medicine forward? Are there other ways to get this expertise and information out there?"

It's rare for new specialties to seek ACGME accreditation, said Jeanne Heard, MD, PhD, ACGME senior vice president of accreditation committees. In the last seven years, six subspecialties -- but no specialties -- have sought ACGME accreditation. Many subspecialties exist without ACGME accreditation, she said.

Dr. Kunz said physician training in addiction medicine is sorely lacking and courses on the subject are rarely taught in medical school.

"We think that medicine and the nation are now ready to address the primary care of addiction and not just the consequences," he said.